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INF + Tenofovir + Simavastatin
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INF + Tenofovir + Simavastatin

After treating with mono entecavir for 5 years, I decided to switch to tenofovir (Pavtino-B made in India) combo for two months.
And recently I have consulted with my doctor to add on interferon  Pegnano 180mcg/0.5mL made in Vietnam

Now I am on : INF Pegnano + Tenofovir + Vit D3 10.000IU + Simavastatin 40mg

Here is my status HBV

Date : 19/05/2014
HbsAg : 8462 IU/ml
Anti-hbe+ seroconversion year 4th entecavir
GGT : 38
ASAT : 38
ALAT : 29
Creatine : 12 mg/l
HBV DNA : Undectable since 3 months with Entecavir
Fibros scan : 4.3 kpa
Phophatase Alcaline : 156 UI/L
Alpha Foetoproteine : 2.28 ng/ml

After 6 Injections with interferon starting from 03/06/2014, here is the test result 15/07/2014

HbsAg : 7386 IU/ml
Anti-Hbe+
GGT : 75
ASAT : 79
ALAT : 87
Creatine : 12 mg/L
Vitamine D TOtal : 50 ng/ml

I am thinking to increase my dose on Vit D3 to 20.000 IU and Simavastatin to 80mg.

Can you give some advices?





79 Comments Post a Comment
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Avatar_m_tn
you can try but since this is all experimental we cannot suggest anything.hbsag decline is a good sign since such high levels are less responsive

please let us know if hbsag decline further with sim 80mg.be careful about muscles pains, vit d should prevent that but it is a common side on high dose sim

Creatine : 12 mg/L, is this creatinine?
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Avatar_m_tn
Yes Stef 2011 it is Creatinine and it is reached near upper limit.
Anyway there is no problem with dose vit D3 20.000 IU ?
I will keep updated.
Thanks for quick response stef
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Avatar_m_tn
it is best you do creatinine clearance by 24hrs urine collection just to stay on the safe side

in the meantime you can decrease creatinine by baking soda 1 tea spoon daily and then check your ph urine to stay around 6.5-7 this will help kidneys a lot.to check urine ph you can buy small paper test sold at pharmacy

other ways to decrease creatinine are not good during pegintf because they decrease inflammation and this is needed while on peg
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Avatar_m_tn
if your results keep this way i think sim combo may be more interesting than nitazoxanide or ezetimibe.i think you and otan are the pioneers on this combo

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Avatar_m_tn
Do you know your HBV genotype?
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Avatar_m_tn
Stef : what is the backing soda ?  you mean taking it a tea spoon per day ?

The_PS : I dont have a test on HBV genotype because it is expensive i just ignore it.

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Avatar_m_tn
http://en.wikipedia.org/wiki/Sodium_bicarbonate

if you dont like the taste you can add lemon or maple syrup, it is good to lower acidity (low PH).acidity promotes cancer and makes a lot of work on kidneys that try to balance ph towards alkaline 7
the optimum balance is around 7-7.5 of ph for human body
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Avatar_m_tn
Thank Stef2011
I will find it when I go back to the city.
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Avatar_m_tn
Also monitor cpk if you go on high dose 80mg sim because it can make muscles and back pain, if so you can take paracetamol but for short period, in case of pain it is best to lower dose
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Avatar_m_tn
I go with tenofovir + vitD3 20 000 ui in the morning and simvastatin 80mg at night before bed.
after taking simvastatin I just feel tired and sleepy immediately and wake up with normal mood with no pain at all.
Should I continue with the high dose or more test need to be done to assure the safety ?
Thank Stef2011 for always sharing a good info

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Avatar_m_tn
No no test strickly needed, you should feel a lot of pain before test cpk becoming elevated.tollerability is different person to person i remember i could tollerate 20mg not more
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Avatar_m_tn
very interesting articles that might give ideas on antiviral effect of simvastatin if there is any in vivo:

Cyclophilin A: a key player for human disease
in particular the paragraph: CyPA and hepatitis virus
http://www.nature.com/cddis/journal/v4/n10/full/cddis2013410a.html

simvastatin is a cpa inhibitor
http://circres.ahajournals.org/content/98/6/811.full
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Avatar_m_tn
I just have a test on creatine this morning cpk seems not elevated.
Creatinine : 12mg/l
Creatine phospho-kinase (CPK) : 90 ui/l
Regarding to baking soda it is likely no one know about it in my town (Phnom Penh capital of cambodia).

