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How dengerous is reseroconversion of HBeAg?
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How dengerous is reseroconversion of HBeAg?

Hello,I have a question on behalf of my friend. She has HBV infection,with a high VL and moderate damage to the liver. Her ALT was always normal,until recently. For the past month it jumped to high 300s and it stays on this level. Further testing revealed the she's reseroconverted from HBeAg- to ABeAg+.The doctors are hesitant on treating her with interferon right now,fearing further increase of her flare up. Do any of you have any suggestions? She's worried. The last she's heard from the doctors is that they will wait for the ALT to come back to normal levels and then treat her with interferon. Her next visit is in 6 mos.She's worried about further damage to her liver with this flare up. Who knows how long this will last and what will the outcome be. Please,if you have any thoughts or advice,let me know. Greatly appreciated.
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Avatar_m_tn
reseroconversion happened on its own

so she never had drug treatment, in this case it is not a bad sign and she might even have more chences of hbv eradication.which country is she?all those tests are expensive but without them therapy is not personalized by just a guess, it works but we just guess for many results.it is like if we are blind and mostly we assume this or that

if we are sure she had no previous treatment and if really they don t want to start a treatment now, she might try alinia with generic nizonide just as an interferon pretreatment, in chinese forum a women just posted she had hbvdna from 7 log to 3 logs in 4 months and hbe negative.this might lower both hbvdna and alt and this pretretment will increase chances of hbsag eradication with interferon

Her biopsy showed fibrosis 2/3 level
how come 2/3 level, biopsy must give a clear result of f2 or f3, there is a big difference unless there is a mistake in biopsy because the sample of liver is too small

if the level is fibrosis 3 she must not wait long because once in to cirrhosis f4 the liver cancer risk increases and remains increased even after cirrhosis regression.interferon is not very good at fibrosis regression but it is anyway the first good try to eradicate the virus

my suggestion is again:
1,5 or 2g ntz pretreatment 4 to 12 weeks
interferon+ntz 48 to 96 weeks according to hbsag decrease and if hbsg still more than 1log at 96 weeks continue with ntz mono after 96 weeks

if the also do interferon+lam in that country it is better to add interferon+lam+ntz 48 to 96weeks in the central combo and follow ntz monoafter 96 weeks since lam wihout interferon might make resistance even if ntz is present we have no data on this

as shown in our group and in hcv treatment this is the best combo to increase interferon SVR
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1024307_tn?1292002086
Of course reseroconversion from HBeAg- to HBeAg+. Sorry for the mistakes.:)
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Avatar_m_tn
it is not dangerous but it means the virus is replicating and making damage at a higher level, also hbsag quantity is much higher on hbe pos

in terms of clearing infection hbe pos/neg or hbeab antibody pos/neg makes almost no difference.usually the chances of hbsg eradication are a little higher on hbe pos when using interferon

The doctors are hesitant on treating her with interferon right now,fearing further increase of her flare up
alt 300 or higher not a problem at all if she has no decompensated cirrhosis by fibroscan or biopsy.the flare up will be inevitable because she is full of infected cells that must be killed, tenofovir might have less flare up since it doesn t block infection but replication only

Do any of you have any suggestions? She's worried.
if this has happened naturally without any drug or resistance this is not a problem at all , on the contrary it is avery big problem and if there is resistance she must look for the most expert specialist in the country not just a doctor

ALT to come back to normal levels and then treat her with interferon.
pretty stupid, high alt and low hbvdna are the cons of using interferon and the results are better during this phase.with low alt and high hbvdna all drugs are less effective.
hbcab IgM at values higher than 0.2s/co is the best moment for interferon and is usually when there is a alt flare.i am sorry but the doctors you have a really incompetent, of course i have the point of view of mine which are among the most expert scientists on hbv in the wrold but your friends' look very incompetent

