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Hepatitis B and Diarrhoea
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Hepatitis B and Diarrhoea

Afternoon everyone;

5 weeks a go I had a acute hepatitis B case, I spend around 10 on the hospital until the liver got better, as initially doctors speak about a possible transplant. At the same time also I started a treatment with Lamivudine 100 gr per day.

Since 3 weeks ago I am suffering from diarrhoea, and last week doctor decided to do some check of my faeces.

I would like to know if it is a commune side effect of Hepatitis B or if Lamivudine could have such an effect.

Thanks for your help.
20 Comments Post a Comment
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Avatar_m_tn
first of all lamivudine is a wrong choice because it is not used anymore on hbv and even for fulminant hbv tenofovir or entecavir are the best choice because they suppress hbv immediately while lam is too weak and takes too long to make hbvdna und, also rates of patients without death is much higher for tenofovir or entecavir than lam

if you are having liver decompensation making hbvdna und, ast-alt normal as soon as possible and then use of immune suppressive cortison is the way to go since your liver is being destroyed by your immune system that had a over reaction, by the way vitamin d is very low in these cases and it may no be bad to supplement if extremely low, have a test for it too.i have no idea if it can work while the immune response is started but if you find levels to low making it normal is not bad.usually death arrives when vitd25oh and vitd1.25oh get to 0ng/ml, this has been observed in aids and other infectious diseases

as to diarrhoea it will be managed by your doctors, it is not correlated to hbv or hbv drugs at all but if you are having liver failure all immune system can get messed up and you can have superinfection
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Avatar_m_tn
After 4 weeks with lamivudine would to be late to change to tenofovir or entecavir? Any secondary effect like loose on effectiveness for changing the treatment?

I only have the blood test result for the first and second week, for the ALT i went from 2242 to 541 in one week (is not written the units could iu/l?).

Who do I know if my liver is compensated or not? which parameters define it?

I have the next appointment with the hepatologist in two weeks time, should I ask to see him as soon as possible to discuss the treatment?

Also, I feel sometimes some discomfort on my abdomen area, is this related with the hepatitis b as a normal side effect?

Regards
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Avatar_m_tn
After 4 weeks with lamivudine would to be late to change to tenofovir or entecavir? Any secondary effect like loose on effectiveness for changing the treatment?

if hbvdna is detactable you may add tenofovir to lamivudine but we must be sure kidneys are working perfectly so that we dont have extra work on the kidneys because tenofovir is heavy on damaged kidneys baseline and with a fulminant hbv some kidney damage happens if liver goes badly decompensated.creatinine clearance by 24hrs urine collection will tell how function is although thi test is not very very high sensibility, there are no tests extremely sensitive for kidneys function

entecavir is less work on kidneys when they are damaged but the combo lam plus entecavir is not common, the point is you cannot stop lam but only add on in this situation (a stop of the antiviral can be lethal
) but when you make add on we must be sure kidneys are doing ok because after liver failure it is the kidneys to fail for the extra work not done by the liver

the correct choice was entecavir or tenofovir from the start, since fulminant hbv is very rare, 1% cases, there  s not much clinical reports

do not exclude to check your vit d level if extremely low like 10ng/ml or less than 25-30ng/ml this can also help


I only have the blood test result for the first and second week, for the ALT i went from 2242 to 541 in one week (is not written the units could iu/l?).

well this is good if second week they get to less than 100 you should be ok and recover but it is hbvdna level to tell if the antiviral is fully working, with hbvdna less than 10iu/ml also alt should get to the normal values which are less than 30
i guess you are responding to lam, wht about liver function, bilirubin, albumin, platlets, PT?this will tell if liver is compensated

I have the next appointment with the hepatologist in two weeks time, should I ask to see him as soon as possible to discuss the treatment?

you need hbvdna to judge first, although lam is very weak and not used anymore even for pregnancy it is possible you are among the responders.

the problem with hbvdna is that good labs have it in few days while bad labs/hospitals are slow with the test because pcr is very expensive and they wait to have many test requests to save money on the pcr...but i guess in your situation they should not care about waisted pcr and do the test even if it was you only

Also, I feel sometimes some discomfort on my abdomen area, is this related with the hepatitis b as a normal side effect?

there are no sides from hbv antivirals, what you feel is due to the liver working less than normal but this happens even when we eat too much...in the end you need ast-alt, bilirubin, albumin, platlets, pt and hbvdna to judge if you are out of danger, all these tests are ready same day except hbvdna so you may ask for liver function tests now.if alt is around 100 by second week you should make it even with lam

after you are out of danger zone you may discuss tenofovir add on to lamivudine if hbsag does not go down the second or third month of therapy



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Avatar_m_tn
Good afternoon;

Is now around 2 months since my Hepatitis B acute case, and according with the latest blood test the transaminases are now normal and Bilirubin a approaching normal (27 mic-mol/L). HBV DNA levels are awaited (next week) but 2 weeks ago they were 250 (iu/ml if remember ok). I am currently HBsAg negative.

A couple of days ago I started back on the gym, and not sure if this is a coincidence but I currently have a kind of liver "pain" I feel some kind of discomfort for example driving and sometimes relates with certain right arm movements, my next appointment with the liver consultant is in two weeks.

Should I contact him earlier, is this related with possible permanent damage to my liver?

Thanks for your advice.