I will continue to find it anyway.
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Avatar_m_tn
HbsAg quantity test after 12 injection pegnano + simvastatin 80mg + vitd3 20000 IU

HbsAg : 2848 IU/ml
ASAT : 60 UI/L
ALAT : 69 UI/L
GGT : 80 UI/L
Akaline Phosphatase : 215 UI/L  (N: 80 - 306 UI/L)
Creatinine : 11 mg/l

Blood Cell count are in normal range
Leucocyte count are in normal range
- Neutrophils : 2,50 giga/l             ( 2,00 - 7,5 )
- Lymphocytes : 2,41 giga/l             (1,50 - 4,0 )
- Monocytes : 0,48 giga/l
- Platelets : 193 000 / mm3

It is a huge drop HbsAg so I think i countinue with simvastatin 80mg and Vitd3 20.000 UI per day.


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Avatar_m_tn
wow thanks for the update, it is indeed a very huge drop and very unusual by 12 weeks, right when you take more sim and with such a high baseline of hbsag

did you feel more sides by sim 80mg?some more low fever?
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Avatar_m_tn
I took simvastatin 80mg since the 6th injection so it is already 6 weeks.

For side effect, i feel a bit tired and sleepy a few days at the beginning then i think my body can adapt it and feel normally.

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Avatar_m_tn
also which date sim was increased to 80mg?
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Avatar_m_tn
I started Simvastatin at the same time with Interferon begin with 20mg for a few days then inscrease to 40mg for 6 weeks and finally started with 80mg till now.
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Avatar_m_tn

-66.34% by 12 weeks, very unusual.

if others try this we will be able to confirm if it is sim
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Avatar_m_tn
I will ask for it on the 17th when I meet my doctor. Perhaps I have a good chance as well. I did another hbsag test to confirm before I head back to the states
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Avatar_m_tn
http://clinicaltrials.gov/show/NCT00994773

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2869246/

Principal Investigator: Teddy Bader, M.D. University of Oklahoma

doctor bader is studying simvastatin on hbv but i dont think they ever combo with peginterferon.i did try sim myself with tdf plus etv but it didn t work combo with nucs.

it would be sueful to find some study with pegintf plus simvastatin, even in vitro, but i only found hcv trials with sim
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Avatar_m_tn
also remember to increase vitd before starting treatment, it is best to get some immune action before adding antivirals or peginterferon

my guess on this is:
tenofovir reduces virions fast, this lowers immune activation but if we get vit d high before reducing virions we get more macrophages/phagocytes activity, this may keep more immune activation even when virions will go down when we add nucs or pegintf

same thing with peginterferon, this drug enhances immune activity already in action before we start it, so even in this case it is best to have high vit d before treatment
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Avatar_m_tn
I started my vitamin d 4 days ago and taking 11200 iu per day
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Avatar_m_tn
it is great so we can expand our experience with inf + simvastatin and vitD.

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Avatar_m_tn
after 17 injections pegnano + Simvastatin 80mg + Vit D 20000
there is again an enormous drop HBS

Hbs quant : 895 IU/ml  down from 2848 IU/ml
Vit D         : 59.76 ng/ml
Creatinine : 13mg/l
Calcemie : 89mg/l

It is likely hard to inscrease vit D even with 20000 IU per day.

What do you think about the result stef ?





