I need urget help on HBV--Please help me

[nihi120]

I am male and my age is 29yrs. Last week I come across that HBV virus in my blood. I had some stomach infection too. I Consulate with Dr. Mahesh K Goenka in Kolkata, India. Then I went for some test , test result are
LFT-
Serum Total Protein(Biuret)        7.5g/dl                         (6.4-8.3 g/dl)
Serum Albumin (B C Purple)       4.4g/dl                         (3.5-5.1 g/dl)
Serum Globulin                          3.1g/dl                         (1.8-3.6g/dl)
Ratio                                         1.4:1:0                        (1.0-2.0:1.0)
Serum Total Bilirubin(jendrassik Grof)  0.6mg/dl               (upto 1.0mg/dl)
Serum Direct Bilirubin(Diazo Method)  0.1mg/dl               (0- 0.2mg/dl)
Serum SGOT/AST(UV Kinetic)       57U/L                          (10-42U/L)
Serum SGPT/ALT(UV Kinetic)        58U/L                          (10-40U/L)
Serum GGT(SZASZ)                          12U/L                       (07-64U/L)
Serum Alkaline Phosphatase(PNP-AMP) 99U/L                  (53-128UL)


Hepatitis B Surface Antigen            Reactive
Value                                                          1211                 (0.0-1.0)

Anti HBc IgM, HBeAg

HBE ANTIGEN DETECTION
HBe ANTIGEN                                              Postitive(Index 4.79)        (Positive:Index>01)
Method Used      Enzyme Linked Immunofluorescent Assay

ANTI HBC ANTIBODT(IGM)
Anti HBc-IgM                                            Equivocal(6 IU/ml)                              Negative 10 IU/ml
Method Used      Enzyme Linked Immunofluorescent Assay



HBV DNA Viral Load
4.45x10^9 viral copies/ml (Four billion four hundred and fifty)

USG U/A
Ultrasound Report shows liver and kidney is normal.


P Time(Prothrombin Time)
Test         15.6secs
Control    14.4secs
INR( International Normalised Ratio)  1.09

Serum Triiodothyronine(T3)        1.1ng/ml                             For Adult(0.8-2.0)
Serum Throxine(T4)        12.8ug/dl                                       For Adult(5.1-14.1)
Thyriod Stimulating Hormone(TSH)        2.3ulU/mL                For Adult(0.27-4.2)


Dr. given me Tab RAZO 20mg, Tab Domstal 10mg, Tab Silybon 140mg TDS, Cap VSL#3 for 15 days and After 15 days he will check again. I thought these medicine for my stomach problem.
For HVB he told you have hepatitis B  not chronic. you will be  definitely fine. I asked  whether I need some more test like hbsag quantity and fibroscan. He told me not required now. After 15 days you come and meet me.

So please tell whether my Doctor is in right way or I have to consult some other doctor? Aslo tell me whether these medicine have any side effect which may be increase my HBV. Can my HVB cure as doctor told.
Please help me.

[stef2011]

what is bad about your results is the hbvdna going up together with hbsag and ast/alt while on tdf
if conifrmed by a second test it would be best to have an add on to tdf like etv

is it possible you missed some tdf pills from time to time?

[stef2011]

we can only guess why hbsag went up:
the use of antivirals suppresses hbvdna but also immune response so as hbvdna went very low the immune system is less stimulated and hbsag can rise

the response to antivirals has 3 patterns on hbsag:
most no change of hbsag
a good part rise of hbsag
very very few a slow decline of hbsag of tiny amounts per year

antivirals take 5-7 years to have an impact on hbsag quantity and very slowly decrease hbsag quant

[nihi120]

thanks Stef for ur valuable suggestion. I will defiantly not take Interferon more. Please explain me reason for this much increment in HbsAg Quant value in 1 month of time?

[stef2011]

consider that hbvdna higher than 10^7 IU/ml has less responce on both antivirals and intf often, this hi viral load makes also a lot of immune tollerance

the lucky points for you:
genotype A
hbeag pos

i think it worths to hold on and retry by the sequential combo i suggested above and a type of interferon we are sure not to be fake

[stef2011]

your baseline hbvdna was very high so tenofovir plus entecavir are best to suppress hbvdna to undetactable

as regards interferon you are not responding or intf was fake

i do suggest to stop interferon now and add entecavir to tenofovir so you can suppress hbvdna to undetactable fast and keep the combo from a minimum of 6 months to 12 months
the best choice is go on with this combo for about 1-3 years and then retry intf add on and see if you respond

[nihi120]

Hi All,

I am also undergoing treatment of TDF+PEG. I have just received my week 36 result and very confuse, whether i should continue Peg interferon or not. Here is the complete history to the latest of my result:
Baseline result (mid of May)
Hbs Ag (Quant) : 37903 IU/ml
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs:Non-Reactive
HBV DNA : >1.10x10^8 IU/ml
AST : 42
ALT : 65
Genotype-A
Fiboscan-3.5

