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HEP B

I was first diagnosed with HBSAg + in 2003 tested HBV DNA which was undetectable (in 2005). didn't take it too serious for 4 years or lets say didn't know what to do with this??. Now in a routine medical exam, found HBSAg still +, ALT are raised to 120 rest of LFT are normal, HBeAG is negative but then Viral load is 11000 (not sure copies or IU, i know it makes a difference if these are copies or IU). some say should be on treatment other saying not. My doctor want me to undergo a Liver Biosy and I am not ready for this as have no problems or sysmptoms and only came to know about this through routine medical exam. Liver biopsy is scary and side affects and risks, what would you suggest guys??
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27 Comments Post a Comment
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Avatar_m_tn
ask for a liver fibroscan ( if available)
fibroscan is available in a small number of hospital in the US. i think it would have to be a cancer and liver disease center of some sort.
as for liver biopbsy it may not be needed at this time but i think overall isnt something you want to do often... i would wait and may even have a second opinion with a different doctor.
even at 11000 copies which is less than IU by miles , you are still considered a candidate for treatment. know this though, starting treatment while hbeag negative is an endless treatment course ( i,e.. for life ) with no end in sight unless somehow you resolve hbv alltogether ( 1-2% chance every year ) or a cure is found ( nothing in sight for the near future ) so your chances are almost slim to none of resolving this problem.

i would run more tests and may wait  for like 3 sets of tests over a span of 9-12 months. if the results remain unchanged from the current result then maybe treatment is needed and a biopsy should take place.. biopsys shouldnt be repeated a lot.. maybe one or two times in your life time but remember one thing, the only organ in your body that regenerates is your liver so the tiny piece they are gonna take out of your liver will regenerate and go back to normal...

good luck
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Avatar_m_tn
Thansk for your comments. Is Fibroscan paibless unlike Biopsy?
Its really very difficult to convince your ownself just on the basis of Blood Test Results when in reality you are not facing any sorts of problems or symptoms and living a healthy life- apparently.
if started treatments how bad are the side affects ike nuisea, vomiting, headache etc etc. if they are 11000 copies , then it is just over 2000IU, am i right? so its just the threshold for the treatment.
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Avatar_m_tn
if you have normal alt/ast or never more than 200 fibroscan is more accurate then biopsy because biopsy is limited to the piece of liver they take but not all the liver (you can have different damage in different parts of the liver).So biopsy is not required so often as once.
i suggest no tx if you have no liver damage (fibroscan 7-10kpa), also ultrasound is a good exam to check liver damage.
be very carefull do not wait for synthoms, you can have no synthoms and have cirrohosis or liver cancer which is an advanced state of the disease, you check carefully by blood tests and fibroscan for cirrhosis and ultrasound for cirrhosis/liver cancer.checking for liver cancer is important because we have a higher chance of liver cancer especially with high hbvdna (not your case)

the best first line tx is peginterferon at the moment but it can have many sides, when trials of antivirals combo (tenofovir+entecavir) will be finished and if toxicity is low over the years this will be a very good tx choice (almost no sides)
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Avatar_m_tn
Hi, Thansk for your comments. I got the Scan done which was ok. i will wait for another 4 months to have blood test to see if to start treatment. Foibroscan is not so common here in UK as yet but i ill try and ask for it.
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181575_tn?1250202386
Here's my 2 cents:

You are 32 yo HBeAg negative, (so assume HBeAb positive), had UND DNA, then shot up to over 1000 with over 100 ALT.  This could be a flare. Hopefully it's not a too frequent thing.  Or it could be a sign of disease reactivation.  I would monitor the DNA and ALT every 3 month to see the trend, to get a better sense of what's going on.

If the numbers stay high for over a year, then it may be wise to start treatment.  And since you are HBeAG -, ask for combo treatment to minimize risk for anti-viral resistance.  

It treatment is needed you should get additional imaging test done or a biopsy to establish a baseline.  This will let you know how liver look in the future compare with the past.  It will help you make better choices.  Good luck.
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Avatar_m_tn
Thank You so very much for your helpful suggestion. i am goig to repeat the tests in May and tehn take it from there. you mentioned combo treatment, if you could mention the names of teh drugs. any alternative to biopsy, probably fibroscan?
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181575_tn?1250202386
The combo you want to try first is Tenofovir and Entecavir.  If you have no resistance to Lamivudine, then Entecavir 0.5mg.  If you already have resistance, then Entecavir 1.0mg.  If you treat, you are in it for the long term.  You want to do everything in your power to "protect" the antivirals.