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Avatar_m_tn
very very results, this is not even 24 weeks and you already decreased 1log but what really matters is the number if you go less than 500iu/ml hbsag clearance at 48weeks is certain....well actually chances are very very high even now

i really hope we have found how to fasten hbv cure by sequential plus vit d plus sim, however we need a lot of members on this to reach scientific proof

calcium is perfect so you may increase vit d even more than 20.000iu daily if you like although creatinine is still high, did you check creatinine clearance by 24 hrs urine collection?you know blood creatinine test is of very little relevance, was it that elevated even before peg?
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9624973_tn?1413019730
Those are very good results, is there anyone that is currently trying combo with simvastatin so we can have a clear image if it works ?
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Avatar_m_tn
missed good, very very good results, i d say incredible if all members trying this sim add on get such decline of 1log or more before 24 weeks

we cannot say it is sim for sure because it is possible to get such results on sequential but i suggest all to try this add on and see since simvastatin is a safe drug with minimal sides
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Avatar_m_tn
otan tried it on peg mono and cleared hbsag by 24weeks

lagona is second member trying

i am trying this myself too but have no results yet

i dont remember if other members are on this, if so please share your results here
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Avatar_m_tn
thanks lagona for this wounderful sharing, as steff says we hope that this combo will we be speed up cure
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9624973_tn?1413019730
i think i will go for a combo if treatment will be needed . i will move to UK next month. and i am thinking if to treat in romania (as its my home and i could come for treatment) or uk, as romania just started to watch hbsAG and they treat by the book ...not personalized treatment, that is very bad for us . what are your suggestions ? as for italy, do you think the prices are acceptable if i would consider it ? i could come by 2,3 months .. ?
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Avatar_m_tn
if you can get residence in italy treatments are free in mono to get a combo free you need to find a very good hospital and liver specialists
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Avatar_m_tn
Yes Stef  my creatinine is upper high level of the range for years.
What can it be indicated with clearance by 24 hrs urine ?

Regarding to the combo I think simvastatin has play a key role in reducing HbsAg because when I start with the first 6 injections Pegnano + sim 40mg the Hbs drop only a thousand which acccount only 12% while my vit D is already 50ng/ml before INF.

After inscreasing sim dosage to 80mg there is a hug drop Hbs started.


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Avatar_m_tn
What can it be indicated with clearance by 24 hrs urine ?

kidneys function.creatinine in blood is normally high on high body mass or those making gym but creatinine clearance is not affected by this

studyforhope suggested another test i think urine  creatinine/albumine ratio, this shows early damage to kidneys cells before function goes down.

in case you have low kidneys function when you stop peg and clear hbsag you may go for fibroguard, liposomal resveratrol and curcumin, glutathione and see if function goes better and of course baking soda.if function is ok it is your normal creatinine values to be 1.3
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Avatar_m_tn
i hope i can confirm this data too
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Avatar_m_tn
My result up to date on 04-12-2014 after 27 injections :

GAMMA G.T : 53 U/L
ASAT : 76 UI/L
ALAT : 71 UI/L
Calcemie :  8.1 mg/dL
Creatine : 1.3 mg/dL
Alpha fetoproteine  : 1.73 ng/ml

HbsAg Quant : 257 IU/ml  down from 895 IU/ml

I am still on vit D3 25000 IU + Simvast 80mg + Tenofovir + Pegnano

Once again HbgAg drop alot.

Hope i will wipe out the virus soon.


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Avatar_m_tn
wow wonderful news at this point we are 99.9% sure you will clear soon since this incredible result in about 24 weeks

i think your hbv cure is based on these facts for sure:
number of years under antiviral before add on, 5 years
use of high dose vit d3
maybe the use of simvastatin but others must confirm this

did you also check vitd25oh and parathormone, this may help others to find the right balance of these two tests for response?in any case calcium is low so anything you find from vitd25oh will be safe, remember i am vitd25oh way higher than 1000ng/ml and no problems at all

as regards creatinine i think you should check creatinine clearance, it is probable that for your muscle mass your normal serum creatinine is normally higher than others with no issues.creatinine clearance will tell you the kidney function which i am sure it is optimal
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Avatar_m_tn
yeah stef I dont have the test on Vit D yet for the cost reason.

creatinine clearance is the test with Urine ? I will ask the doctor for next test and Vit D too.

