As you may have read going through this thread I’m still Hbeag+ ALT slightly out og range (70-80) and my VL has always beein >100000000.
I had been on Pegasys IFN180 mono tx for 8 months (2 years ago) and then I quitted as I seemed to not responding to tx… (just for you info I have not had any side effect at all but VL was almost always >100000000).
After that I just have my blood tests done every 3 or 4 months, ultrasound every 6 months …… so I’ll keep on monitoring how this stuff is progressing..
Now.. got my latest labs last week.. and I was really surprised as my VL dropped down to 50000000… yes mate I know this is still high but I’ve never had a result like this in 26years.. Neither had I while on tx…
hbvdna has very little meaning in terms of infection and it flactuates up and down usually getting to completely undetactable too.it is a very good tool to monitor if therapy is working
your situation is common on asians and with such high viral load you might get some results only from entecavir 1mg+tenofovir combo, nitazoxanide might help too
are you 100% sure you were not immune tollerant and abnormal alt was due to hbv?is your hbeag still positive?
if you drink alcool, are overwheight and eat a lot of fats/meat alt can be that high and it is not due to hbv
i suggest you keep monitoring hbvdna and start drug only if it stops decreasing and reverse to increase
did you ever check liver damage by biopsy or fibroscan?
the VL never decreasead even when I was on IFN therapy! Docs wanted me to quit tx as they told I may have still been in the immune-tolerance phase..
I'm stell eag + .. as I've been being since my birth (I'm now 26 yo)..
I had a liver biopsy in 2007. Everything was good, they found F1 (Metavir) but doctors said there’s nothing to be worried about. I had also ultrasound test once a year and no liver damages were detected.
on immune tollerance it is better to let the virus be, i would check why alt was so elevated
all the drugs can worsen situation because it immune system activates it makes more damage, it is better to wait for immune tollerance to be broken naturally and you will see this from hbvdna getting down and alt getting elevated for sometime, in the meanwhile you don t have to worry because your liver damage is almost none but do check with biopsy again in 2-3 years not more
a saw a study where they broken immune tollerance by monthly hbv vaccine+antiviral but i'd wait to happen naturally
yes mate.. to be honest I often have cheese, salami, meat at meals.. but you know.. I'm 25yo and pretty always hungry!!!!
I wish I could seroconverto into Hbeag- as my mom did (she's hbs+ hbeag-) in the past.. but this is not happened yet after 25 years of hbeag+... so I actually do not now whether this is gonna be lilkely or not..
I also was strongly pushing for AV (ETV, TFV) before starting IFN tx back in the past but doctors didn't suggest that way as AV could be taken for all the lifetime and so far no results shwoing low damage/side effects in th long term have been proven...
yes mate.. to be honest I often have cheese, salami, meat at meals.. but you know.. I'm 25yo and pretty always hungry!!!!
there are 2 hepatitis that can happen this way, they can both be heavier than virus infection.fatty liver disease and nash.singns are overwheight, high cholesterol, early signs of diabetes, fat in the liver on ultrasound.daily alcool from as low as a glass or wine or beer can also elevate alt this much
just correct diet and make excercise and see if alt goes down.vitamin E and pcc supplements can help
as to being immune tollerant that's the best situation on hbv, pray to stay like this as long as possible, because it is like having no virus
do monitor and when hbeag seroconversion will happen or hbvdna will get down to ver low/und that's the best moment to try peginterferon+nitazoxanide or if this happens in 2-3 years you might even have interferon lambda available
do not consider tnf or etv, they both are useless on virus and needed only to prevent or reverse liver damage.we have seen that used in combo with peginterferon they can increase svr but do not consider them without interferon
it is also good doctors didn t try etv or tnf with you being immune tolerant because you might have developped resistance without making hbvdna und
i have also seen a study where they used monthly hbv vaccine shots plus antivirals and they could break immune tollerance on most without making alt flares but i don t see the point to breaking immune tollerance since it doesn t make any damage to the liver.this was also a small study so i wouldn t try this
good she is like most of hbv carriers, if you have hbsag quantitative test available check her quantity, if it is as low as 500-1000iu/ml she might get rid of it by ntz or even clear it with a possibility of 11% per year
well you are in immune clearance pahse but your immune system is too weak, this is what i suggest to my point of view:
