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

[grmr]

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!!!

[stef2011]

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?

[grmr]

Hi Stefano,

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.

Thx a lot

[stef2011]

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

[grmr]

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...

[stef2011]

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

[stef2011]

as to your monther is she inactive carrier with no liver damage or on therapy?

[grmr]

yes, she's inactive!!!!

[grmr]

and she's never had any tx!!!

[stef2011]

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

[grmr]

could it be tha same for me also in the next future?

[stef2011]

too early to say we have to wait and see how your immune system works/hbv mutates after immune tollerance

anyway interferon lambda will be available in a couple of years and long treatments by interferon+ntz+etv or tnf will probably make very high eradication rates

[grmr]

hey, guys.. not so good news here..

Got my last lab made 3 wks ago..

VL still above 1000000000
AST 198  (range 0-50)
ALT 589 (range 0-50)
GGT 79 ((range 0-50))

still eag+..

Just to summarize i've been on IFN for 7months 2years aog and had to quit tx as qhite bllod cells were too low and I was getting no effect and no results on VL..

What's going on mates???  I really do not want to restart IFN shots tx...

[stef2011]

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

[stef2011]

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

[stef2011]

another consideration is, do not waste the chance to clear hbv.

at this stage you have little mutations and if you awake your immune system your chances to clear are much hgiher than hbeag negative

so if you have no problems covering expenses i'd try the first gcmaf way and then the second way in case gcmaf fails

gcmaf needs tests available at redlabs.com:
vdr genotype, because ff/BB genotype doesn t respond to gcmaf
nagalase, to see if hbv is supressing your immune system by nagalase

[grmr]

hi stef, thx for your answers, well detailed!

Well, as I'm still eag+ Is there any little chance to get eag serconversion only on combo? Doctors say the latest combo is etv+tfv.. I reallu would not like to get back to ifn shots....

[stef2011]

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

[grmr]

.. I'm pretty scared as I belive doctors will push me again on pega shots... really do not want.. :(

[stef2011]

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

[grmr]

do you have any clue on when the lambda ifn would be approved here in italy?

[stef2011]

patent of alpha expired, in the meantime they will make trials, but this makes no difference to you as long as you have hbeag pos you can get in the trials

[grmr]

I could but seems to be unfeasible for me due to costs and logistics...i knew from u that not all hospitals have this trial availabe rigth now..

[grmr]

just an addition... I read on www that lambda is being tested on HCV.. will it be approved for HBV also?

[stef2011]

no it is tested for hbv and hcv, but for hbv they started on hbeag postives only in any case you dont need to rush, you need tnf+etv first to make hbvdna und and then try interferon lambda

these hospitals are doing the trial on hbv only

Ospedale S.M. Annunziata - Firenze- Dr. Francesco Mazzotta
Unità Operativa Malattie Infettive
via Antella,58 - tel [phone]

Università La Sapienza - Roma - Prof.ssa Gloria Taliani
Dipartimento di Medicina
viale del Policlinico, 155 - tel. [phone]

these are doing on hcv

Azienda Ospedaliera Universitaria Pisana – Ospedale Cisanello- Pisa - Prof.ssa Maurizia Rossana Brunetto
Unità Operativa di Epatologia
Via Paradisa, 2 – Tel. [phone]

Università La Sapienza - Roma - Prof.ssa Gloria Taliani
Dipartimento di Medicina
viale del Policlinico, 155 - tel. [phone]