INF + Tenofovir + Simavastatin

[lagona]

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?

[stef2011]

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?

[lagona]

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

[stef2011]

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

[stef2011]

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

[The_PS]

Do you know your HBV genotype?

[lagona]

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.

[stef2011]

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

[lagona]

Thank Stef2011
I will find it when I go back to the city.

[stef2011]

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

[lagona]

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

[stef2011]

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

[stef2011]

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

[lagona]

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.

[lagona]

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.

[stef2011]

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?

[lagona]

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.

[stef2011]

also which date sim was increased to 80mg?

[lagona]

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.

[stef2011]

-66.34% by 12 weeks, very unusual.

if others try this we will be able to confirm if it is sim

[mike9111]

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

[stef2011]

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

[stef2011]

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

[mike9111]

I started my vitamin d 4 days ago and taking 11200 iu per day

[lagona]

it is great so we can expand our experience with inf + simvastatin and vitD.