Biopsy is still the gold standard but fibroscan is a good alternative.  I know how you feel, "do I really really need the biopsy?...I don't know about them jabbing a needdle into my liver...I mean, is a biopsy really neccessary?"...lol  The procedure is probably not that bad but the anticipation is the worst.
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Avatar_m_tn
Thanks for responding. I was just wondering if anybody got hypothyroisdsm with Hep B. Any connection in these two??
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Avatar_m_tn
Hi

HbsAg positice
HBeAG Neg
Viral Load six months ago - 11000 IU
ALT 81

rest normal.

just had another bLood Test last month and Doc was surprised to see the Viral Load was 168 IU.

she said dont do nothing, just monotor it every six months.

P.S I been taking Milk Thistle one tab a day in the last 3 months. dont have a clue if this was teh reason for the drop in the load. BUT there was definitely a drop..
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Avatar_m_tn

Milk Thistle has been reported to have antiviral activity against hbv and hcv so that is probably it
UK medical care system is nothing good, no research. no updated machines tests and so on...so look for the best if you can, fibroscan and hbsag quantity in iu/ml is routine here in italy and you must absolutlely find them, biopsy not used anymore (only particular cases)

since our progress with nitazoxanide (alinia) on hbe negative/hbeab positive i strongly suggest to start it but you need a lab for hbsag quantity in iu/ml (abbott test kit) because your hbvdna will get und in a couple of days and then you have to monitor hbsag.

once hbsag will get negative and hbsab positive you are free of hbv, i got a 2600iu/ml drop in 4 weeks only and hopefully get rid of hbsag by one year, hbe negative have medium hasag at about 5000iu/ml (from as low as 1000 to as high as 10000) so getting it negative especially starting from 1000-2000 shouldn't be longer than 1-2 years

until now no sides from ntz, follow our alinia thread for more about it
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Avatar_f_tn
I'm 28yrs old asian female, started treatment with Hepsera first to treat hep b, then doctor added enticavir.  After taking them for a few years, my viral load became undetectable, hbeAg negative and hbeAb positive.  I know it's not advised to stop treatment, but I made the decision to stop the treatment sept 2009.  My viral load stayed undetectable until march 2010.  Here are my lab results for march and June:

Mar:  virus DNA 63 IU/mL
         virus DNA 367 copies/mL
         ALT 25
         AST 30

Jun:  virus DNA 138 IU/mL
        virus DNA 803 IU/mL
        ALT 20
        AST 28

I visit this site from time to time and recently, I noticed the topic of Alinia keep coming up.  I'm going to see my doc next week, and I'm wondering if I should bring that up.  Or is he going to think that I'm crazy for wanting to try that.  

Also, I would like to know if you need prescription for Alinia.  
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Avatar_m_tn

you should have checked hbsag quantity in iu/ml that can tell level of cccdna and if your immune system has got control over hbv.i wouldn't have stopped therapy but now you should check for the hbv mutations before starting again and choose between:

ntz monotherapy, no sides, no resistance, might be stopped if hbsag gets lower than 500iu/ml but i would point to hbsag negative with ntz if hbsag decrease

ntz+interferon, possible heavy sides from interferon but this should be the most potent combo.like for hcv 4weeks lead-in ntz mono and then interferon+ntz

ntz+entecavir or tenofovir or both

the good is hbvdna positive will henance ntz and immune response, so for any choice start with 4 weeks minimum of ntz monotherapy and then add a combo

my suggestion start with ntz mono 6 months and check hbsag and hbdna quantity, the doctor might help very little because all this is off label

alt will get elevated at the begning because as you can see you have infected cells producing virus (hbvdna detactable) but immune system cannot see them, once ntz is started immune system will kill them and hbvdna will decrease

please if you choose to start ntz PM me and join alinia group so we can all share results
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Avatar_m_tn
you should also check the following if you can because hbvdna detectable can have different meanings, it can be your immune system cannot see infected cells but at the same time it can be it is reacting producing hbsab and slowly decreasing hbsag, although the second is very very rare and the first veru very probable:

hbcab Igm quantity, if higher than 0.2s/co (active hbv) your immune system is reacting to a new assault from hbv.if lower than 0.2s/co (inactive hbv)  probability is that immune system is controlling hbv and slowly decresing hbsag or keeping stable

hbsag quntity iu/ml, it will tell us if you are inactive or active.hbsag<500iu/ml 100% inactive.hbsag1000-1500iu/ml active cronic (chronic) hbv that can be in inactive state for certain periods
hbsag <1500iu/ml good probability of making hbsag negative by ntz in 1-2years or by interferon in 5-10years