Regards
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Avatar_m_tn
The liver should regenerate itself by about 6 months, eat organic fresh veggy , take 5000iu daily of d3 to make your levels around 60-80.ng/ml

If you can easily afford take fibroguard and have a fibroscan in 6-12months after the acute case.what is Hbsab
level?take fibroguard when Hbsab>10miu/ml
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Avatar_m_tn
The pain is nothing to worry about just the pressure of the liver on close organs
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Avatar_m_tn
HBsab level is not written on the letter that they send to my doctor. I will ask for it.

Can I start doing exercise? I use to run an hour per day, or should I take it easy?

I have been offer a work secondment on EEUU startin in January for 3 months, can I have any problem with the visa since I have Hepatitis B?

Regards
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Avatar_m_tn
Take it easy now no gym,rest until you have a good level of immunity antibody which is hbsab >250miu /ml

Also 10miu /ml is considered protective but it is too low, of course also hbv dna must be und.at this point hbv is over

Remember never use immune supppressive drugs like steroids, chemist or reumatology drugs because hbv can return.using those drugs tenofovir preventive therapy is a must because there have been many deaths due to fulminant hbv
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Avatar_m_tn
I meant chemio, this damn ipad changes allwords.....really hate ipads
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Avatar_m_tn
Hi I have a hepa b virus running in my system for couple of years now... before my sgpt was 500plus and my sgot is 500plus too. My question is... If those two (SGPT&SGOT) went to normal count, do I have a chance to be cured? Because right now my SGOT is in normal count... and my SGPT is about 90 U/L...
The reason I am asking is... I would like to work abroad... and I think they always check for Hepa B for medical exams..
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Avatar_m_tn
SGPT&SGOT only show the extend at which your liver is being damaged. To know about your chances to cure HBV you need to do more tests - LFP, full hbv panel, fibroscan and US. Hbsag quant.
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Avatar_m_tn
Hi david what did you take for your Heb B??

am curiouse to know as you got this fast result in such a short time

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Avatar_m_tn
Hi david what did you take for your Heb B??

he did nothing, immune system clears hbv on adults
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Avatar_m_tn
steff is right. At times those drug sellers and doctors dont tell you the difference between acute and chronic. they charge and give you drugs. but if it is at the acute stage, about 90% of adults clear Hbv with the help of strong immune system
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Avatar_m_tn
Good evening everyone;

I have today my 3 months review with the hepatic consultant, I have ask him about the results of last month blood test (2 months since acute infection).

HBsAg Negative
HBcAb Positive
HBsAB - was not requested
HBV DNA 25 iu/ml (one month earlier 250 iu/ml)
ALT 39 iu/l (not sure about the units, previous was 116 one month earlier)
Bilirubin 27 mic-mol/L
INR 1,1

On todays test he has requested HBsAB and vit D also, that should be ready in a couple of days.

My question is the following, is Lamivudine 100 mg day doing anything? Should not be after two months the HBV DNA undetectable? I have read that the capability of a test is 20 ... is that right?

Thanks for your time.

Regards
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Avatar_m_tn
My question is the following, is Lamivudine 100 mg day doing anything?

little to nothing since hbvdna is detactable but you ll never know better keep it until hbsab is high, it has no sides effects so..........

good to know that the most expert researchers asked to ban use of lam for chronic hbv at this year liver conference in US

I have read that the capability of a test is 20 ... is that right?

no sensibility is now between 6 and 10iu/ml, but the test can random detect even 1iu/ml but random not all the time
in any case this test is useless in your case, it just measures hbvdna in blood and not in the liver, hbvdna in the liver is toally different

the best test is hbsag, when negative you have very little infected cells in the liver and very little virus inside liver cells and much less inside the liver among cells
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Avatar_m_tn
Hi Stef2021;

I had today my 3 months test results (from acute infection):

HBsAg Negative
HBcAb Positive
HBsAB - Positive 183 (units are not given, but the report mentions is high)
HBV DNA < 10 iu/ml
ALT 15 iu/l (not sure about the units)
Bilirubin 11 mic-mol/L
INR 1,2

vit D was requested but is not on the report.

I am still taking Lamivudine 100 mg; the report suggest taking it for further six week an then stop it. The report also suggest that the virus will be cleared spontaneously.

Then, it is normal that HBV DNA will take longer to be undetectable?

Thanks for your time.

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Avatar_m_tn
lam is very cheap and has no relevant sides so it is best keep it for some time after hbsab is formed.it would be best to have it quantitative miu/ml so we are sure about the course and also hbcab igm.these antibodies should pick right after acute hbv and then slowly decrease as all virus is cleared

vitd levels above 50iu/ml are best for your health in general, see all studies about it and all the diseases a good immune system activated by vit d can control on vitaminwiki.com


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Avatar_m_tn
Vit D levels where 44 nmol/l one month ago ; thus I started taking daily 25 ug daily.

Is this supplement enough under your opinion stef?

Today the doctor has decided to stop with lamivudine treatment  

183 IU is for HBsAB according with the doctor. Is this a good level?

Regards
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Avatar_m_tn
Good evening,

I did stop lamivudine treatment around 3 weeks ago, and since a couple of days I feel a discomfort on my right body ribs. Is now around 5 months since I had the acute hepatitis B case.

Last months test showed immunity developing, but I am worried if this could be a relapse. Is normal to still feel this pain or discomfort after 5 months? Can be related to stopping the treatment.

Thanks  in advance.
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