Immune tolerant or break immune tolerant phase?

[freewind2013]

Hi everyone
  I am a chronic hepatitis b carrier, probably type B or C, since born. I am 25 years old right now.  My recent check shows  HBsAG and HBeAg are positive with high HBV DNA count. My ALT is normal as defined by my family doctor (i didnt check the exact number). Not sure of AST.  My doctor said I am still in immune tolerant state.  I am wondering of following questions
1. its is possible to stay in immune tolerant state for lifetime? (from research paper i read, most of ppl enter immune  clearing phase in 30 to 40s, so my guess is not?? i need confirmations)
2. Is it better to stay in immune tolerant phase or to break immune tolerant state? ( for this question, i cant rationalize a good answer. Since in immune tolerant phase, there is minimal liver damage, but high viral replication and high viral load (high HBV DNA). Minimal liver damage is always a good thing I guess. IN THE OTHER HAND,  breaking of immune tolerant state means high degree of liver inflammation for a period of time with HBeAg seroconversion and low HBV DNA. After immune tolerant most of people enters inactive (HBeAg negative) carrier stage (low HBV DNA, normal ALT)  and maintains that way. So low HBV DNA is also a good sign. Then which one is favoured???)
3. If breaking immune tolerant state is favourable,
    a) how to break it (increase in immune system? taking drug?)
    b) how to mimic liver damage during immune clearing phase (that is my major concern here)
4. Does entering immune clearing phase define as a Hepatitis B patient instead of carrier then? ( or the term carrier does not really mean anything)

Hopefully someone can give me advises to those question while i look deeper into individual research paper.
Thank you in advance.

[stef2011]

if your alt is 800 fibroscan is not reliable now because most of the reading can be inflammation, you have to retest in 6months when alt is less than 200 and inflammtion is less, better start treatment anyway

is it ok to take entecavir? does it lessen the chance of getting into cirrhosis?

it is ok if you can make resistance test, is it available in the philippines?this because if you have    the resistance to entecavir is more than 50% while tenofovir doesn t require this test because it has no resistance

around 10% hbvers carries lam mutants
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1803124/

[kinetix1208]

just got my result from fibroscan, it's 11.9kpa, very high, and according to
the result:

For Hepatitis B with elevated ALT:
Minimal or No Fibrosis  = 7.5 - 12.0
Advanced Fibrosis >12.0 - 13.4
Cirrhosis > 13.4

so i'm in the gray zone, but close to advanced fribrosis. now i'm scared.
what should i do the normalize my liver?

the doctor told me to take entecavir, i talked about tenofovir but hesistant in prescribing it to me since this is not approved yet in the Philippines, this is sad.

is it ok to take entecavir? does it lessen the chance of getting into cirrhosis?

I hope i was still in immune tolerant phase. :(

[judas13]

   it sad to say that some of our doctors here in the philippines are not so good to handle HBV patients and it happened to me personally that makes me doubtful and cautious about thier profession. this case is very rampant now in our country and our government do nothing about this. very FRUSTRATING.!
  im very thankful i came up this forum ,it gave me a lots of informations and educates me as well that i cannot find to some ignorant doctors.!
pls let me know if you find a good doctor.
  

[stef2011]

you can also add that hbv clearance on hbeag positive is irrelevant on entecavir and 16% on tenofovir at 3years, so entecavir is a total failure also in clearance rates in your case

the highest clearance was on tenofovir+peginterferon like gmr treatment, it reached 24% hbv clearance in ashort time, dont remember if 6 or 12 months, this 24% could rise much more in  personalized hbsag tdf+pegintf long term treatment like tdf+pegintf for 2 years or more

[kinetix1208]

I'll try to talk to the doctor about this, she is a new doctor to me because i keep on changing doctors everytime i notice that they don't know anything. Hopefully it would be a good discussion, i'll ask her about tenofovir and her thoughts about it.

There is a fibroscan in the hospital but i will also confirm it. Hoping also that they have test for hbsag quant in iu/ml as well.

Thanks a lot.

[stef2011]

i guess the best way is get a big pharmacy in the philippines to get it for you after you find a doc to prescribe and monitor or directly move to a close country for monitoring since you even miss all the tests to monitor response in the philippines

i remember vietnam goverment pharmacies started generic cheap peginterferon too and they have all tests like hbsag quant, hbvdna and fibroscan to monitor