Thanks

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Avatar_m_tn
My 48 weeks of treatement result :

Hbs Ag Quantitative (Cobas e601) : 82 IU/ml
GGT : 60
ASAT : 66
ALAT : 57
Creatinine : 1.3
PCR : Undetectable
Vit D3 : not avalable yet

I have decided to continue Interfereon for another 24 weeks + Vit D3 25000IU (daily) + simvas

Any comments are welcome
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Avatar_m_tn

very good choice, please when you check vitd25oh check intact pth too at same time, this is mandatory to understand if there is sufficiency
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Avatar_m_tn
nice results ! good luck ! :)
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Avatar_m_tn
Dont you people suffer from side effects from injections ? I was told these injections really work well when you very high viral load and comes with lots of side effects.
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Avatar_m_tn
stef2011 : PTH mean parathyroid hormone test?
I will try to find it out at the lab

rockla : I don't feel any suffer effect from the injection
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Avatar_m_tn
Please don t report here what you hear because thats complitely wrong, all the opposite, pegintf doesn t work with viral load with works best with undetectable
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Avatar_m_tn
Ok so PegIntf helps in lowering the viral load from Liver than from Blood
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Avatar_f_tn
Excellent result .you start interf with high hbsa value but you achieve a good result .i want realy try peginterf.now do you stop the injection or continue since you are in the 48weeks?
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Avatar_m_tn
flyinsky : yes i continue it for another 24 weeks.
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Avatar_f_tn
So do you support side effect?thanks
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Avatar_m_tn
Side effects from IFN are only listed on the packaging as an insurance against the maker of IFN. Some don't get any at all other than a fever the first injection. For me, I also experience very low WBC and neutrophils count.

To Lagona: Yes, your HBsAg is very low. Congrats. Instead of upping your Vit D3 dose, do you take zinc and selenium supplements as well? Hoped once your HBsAg becomes UNDETECTED, you developed surface antibodies simultaneously. Good luck!











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Avatar_m_tn
Hi Stef,

I finally got result from PTH test and Vitamine D Total and it took so long to have it done.

Vitamine D Total :  > 70 ng/ml
PTH  : 18,25 pg/ml

It is strange with Vit D result they cannot give me exact number when it is lower than 70 ng/ml

PTH : i dont know what it is shown ?

Any recommendation is welcome.

Thanks,

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Avatar_m_tn
they can not give you exact number when its higher than 70, not lower. If you supplement d3 or expect high result, you need to tell about it in the lab so they can dilute a sample and give you accurate result.
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Avatar_m_tn
PTH  : 18,25 pg/ml

this is still a bit high, what is the minimum range in this lab?when pth gts lowest range of norm we know vit d is enough in your tissues/cells.vitd25oh is not precise because it just checks blood and if there is receptors resistance it is useless

Vitamine D Total :  > 70 ng/ml

they need to dilute blood sample to get higher values but it is not important pth test will tell us when vit d is sufficient in tissues cells

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Avatar_m_tn
also keep an eye on serum calcium and urine calcium
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Avatar_m_tn
Hi Stef,

My lab PTH range it as normal from 16 to 65 pg/ml
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Avatar_m_tn
in this case you have now good amounts of vit d and you can keep vit d dose you are taking and  u should have max immun e modulating effect and see effects after 6 months on this stable pth values

the best range to keep pth is: around 10-16pg/ml for you, on lowest normal or little less than normal.keeping same vit d dose it should continue to lower but anyway even 18pg/ml is ok

keep an eye on calcium and urine calcium, no dairies diet and 2.5-3L of low ca water
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Avatar_m_tn
let us know if hbsag goes down, it should after 6-8months of those pth values because vit d n the cells should be able to help immune modulation
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Avatar_m_tn
my latest test result till present :

calcemie : 8,9 mg/dl (N : 8,1 - 10,4)

Creatinine : 1,3 mg/dl (N : 0,7 - 1,3)

HbsAg Quantitative (Cobas e601) : POS 27,71  IU/mL (N<0,05)

PTH : waiting for results in a few days

I am doubt if I could clear it at the end of the course 72 injections.