.She's worried about further damage to her liver with this flare up
if she is not on cirrhosis or f3 she has nothing to worry anout the liver, the problem is the mess with hbv.can she monitor liver damage yearly by fibroscan?but again liver damage is the lastest issue now plus alt does not reflect liver damage, they might be even almost normal but if hbvdna is high the damage is the same

post all the situation, tests results, hbv genotype and mutations both with or without drugs and the drugs taken, also consider that interferon monotherapy doesn t have that great results at all t must be used as combo with antivirals since hbvdna reduction is almost never to und and relapse common
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Avatar_m_tn

of course the meaning of hbe pos is immune response failure and if drugs were used even worst it means resistance and something gotta be done...that said the number of infected cells both with hbvdna und or not might be about the same, hbsag quantity together with hbvdna might tell what immune system is doing and how much the infection is getting worst, in any case it usually the ebst moment for interferon which can also be stoped in case of flare up, the hbsag quantity monitoring before and after this flare might tell what interferon can do and if a flare can happen or not
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Avatar_m_tn
pretty stupid, high alt and low hbvdna are the cons of using interfero

sorry made a mistake i meant the pros, the best indications to start interferon:
high alt (300 is low, 1500-3000 can start to be high)
hbvdna low (3-4 logs)
hbcab igm>0.2s/co

also drug resistance mutations can make hbv weaker to interferon

best combos to eradicate hbv from latest conference in europe and boston 2010
peginterferon+lam or better etv or tenofovir, peginterferon 2 year or more if hbsag decreasing and antiviral not stopped until hbsag negative

peginterferon+antiviral+alinia probably the most potent combo
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Avatar_m_tn
hbsag quantification is of course essential to see if interferon is working same as we say for alinia
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1024307_tn?1292002086
Thank you Stefano. I knew I can count on you.:)
There isn't much to add about the test,because she has not have any more test done due to unavailability in her country. Therefore the mutation,HBsAg level,genotype-is all unknown. The reseroconversion happened on its own. As she was getting ready for her upcoming interferon treatment. I agree with you,that is a shame the doctors don't treat her. Her HBV DNA is almost 2mln IU/L. I just found out that her ALT jumped from high 300s to almost 500. Still nothing is being done. Her biopsy showed fibrosis 2/3 level. That's all she knows about it. Thank you again,Stefano.
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Avatar_m_tn
reseroconversion happened on its own

so she never had drug treatment, in this case it is not a bad sign and she might even have more chences of hbv eradication.which country is she?all those tests are expensive but without them therapy is not personalized by just a guess, it works but we just guess for many results.it is like if we are blind and mostly we assume this or that

if we are sure she had no previous treatment and if really they don t want to start a treatment now, she might try alinia with generic nizonide just as an interferon pretreatment, in chinese forum a women just posted she had hbvdna from 7 log to 3 logs in 4 months and hbe negative.this might lower both hbvdna and alt and this pretretment will increase chances of hbsag eradication with interferon

Her biopsy showed fibrosis 2/3 level
how come 2/3 level, biopsy must give a clear result of f2 or f3, there is a big difference unless there is a mistake in biopsy because the sample of liver is too small

if the level is fibrosis 3 she must not wait long because once in to cirrhosis f4 the liver cancer risk increases and remains increased even after cirrhosis regression.interferon is not very good at fibrosis regression but it is anyway the first good try to eradicate the virus

my suggestion is again:
1,5 or 2g ntz pretreatment 4 to 12 weeks
interferon+ntz 48 to 96 weeks according to hbsag decrease and if hbsg still more than 1log at 96 weeks continue with ntz mono after 96 weeks

if the also do interferon+lam in that country it is better to add interferon+lam+ntz 48 to 96weeks in the central combo and follow ntz monoafter 96 weeks since lam wihout interferon might make resistance even if ntz is present we have no data on this

as shown in our group and in hcv treatment this is the best combo to increase interferon SVR
Blank
1024307_tn?1292002086
I will let her know all your recommendations. Thank you,Stefano. The biopsy result comes as between 2 and 3. It didn't come as a single digit. I don't know why. She lives in Poland. They don't do combo treatment there. It's either interferon or lamivudine. Entecavir is also used when resistance to lam has developed and there is a mutation. But not in treatment of naive patients. These are her choices,where she lives. Thank you again.
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Avatar_m_tn

poland has a very very very poor healthcare system like a century ago if she has a chance of using doctors in germany that would be better then she gets therapy and most tests in poland, actually with low cost you move everywhere in europe at the cost of a city bus and also trains are extremely cheap.i myself take an airplane just to go to have blood tests i can do in my city just to have the researchers follow everything

germany is like italy and all kind of tests are available, the best hospital for hbv is in hamburg, the university hospital.
the wrong choices in antivirals monotherapy can make more damage than hbv itself....anyway since she uses interferon and ntz she is safe from resistance and mutations
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Avatar_m_tn
i mean
the best hospital for hbv "in all europe" is in hamburg
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