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Hbs+ hbeag+ --- VL after tx...

Need some thoughts here…

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…

ALT still around 70 however….

Any ideas?????

thanks to you all guys!!!
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correlating your age with your blood tests it is possible that now you are in Immune Clarence phase and at the end you go on HBe negative or Hbs negative.

do you have also some otehr tests results ? (qhbsag, hbvdna, fibroscan, ....)
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u just need to monitor hbsag quant and hbvdna, if both lowering you will seroconvert

osp riuniti bergamo, makes hbsag quant in 2-3 days with internet delivery.hbvdna 1-2 weeks

fibroguard/heptoboost may help if platlets, pt and liver functin are getting worst
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Well Stef, the problem is that my VL has always been >100000000… so it’s out of range and non countable…. It could be 100000001 or 200000000 so ) do not know how long it takes to go under those limit…

Will try to get Hbsag quant done within December….  
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get the test done at bergamo, they got the new assay with sensibility 10iu/ml to 180billions o cmqe arriva a bilioni, mentre prima si fermava a 100 milioni
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thx to all u guys.

So far I'm getting blood tests done evrey 10 days and have started takin milk thistle and vitamin D3 supplements to weaken the virus...

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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
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thx Stefano.... coffee wise I'm ok.. I use to drink plenty of Espresso!!!!
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got latees VIT25DOH values...23.. is that pretty low isn't it? Shoud I get it to 80/100 right?
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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
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you are sure about testing D3 ?

as far as I know they are 2 diferent test for vitamin D
- 1,25-(OH)2-VITAMINA D3
- 25-OH-VITAMINA D

and for your test name it look that you have the second, double check if you got the correct one (D3)
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attention:
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
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thanks for pointing this out.

i was under the impresion that 1,25-(OH)2-VITAMINA D3 is the correct one and not 25-OH-VITAMINA D, so i learn something today :)
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let's get it to 80 and see...

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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?
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if you have no sides at all interferon is not doing a thing, it was all blocked by hbv
the sides effects are due to immune activation so most of them without any side are having no effect at all
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sounds like I've never made any tx...
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update 8/11/11:

- AST 118
- ALT 380
- GGT 180

PT: 124 (80-120) ---> high

transaminasis vbalues went down, started milk thistle and vit D3 supplemntes..

any support is highly appreciated...
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what about hbvdna and hbsag?they should be down too

when hbsag and hbvdna gets down to low levels it is the best time to attck with tenofovir or interferon
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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..

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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
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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
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Many thanks for your valuable suggestions, much appreciate your efforts.

However I recall reading somewhere the end point for Hbeag+ patient IFN therapy was the seroconversions to eag - ..wasn’t it?
Only for eag – patients the goals was to get rid of Hbsag…

Really do not know what to hope… serocovnersions to eag- or keeping eag+ status which has better response to tx..
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collected last weekly labs

ALT 111
AST 372
GGT 113

PT now in the range 111 (80-120)... so I beleive this means liver is making his function... isn't it..??
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i will meet doctors in the next days.. really do not want to ga back to ifn... i'll push on TFV /ETV but before this I'd need to get checked for precore mutation rigth?

In case they want me to restart IFN may I have no sx as I did some years ago???
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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
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when do you get hbsag nad hbvdna?at ospedali riuniti di bergamo, hbsag about 3 days, hbvdna about 7-13 days
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latest labs ALT 320 AST 100 GGT 103
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maybe you should put your ALT / AST / GT / PT / VIT D / VL ..in a tabel and maybe a pattern will be visible.

BTW on the Nov 15, 2011 post you maybe switch ALT value with AST value - just double check.

on the other hand I can see that a maximum was ereach in Oct and now it start to decline (I guess that you are in the last part of immune clerance phase  and maybe a e seorconevrsion can happening )
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hi all,

got latest lab

AST 70
ALT 240
GGT 76
EAG +
anti-hbe -
VL >1000000000 (out of range)
PT 117 (80-120)

so far I see i'm still eag+ so he combo tx tdf+pega may have higher success rates.. I believe I can start this next month..

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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
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it may also happen that tdf makes hbvdna und in 3 months but this is rare, in this case interferon+tdf can work
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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?
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yes you are not totally immune tollerant but that little immune response is of n o help
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thx again stef.

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..
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start l-carnitine which will keep platlets higher and go as doctors said tdf first and then add on interferon

i will be starting around february too, i will be doing gcmaf atthe same time, the reports of gcmaf are that it even prevents chemios sides so i guess it will help me with interferon too
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so we're starting more or less at the same time..
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here i am my fellows... got latest labs.. not so good mates..

AST 85 h
ALT 308 h
GGT 78 h
Pt 115
VL >1000000000 (out of range)
Colesterol 223 h (120-20)

you see the only one inside the range is pt.. i believe this refers to liver functionality...

What surprised me is the cholesterol which for me seems a little unussal as i'm 26yo and live a healthy life style..no fatty food meals nor alcohol abuse..

any feedback is welcome..

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sorry colesterol range is 120-200... :)
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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
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Pt was (protrombina). Platelettes are arounf 190

so should I worry for cholesterol?
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sorry confused it because it should be 1.15

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
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is that harmful? may it be caused by VIT d3 i'm currenlty intaking 10000 daily?
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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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of course my hbvdna and hbsag are much lower than yours because my immune system is much more active, but in my case hbv escaped most of my response

in ur case the chances of success with therapy are higher because you dont have a good immune response yet, so hbv has not mutated yet to escape it

so tdf will make hbvdna und and make some immune response

interferon will boost that little immune response to clear hbv

having hbvdna nd will make impossible for hbv to mutate and escape your response

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just a further advice... what about dringkn beer/glass of wine in such conditions once a week (1 glass on meals)?
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definitely poison for us, avoid absolutely

it also decreases immune system damaging dentric cells that are already non reactive to hbv
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neither once weekly?
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none, my first acute flare at 19yo was due to drinking even if once a week
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... so of course i do not mean getting drunk, for sure.. only a glass on meals...

none at all.... :(
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go for none at all now if you can
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