Right now there is only 7 injections left.

In case there is still no antihbs appeared should I continue with it?

I might have conflict with doctor if I insist to continue as doctor has no experience with the treatment last longer than 72 injections.

Welcome for your comments.


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Avatar_m_tn
you can supplement with about 3000-4000iu vit A retinoid type from cod liver oil per day to balance with vit d, this can reduce creatinine and make no vit d toxicity even if dose is too much
i already did this and my creatinine lowered from 1.3 to 0.68, at the same time i could reduce vit d dose and pth remained low norm range 17pg/ml (norm 10-80pg/ml)

if pth come less than normal range lower vit d dose
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Avatar_m_tn
thanks for quick response

OK let me find me find it out at the phamarcy for Vit A.

Is there is any different kind of Vit A to consider?

Thanks
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Avatar_m_tn
Impressive results lagona.. Sim worked good for u but not on me. Hope u clear and share ur happiness
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Avatar_m_tn
yes the best vit A is from cod liver oil which is the retinoic type and natural, if you find it ifos certified, also double check there is synthetic vit A added but it is the natural one

but i suggest to consume animal liver, all livers are full of vit A, it is best just to try it in the diet first because vitA can also block vit D if it is not in the right balance and this is too difficult.

if you see that creatinine goes out of range then you may try the one from cod liver oil and see if it balances vit d and make nromal creatinine
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Avatar_m_tn
Y vit a blocks vit d?
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Avatar_m_tn
Impressive results ! hope you'll get hbsag negative soon :)
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Avatar_f_tn
Any bad side effects from peginterferon?
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Avatar_m_tn
Hi Elijah

I don't feel any side effects since the beginning.

everything is like normal as it is before getting inf.

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Avatar_m_tn
No side effects and such good response ? that's nice :) Maybe it d3 what helps.
I had some mild sites after first 4 shoots but now I feel normal.
How was your ALT during peginf thereapy ? What was the lowest/highest ?
Mine went up recently to 245 after 5 weeks.
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Avatar_m_tn
You could show your doctor results of studies where they tested Interferon therapy for 96 weeks. I know of a this one, there might be others but I am not sure:
http://www.ncbi.nlm.nih.gov/pubmed/22859496
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Avatar_m_tn
How old are you lagona?
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Avatar_m_tn
U should try zadaxin with ur last 7 injections. Y not give it a push. U r on the borderline. Ur virus seems stubborn to the extreme level but u should not give up coz it may relapse if u stop. U r on edge to win so try it.
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Avatar_f_tn
I'm thinking I should've tried peginterferon instead of tenofovir. But the horror stories from peginterferon scares me.
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Avatar_m_tn
Only peg can give u a chance to clear the virus not tdf
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Avatar_m_tn
Wow!! its great that things are working out for you.  So happy for you :)  Wish you the best!!
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Avatar_f_tn
Yes I know but I'm afraid of the side effects from Tenofovir
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Avatar_m_tn
What horror stories ? Most of the people have side effects but they are not very bad. I'm after six shoots and for now it's ok. Only first one was quite hard, high temp, shingles.
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Avatar_m_tn
all here are reporting minor sides effects, i think that the use we do of vitamin d is preventing heavy sides and boosting response, as more members will be on it this will be easy to confirm

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Avatar_m_tn
This week after 15th shot m feeling continuos nausea though :(
At 6-8th shots I had vomiting and abdominal discomfort
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Avatar_f_tn
Do a quick Google search of people that have tried peginterferon. Many people have side effects that didn't go away after treatment.
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Avatar_m_tn
that s hcv and it is different to hbv.


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Avatar_f_tn
How are the sides different from people with HCV?
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