interferon has been useless because too much hbvdna, hbeag and hbsag suppress your immune response, so start from boosting immune response
start taking vitd3, 10000iu daily, until you reach a serum level of about 70ng/ml then decrease dose to find maintenance.check serum calcium while on this because a very rare paraormone disease (dont know correctly in english) can increase calcium while on high vit d3
start simvastatin 40mg and check that alt doesnt flactuate too much
then you may try gcmaf from gcmaf.eu for 6 months and see if you get to hbeag negative and hbvdna low/und
this is just a try with no sides effects, no risks
another try is use:
entecavir+tenofovir, this will make hbvdna undetactable and improve immune response to interferon overtime
if you have no liver damage this antiviral combo is totally useless on infection but you cn use it because lowering hbvdna will improve your immune response and interferon might start working on a combo like this
so once hbvdna und for 6-12months you may try tnf+etv+interferon+simvastatin+vit d3 +alinia and see if you clear hbsag and hbeag
i dont like this combo because expensive for etv+tnf+interferon, the others are very cheap, but not sure if it will work after all this expense
int'l liver congress 2011 in berlin made a trial on interferon+nucs and 2 cleared hbsag, one of these two was previously non responder to interferon
you can make etv+tnf and retry interferon when the lambda type will be available, the lambda has fewer sides
as to the potency of tnf+etv i have seen few people with high hbvdna achieving hbeag neg and almost zero hbsag neg.it is early because data on this combo is not public yet so we should wait for the int'l liver congress at end of oct
do start the supplements of vit d3 and sim anyway, they will weaken the virus
no wthat i know you are italian try to get to cisanello pisa with the doctors i told you or lampertico milan, they are among the best in the world for hbv they will know for sure what's best for you better than me
since youare hbeag pos i will try to get hold on interferon lambda, it has no sides compared to norma interferon, higher rates and if you increase vit d3, coffee 4-5 cups a day, simvastatin 40mg you might even improve the results
there are a couple of hospitals in italy doing the trial, check bms italian website for trial locations.firenze has it for sure, i could not try it because i am hbeag neg
by the way check new posts about coffee 4-5 cups a day and vitamin d3 on fibrosis, they are also useful on that
it is also good to lower cholesterol, i posted a study time ago about the link of cholesterol, low vit d3 and insuline resistance on fibrosis development, so supplements like red yeast rice (biostatine) 1 pill a day and low sugar intake and moderate excerccise can all help a little in your situation
got latees VIT25DOH values...23.. is that pretty low isn't it?
yes it is very low as in all patients with cronic diseases.me and my sister had it at 11ng/ml....
Shoud I get it to 80/100 right?
yes, 10000iu daily necessary and then recheck in 1-2 months.to reach that amount you need dibase liquid.they say to take 2000iu daily but that's for healthy people for us only 10000iu daily can work
if you can afford recheck it every 4 weeks bot vit d25oh and calcium otherwise recheck in 8 weeks.it is about 16euros but some private labs charge even 25 euro or more.
it is lso better to go to a private lab because you pay the same with doc prescription, it is not covered by healthcare
1,25-(OH)2-VITAMINA D3 this test is not needed, it doesn t reflect deficency.ini taly it is extremely expensive and some hospitals dont do it, so no problems to confuse
- 25-OH-VITAMINA D
this is always vitamin d3 which is the only ntural vitamin we have in our blood, some tests detect both d2+d3 but since d2 is only chemical there is no possibility to have wrong readings
remember to avoid the chemical type of vitamin d2 which is not effective, in italy you need prescription for this one and it is not used at all, so again difficult to make confusion.other countires may still use d2, i think this is just to make confusion i see there is a drug makers push in US against vit d3 and correct doses and serum blood ranges, so in US you have to watch out, in italy everything is normal and europe probably too
some old tests still use max normal range 10-62ng/ml, the new tests have correct ranges 35-100ng/ml or 40-100ng/ml
I also wanted to post the following question: as you see by reading the whole thread I went through an 8months lasting MONO PEG-INTERFERON 180 back in 2008/2009… no side effects at all but it didn’t work so still eag+ and VL >100000000…
The question is: may I have gotten any benefits even if it didn’t’ work? May my immune system have been boosted?
well stef... will check them in Dec... toggetehr with an Ultra sound... believe me I really wish I could switch to eag-...
do not want to start again ifn tx due to side effects... and i read also TFV has got quite a few of side effects..