June result (week 4)
Hbs Ag (Quant) : 22583.7 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs :Non-Reactive
HBV DNA : 320735 (going down)
August result (week 12)
Hbs Ag (Quant) : 36915.98 (going up)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs :Non-Reactive
HBV DNA : 13825 (going down)

Nov result (week 25)
Hbs Ag (Quant) : 37468.4 (going up)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs :Non-Reactive
HBV DNA : 152 (going down)
AST : 43
ALT : 55
Dec result (week 31)
Hbs Ag (Quant) : 37480.7 (going up)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs :Non-Reactive
HBV DNA : 16 (going down)
AST : 47(going up)
ALT : 67(going up)

Feb result (week 36)
Hbs Ag (Quant) : 63897.7 (going up)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs :Non-Reactive
HBV DNA : 45 (going up)
AST : 47(going up)
ALT : 72(going up)



I don't think any medicine working for me now. What I do now? My plan is to stop Peg+TDF and start any herbal medicine now. Please suggest me. Why this much increment in HbsAg Quant value in a month?

[stef2011]

you are intf non responder so you have to discontinue intf and retry in the future
hbvdna decrease id due to tdf but hbvdna decrease or und doesn t mean less hbsag or hbeag, antivirals increase hbsag by making hbvdna und

it is complex if you dont understand it dont worry about it, too long to explain again and again

[nihi120]

Thanks for response..if Intf works on low level then Now my HBVDNA is 15 IU/ml so HbsAg should be decrease not increase. My doctor is telling that don't see HbsAg value, since HBVDNA decreasing  means therapy is working.
Should I discontinue Intf+ TDF both or only intf? If I will take only TDF then how much time it take to HbeAg negative or seroconversion ?

[stef2011]

When will my HbeAg become nor reactive?

when hbsag will reduce to very low levels like 100iu/ml or less


Is Interferon working in my case?
no it is not working, i d stop intf and then readd on in 6-12months.there are several choices of intf combinations: coombo from start, sequqntial and staggered, staggered maybe your case

HBV DNA decreases because of TDF?

of course it is intf has a very weak effect on high levels of hbvdna

[nihi120]

Hi All,

I am also undergoing treatment of TDF+PEG. I have just received my week 31 result and very confuse, whether i should continue Peg interferon or not. Here is the complete history to the latest of my result:
Baseline result (mid of May)
Hbs Ag (Quant) : 37903 IU/ml
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs:Non-Reactive
HBV DNA : >1.10x10^8 IU/ml
AST : 42
ALT : 65
Genotype-A
Fiboscan-3.5

June result (week 4)
Hbs Ag (Quant) : 22583.7 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs :Non-Reactive
HBV DNA : 320735 (going down)
August result (week 12)
Hbs Ag (Quant) : 36915.98 (going up)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs :Non-Reactive
HBV DNA : 13825 (going down)

Nov result (week 25)
Hbs Ag (Quant) : 37468.4 (going up)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs :Non-Reactive
HBV DNA : 152 (going down)
AST : 43
ALT : 55
Dec result (week 31)
Hbs Ag (Quant) : 37480.7 (going up)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs :Non-Reactive
HBV DNA : 16 (going down)
AST : 47(going up)
ALT : 67(going up)

When will my HbeAg become nor reactive? Is Interferon working in my case? or HBV DNA decreases because of TDF?

[stef2011]

start tdf to lower hbvdna so that intf add on can work (intf doeant  work with hgih hbvdna)

when hbvdna gets very low like around 50iu/ml add on intf

i d do this to try to clear hbv as long as hbeag is pos

[nihi120]

HBeAg- Reactive (Sample/cut-off ratio s/co- 560)( Method- By chemilumiscence)

Anti HVC- Non-reactive( method Elisa)

Anti HBe - Non-reactive(Sample/cut-off ratio s/co- 27)(Method- By chemilumiscence)

HBsAg Quantification-  37903 IU/ml(Method- By chemilumiscence)

Fibro Scan- Success rate 100%
                      Cap(db/m)                                      E(kPa)
                      Median 199                                      3.5
                      IQR* 24                                           0.5
                      IQR*/med 12%                                 14%
HBV DNA-
            Method- Real Time PCR
           Instrument- Real Time PCR
           Sample- Plasma
           Result -   >1.10x10^8 IU/ml
LFT-    AST/SGOT            42          (5-40)
           ALT/SGPT            65          (5-40)
           S.Total Protein(Biuret)       8.1  (6-8)
           A/G Ratio                     1.38      (1.5-2.5)
USG U/A
Ultrasound Report shows liver and kidney is normal.

Liver Biopsy-
     microscopy- Liver biopsy shows maintained acinar architecture. Portal tract show mild chronic inflammation, focal interface activity and mild fibrosis. Hepatocytes show minimal steatosis and occasional ground glass appearance. Few foci of lobutar inflammation seen.
    Liver biopsy- Chronic Hepatitis with Mild Activity
   Fibrosis-1
  Ishak's Modified HAI-5

Earlier My Dr told me that ur ALT is continuously high from last 6 month so you hv to start INTERFERON + TENOFOVIR, So already start to take tenofovir from last 7 days but not  taken interferon. Now  by seeing my biopsy Dr told me that two things-
1. As your ALT is  continuously high from last 6 month so you hv to start INTERFERON + TENOFOVIR.
2. You Liver Biopsy shows there is no much damage in liver so you can further wait for 3 month to start treatment. mean while no medication required.