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Avatar_m_tn
in any case do not choose an antiviral first because ntz or interferon cannot activate immune system at maximum when hbvdna is und

http://archive.mail-list.com/hbv_research/message/20100619.114243.077311f8.en.html

at the conclusions it says entecavir supress immune system and can lead to hbv persistance, i think that tenofovir and other nucs are the same when make hbvdna und but they cannot do otherwise since hbvdna positive makes resistance
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Avatar_f_tn
Thank you for your response.  I never had my hbsag quantity checked before.  My doc always checked either reactive or non-reactive.  I don't think he would monitor my condition if I do start mono treatment with ntz, so I have to find out a way for that.  The fact that it will take 1-2 years for ntz to make hbsag negative is disappointing.  As you can tell, I don't like taking pills.  

Btw, how do I join the Alinia group?  And, where can I get this medicine?
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Avatar_m_tn

well be aware that at the moment there is no drug to eradicate the virus and this looks like the only one with high rates but if you start you must be sure about it and have a lab to test hbsag quantity and hbdna pcr otherwise you cannot see improvemnts

the doctor is not needed usually to make blood tests but if in uk you need a doctor for blood tests and they are not willing to prescribe it, i don't see a way out of it

actually i have seen hospitals in the center of london and i think they are very old and outdated in general, even drugs are difficult to find there, so you won't find this test in uk probably, other told me they don't even have fibroscans..
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Avatar_m_tn

sorry maybe i confused with another guy about you being from uk, anyway:
ntz can be found from lupin official distributors, but if you cannot have the blood test it is not possible to start it without having a clue if it is lowering hbsag or not, i'd give it up without that test and just monitor hbvdna and alt/ast

http://www.lupinpharmaceuticals.com/adrsub.htm#product_t
in some countries it is available without prescription, you might ask lupin for it

the group is for assistance and to share results with other members so all community can benefit, we have also contact with some drug makers but they are not helping, to join just PM me
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Avatar_m_tn
Hi Steafno,

Agreed. UK is outdated in research and facilities. Fibroscan is hardly available. They still use old drugs. I would say they are at least 10 years behind you guys.

I am not going to start any treatment but continue with Milk Thistle. drinking coffee aswell.

HBeAG neg with this viral load shoudln't be on treatment anyway.

My Only concern is constantly elevated ALTs.
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Avatar_m_tn

just follow how our alinia is going at 6 months and then 12 months and check that hbvdna and alt stay low
hbe pos or negative alone has no meaning, the hbv state is very complex and needs all tests to understand situation

i only feel safe since they are following me at the research center with all the tests, at the local hospital where i go to take the free drugs don't check anything, just hbvdna every 6 months.
just like the researcher told me: the difference between us and a hospital is the same as mcdonalds and an expert chef that cooks only for you....
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Avatar_m_tn
Yes, I will keep watching your Alinia progress. In UK they will never prescribe me so I have to get off label. woudl you suggest start using it now o wait for another blood test in 5 months. just to remind, Viral Load was 168 and HbeAg neg.
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Avatar_m_tn

you can just monitor if you are not taking any drug, make sure to find a lab that has the new abbott machine for the tests so that you can follow hbsag quantity

the machine is abbott architet for hbsag quantification in iu/ml, the range is 0.05-250iu/ml and for values higer than 250 they must use 1:1000 dilutition.if you see that hbsag slowly decline you can monitor and wait for alinia 6 months results at least but in case hbsag is inncreasing i'd start alinia now
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Avatar_m_tn

a member in the community got prescription in US, i guess it is just a matter of the right expert doctor to give alinia a try since no other drugs are available for hbsag carriers with hbvdna und or very low
but as i remember UK it's a fight, i had my parents send drugs from italy 20 years ago when i was there because doctors were too stupid to refill my italian prescriptions for light problems so i don t know if they are still like that it's a waste of time to ask them
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Avatar_f_tn
hi, ..i want to know..a person who is hep b posetive..how many year he can live..
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Avatar_m_tn

forever, hbv does not kill if you know you have it

if you dont know you have it it can kill after 40-50yo, it takes a whole life time to make severe damage to a small part of carriers who have weak antioxidant balance
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Avatar_m_tn
HI im here in the Philippines......where can i buy milk thisle I am Hep B victims can i ask help from you is any other medication for me....thank you very much
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1158115_tn?1337774818
michael ung liver aid my milk thistle..tignan u po ung content nya
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Avatar_m_tn
where can i buy milk thisle

pharmacy
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