in the end both etv and tnf have no sides on hbv patients, very very few can have an increase on creatinine
hbeag negative is not becoming free of hbv, it is achived by precore mutations it is worst than you are now with more liver damage and less response on therapy, the time to attack hbv to get rid of it is exactly when you turn from hbeag pos to hbe neg
sine when i was 17yo i was hbeag neg and hbvdna und, this has made no difference to get many mutants along the way and cirrhosis too, so do not be fooled by getting hbe neg and hbvdna und for sometime, it is not a goal....the only goal is to treat to get hbsag low and hbvdna und
i am telling you this because while you may think hbeag neg can give you sometime without thinking about a therapy, hbv builds up new mutants during this period and it is not a good choice to allow this
only getting hbsag to 500-1500iu/ml after hbeag neg can be a sing of real inactive hbv and quite safe, not just hbeag neg
the hbeag vision is from adecade ago without no studies, we now know that hbeag negative is still cronic hbv with liver damage unless hsag is less than 1500iu/ml, if it is higher the hbvdna und with no liver damage is just for the moment while a low hbsag is a truly inactive carrier.so hbeag worsths nothing now as diagnosis but as long as hbeag is positive you can get rid of hbsag with very high chances on the contrary hbeag neg has very very poor chances
so i do suggest to start tenofovir and see if it is potent enough to lower hbvdna ina short time, otherwise i do suggest to see many liver specialists until you find one for the combo, they have instructions not to use the combo because too expensive for healthcare...i had to push a lot even if i am cirrhosis stage where combo si almost on guidelines because resistance can be deadly at my stage
sorry it got even worst, you lost the little immunity you were achieveing
to me the best option would be tdf+etv 1 year and then tdf+interferon.this because hbeag and hbvdna so high destroy all hbv immune response.by lowering hbvdna to und by tdf+etv (one antiviral only is too weak on such high hbvdna) will rescue your immune response so that interferon add-on when hbvdna und will work
if you use tdf+interferon from begining you will probably have:
hbvdna and hbeag high anyway even in 6-12months
as antiviral rescue some immune response ast/alt may get elevated
interferon will make ast/alt elevated
by sequential strategy you avoid the flares and optimize interferon response
thx stef for replying.. I'm in fact startin with tdf for some weeks/months and then adding ifn... anyhow you're right alt is getting lower but still really out of range.. isnt this meaning some immune repsonse is still on?
so what is reccomendable now? would it be better wait again? I do belive doctors will suggest combo tx.. starting tfv and then add on pega.. 115 or 180 as last time I got low platelettese values so I had to reduce from 180 to 115..
cholesterol is controlled by hbv, cholesterol genes are changed by hbv to make its antigens
re check platlets 115 is extremely low, lowest normal range is 150.if so low start tenofovir as soon as possible and l carnitine.low plt means a lot of damage is being done in the liver
if plt doesn t get in normal range and hbvdna gets low fast by 6 months do ask for tdf+etv combo and then interferon add on, jus tlike i am doing, tdf+etv are very fast to make hbvdna und by 6 months even when so high.interferon with low platlets is a problem
you can use biostatine, it is a red yeast rice supplement, it will ower cholesterol in about 20-30 days, this way you will weaken a little hbv and you will respond better to therapies.once you start therapy you can stop biostatine or lower it to one pill a day
biostatine can be found in farmacia, eroristeria, parafarmacie, it doens t need prescription.use that brand only because it is not sure all red yeast supplements work.i hve seen them at auchan and coop but dont know how reliable other brands are
if doctor agrees you may also use simvastatin with prescription but only updated doctors know use of sim is safe, so you using biostatine is easier
of course do not keep chol so high, there is an increased risk of arterosclerosis and chol related diseases in hbsag carriers because hbv upregulates genes
no vitamin d3 is protecting your liver from fibrosis and severe liver daamge as clearly shown by a poster at the liver meeting.the liver with vit d reached f1-f2 fibrosis while the others got advanced nodular cirrhosis
high cholesterol and platlets 190.000 are due to hbv, keep in mind that also cholesterol promotes fibrosis and liver damage, it is all linked with hbv and damage.making cholesterol lower you will also prevent fibrosis
by the way i also had tot chol 218 when i had hbvdna 580.000iu/ml and alt 600, while it decreased to normal with hbvdna und
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