Now I totally confuse that what i do next, whether I start Interferon or not.

[nihi120]

Doctor didn't tell to do hbcab igm test.

In your early post i read that if HBsAg Quantification < 1500 then medicine will work. Is it write?

[stef2011]

very good doctor, its intf+tdf, you have the higgest chances to clear on this combo
hbcab igm?

[nihi120]

Hi,
Its already 6months gone, I have gone through all test again. It bad news that i am become chronic. My resent test reports are-

HBeAg- Reactive (Sample/cut-off ratio s/co- 560)( Method- By chemilumiscence)

Anti HVC- Non-reactive( method Elisa)

Anti HBe - Non-reactive(Sample/cut-off ratio s/co- 27)(Method- By chemilumiscence)

HBsAg Quantification-  37903 IU/ml(Method- By chemilumiscence)

Fibro Scan- Success rate 100%
                      Cap(db/m)                                      E(kPa)
                      Median 199                                      3.5
                      IQR* 24                                           0.5
                      IQR*/med 12%                                 14%
HBV DNA-
            Method- Real Time PCR
           Instrument- Real Time PCR
           Sample- Plasma
           Result -   >1.10x10^8 IU/ml
LFT-    AST/SGOT            42          (5-40)
           ALT/SGPT            65          (5-40)
           S.Total Protein(Biuret)       8.1  (6-8)
           A/G Ratio                     1.38      (1.5-2.5)
USG U/A
Ultrasound Report shows liver and kidney is normal.


By see all reports Dr. Said that Virus is still Highly Replicated so you have to start treatment even your Fiboscan and ultrasound looks no damage in liver, medicine given  :-

Interferon(Pegasys 180mg) + Yenofovci  ( once in week)
Viread 300mg 1 dalily


I did some more test but result yet to come
Liver Biopsy
Creatinine
HBV Genotyping

Hi expert see my report and tell me whether my treatment going in right direction or not..any suggestion may be help me so please help me.
      

[stef2011]

you need all panel:
hbsag quantity in iu/ml
hbcab igm, if possible quantitative in s/co
hbvdna in iu/ml
ast/alt

according to hbvdna level treatment by tdf+intf may be the best choice but only after you check all panel and according to hbsag/hbvdna levels

hbsag can be cleared in 12 months too if hbcab igm is still positive or if hbsag is going down

[nihi120]

Hi,
Its already 6months gone through all test again. It bad news that i am become chronic. My resent test reports are-

HBeAg- Reactive (Sample/cut-off ratio s/co- 560)( Method- By chemilumiscence)

[stef2011]

endless brands, puritans vit d3 5000iu are cheap

[nihi120]

Please Suggest me some vit d3 tablet.

[stef2011]

sorry read hbcab igm wrong and though negative, i am not familiar with iu/ml scale on hbcab igm and it can be detactable in cronic flares too at low levels but we will wait the 3 months and we will know

an easy way to see wht is happening is to follow hbsag quant in iu/ml with hbvdna too, if you have it available you might recheck this again in 3 months, cronic carriers have it very high while acute have it very low after 3 months from the pick of hbvdna

take vit d3 supplements to keep vitd25oh 50-70ng/ml this can help your immune system in case acute

[StephenCastlecrag]

Hepatitis B is a slow moving disease, so 3 month wait is neither here or there.
If you are acute, then no treatment is recommended and in over 90% of adults, you will clear the virus by yourself. In the unfortunate case that you are unable to clear the virus and become chronic, all treatments are long term. Unless you know how you are infected and when, doctors rely on HBcAb Igm to differentiate between acute or chronic, or they just wait 6 months to see whether you still test positive for HBsAg.

Hope I got it right.

[nihi120]

Today i meet with different Doctor, who is best HBV doctor in city, After seeing all the report which i mention above, He tell me you have to wait 3 month, than do test again. I asked that whether it is actual or chronic HBV he told, at now its is not chronic. I asked for medicine, but he told you should not take any  medicine now. Only you Viral Load he high, others are normal only.
Please give your valuable suggestions, It will really help me lots.

[nihi120]

what stephen said same things doctor tell me too that your HBcAn Igm is not negative, it is Equivocal because value is 6IU/ml..For negative case value should be less than 5IU/ml. So after 15 days we will test again. So please tell me whether my Doctor is right or wrong?

[StephenCastlecrag]

Your doctor thinks you may have acute HBV, that is why he is not treating you, yet.

Stef2011 thinks that you are chronic because your HBcAn Igm is negative. But the test results says: Equivocal. That is "not sure".

So I suggest, you see your doctor and test again?