Hbsag Log 1 reduction in one year in two different labs, comparable and significant?

[itac]

Got my second Hbsag quant test.
Last year I got it on October 01 2015 at a lab in Berlin:

HBs-Antigen i.S. (quant.) (CMIA) 2217 IE/ml

This time I got it in a different lab in Germany in Frankfurt:

HBs-Antigen i.S. (quant.) (CMIA) 312 IE/ml

My last hbv dna I got 3 months ago (May) and it was 1390 ui/ml

Genotype is D with precore and bcp mutations

Vitamin d around 27/100 (it used to be 20/100 one year ago - I was taking daily doses of 2000u it went up to 60/100 but then noticed that hbv dna count went up with it from 800 to 1390 so I thought maybe taking the vit d was causing it so I stopped so now it went back to 28/100 (insufficient))

Hbeag is negative and hbeab is positive

Also did ultra sound of liver back in November and they found mild fatty liver so I changed my diet no more even little alcohol avoid fried food try to eat healthy chicken and green bitter vegetables etc

Is the fact both labs are in Germany in two different cities but using the same method CMIA by Abbot machine means they are most likely done the same way and are comparable? Is this log 1 reduction (if I'm not mistaken?) is significant? Can it predict future seroconversion? Should I get back on vit d or start interferon or just do nothing and wait? What's your take?

Please advise.

Thanks!

[sorte]

itac: test is diluted for the values above 250 IU that's why there is some error margin, below 250 it's very accurate

[mike9111]

Ya your drop is so big in 1 year. I wounder if these tests really accurate. I question mine but will know more next year. My drop in 2 years was 223, 140 then 79. If i take the measurement i'm droping about 20 to 30 percent per year. If i want to be very positive i might lose hbsag by end of next year (very unlikely)

[itac]

I wonder if the test is always consistent no matter when or where you get it as long as it's Abbot machine using the CMIA method. I hope they always dilute it and use the same amount of blood. So doesn't matter if I get it at Berlin or Frankfurt it should be comparable but who knows if the lab doesn't messing it up, I'm wondering if I should get it at least at another place while I'm here just to see its more or less on the same level.

[mike9111]

In my case was always same lab same doctor however not abott but eclia method in iu/ml

[sorte]

We do not have insurance system like in US, private healthcare insurance sector is very small and do not covers most expensive cases. Yes, national insurance covers 48 weeks of peginf, with all required tests and doctors visits. Yes it's Roche peginf, but for example if you need entencavir its usually generic one.

[sorte]

In my country, Poland, weekly injection 180mg costs around 200 usd, it's original by Roche. I guess there may be some generic ones available. Here national healthcare insurance covers it always but max for 1 year.

[itac]

Does your insurance cover the Roche brand or the generic one? 200 usd for 48 weeks that's $9600 a year.

[sorte]

I don't think that insurance company will pay for interferon and will take a risk for side affects with such good liver results. So you may start saving money during next observation year and than buy it on your own. If hbsag won't move down of course, otherwise better wait. Remember to take interferon ONLY under doctors surveilance after initial tests.

[itac]

Any idea how much interferon might cost out of pocket for a 1 year treatment? And yes, of course I won't be starting anything without a doctor approval regardless if insurance pays for it or not.

[needadvicewithhep]

Im going to avoid nastiness or sarcasm like you generally write on my posts when I share my results.

But I wanted ask

During this period did you monitor you ALT and AST?

If so from what I understand fluctuating hbsag in this with an elevated ALT can be immune response

But also from what I understand if the ALT alone is elevated this may be an immune response

But if both ALT and AST are elevated it may be due excess of anything including vitamins..

It is kind of funny how you are slowly turning full circle in your thinking after all your critisisms you have had of interferon your now considering trying  it :)

Whatever choices you choices you make i hope they are the ones that get you the best results

Just my opinion im not a doctor

[stef2011]

vit d can only lower alt because it has no toxicity it can only increase calcium levels when doses usually of millions iu are taken for long periods

[itac]

My alt ast levels were always in normal range and never elevated white testing since getting diagnosed one year ago. Also my FibroScan score is minimal F0-F1 and no visible inflammation. So I'm not sure how hbsag could go down like this in one year without elevated ast alt which would indicate an immune response like you say which might then be explained that it's just a fluctuation?  Btw I'm not against interferon per se, just gotta be careful when to start and only if you really a candidate. For someone who has no activity and normal levels, it's really serious decision as you might be bound to life long treatment as a result of such decision.

[stef2011]

with such low value i d try interferon.vit d needs to be optimal range for sure, i don  t think it can be bad, also remember that vit d is not an antiviral so up and down on hbvdna may not be immediate

[itac]

Getting vit d in optimal level is probably not a problem if I start taking 2000iu a day, but starting interferon treatment is going to be more tricky as I need it approved by my doctor/insurance and we don't really have a way to monitor the progress of such treatment as we don't have the hbsag quantity test in the us, so it will be somewhat like doing it in the dark, maybe except using the other markets like ast alt and hbv dna. I think Mike1911 from the forum is also from the us and has same level like mine and his doctor in the us didn't put him on interferon. I guess with no liver damage or visible activity of the virus, it's probably too much risk to start interferon as it can put you on lifetime treatment and no gaurntee for seroconversion.

[sorte]

No one can tell you what caused that drop or was it just random. We know that d3 has big impact on immunity we just don't know all details/doses yet.
Also no one can guarantee you a seroconversion but HBsAg < 100 IU is considered as low. If you have constant hbsag drop, especially such impressive like 1 log per yer, better dont touch it :) and let your immune system do its job.

[sorte]

Regarding to hbv dna change, I had a drop from over 5000 IU to 500 IU when starting d3 supplementation but I have no idea was it just coincidence or not, because I haven't tested it before.

[sorte]

I read that level 60-100ng of vit d is perfect so seems that 2000 IU was a good dose for you. Changes of hbv dna from 800 to 1300 means nothing, just a fluctuation.
If test is cheap for you and you dont have to travel you may do this more often to make sure it's not fluctuation but consistent drop. Are you consider interferon when drop will stop ?

[itac]

I'm not a doctor so I can't really get on interferon unless approved my a doctor and the health insurance company. I'm in the US so we don't have this test.
What would you consider the minimum Hbsag ui/ml amountneeded to start using interferon to gaurntee a seroconversion?

[itac]

Also is there a way to tell if the log 1 reduction was caused by taking vit d or
my diet changes or it's just random? I'm just trying to determine what I did and if it's possible to keep it on the same direction like you said (if it depends in my hands of course)

[sorte]

Yes, it's almost 1 log reduction, full 1 log would be drop to 221 IU but test sensitivity is +-10% so it doesn't matter.
It's very good decline because most of the people during one year of interferon does not achieve such good drop. Just remember that direction is important and you may know more about it after at least 3 measurements, to make sure it's not just the fluctuation.

[itac]

Thanks. So when should I get the next test? In one year? Also what do you think about my vitamin d history:
"it used to be 20/100 one year ago - I was taking daily doses of 2000u it went up to 60/100 but then noticed that hbv dna count went up with it from 800 to 1390 so I thought maybe taking the vit d was causing it so I stopped so now it went back to 28/100 (insufficient)"?