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Inactive HBV carrier

Hi Friends,
                  I'm HbsAg positive since 2 yrs. My HbeAg is negative and Ati HBe is positive and HBV_DNA_PCR is negative since 2 yrs. My ALT is also normal from 2yrs. No symptoms also. Doctor has classified me as an Inactive HBV carrier.. I haven't had any medication since 2 yrs, But today (1/12/2012) doctor has given me Lamivir HBV 100mg tablets once in a day in the morning.
                     Now my question is What is the status of my HepB and Shall I start this medication to bring HbsAg negative.
50 Comments Post a Comment
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Avatar_m_tn
Your doctor is probably out of money. Medical guidelines say should that you should start treatment if your DNA > 2000, alt > 2x normal limit, fibrosis in the liver.

Do not start the treatment before you are sure you need it.

Also check which medication to use, it is not that straightforward.
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Avatar_m_tn
thanks or the reply brother.. So You suggest me not to start the treatment as per the medical guide lines.. Can you explain me in which phase I'm in.. Immune tolerance or???.. I dont understand anything of this disease. The forum says that there are many phases like immune tolerance phase , Immune Clearance phase and Immune Inactive phase.. I dont understand these terminology.. I'm totally confussed.
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Avatar_m_tn
thanks for the reply brother.. So You suggest me not to start the treatment as per the medical guide lines.. Can you explain me in which phase I'm in.. Immune tolerance or???.. I dont understand anything of this disease. The forum says that there are many phases like immune tolerance phase , Immune Clearance phase and Immune Inactive phase.. I dont understand these terminology.. I'm totally confussed. .
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Avatar_m_tn
Lamivir  is Lamivudine, a first generation hbv drug that is no longer considered suitable to treat chronic hepatitis b. So, do not use Lamivir.

As to the present phase of your infection, you have not given us sufficient information to give you an opinion. At the least, we need to know your ALT and viral load. It is very difficult to believe that your ALT is normal, HbeAg negative, and hbvdna undetectable since 2. We need to know these the result of these tests recently.
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Avatar_m_tn
Yes, do not start treatment with lamvir or anything. First get fresh tests, liver ultrasound and fibroscan if available. And change the doctor, find the one who is hbv specialist, not just gastroenterologist.
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Avatar_m_tn
Now it is not possible to tell which phase you are,we will tell after the tests, but surely not immune tolerance because you are hbe neg
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Avatar_m_tn
Hi Bro,
           My reports are as below:
HBV DNA PCR: Below the detection limit
Negative ( Less than 10 IU/ML) as on 31/03/2011
Negative (Less than 3.8IU/ML) AS ON 27/11/2012

---------------------------------------
Anti HBe:Positive as on 31/03/2011
HBeAg : Negative as on 31/03/2011
Anti HBs : Negative as on 31/03/2011
HBsAg : Positive (2.10 S/Co and Cutoff Value <1.00) as on 31/03/2011
HBeAg : Non-Reactive as on 27/11/2012
Anti HBe : Reactive as on 27/11/2012
HBsAg : 64.77 IU/ml ( 10 mIU/ml is reactive) as on 27/11/2012
-------------------------
LFT as on 20/12/2011

Bilirubin Total: 1.43 mg/dL  (Cutoff : upto 1.0mg/dL)
Bilirubin Direct : 0.32mg/dL (Cutoff : upto 0.25mg/dL)
Bilirubin Indirect : 1.11mg/dL (Cutoff: 0.25 - 1.0mg/dL)
AST : 21 U/L (Males: upto 37 U/L)
ALT : 34 U/L ( Males upto40 U/L)
Alkaline phosphatase : 56 U/L (Adults 30 - 120 U/L)
Gamma Glutamyl : 46.6 U/L (Males: 11 - 50 U/L)
Protein Total : 7.7 g/dL ( Cutoff: 6.4 - 8.3 g/dL)
Albumin : 4.6 g/dL (Cutoff: 3.8 - 4.44 g/dL)
Globulin : 3.1 g/dL ( Cutoff: 2.6 - 3.9 g/dL)
Albumin/globulin Ration: 1.5 (Cutoff: 1,0 - 1.7)
----------------------------------------

LFT as on 06/11/2012

Bilirubin Total: 0.84 mg/dL  (Cutoff : upto 1.0mg/dL)
Bilirubin Direct : 0.27 mg/dL (Cutoff : upto 0.25mg/dL)
Bilirubin Indirect : 0.57 mg/dL (Cutoff: 0.25 - 1.0mg/dL)
AST : 19 U/L (Males: upto 37 U/L)
ALT : 33 U/L ( Males upto40 U/L)
Alkaline phosphatase : 71 U/L (Adults 30 - 120 U/L)
Gamma Glutamyl : 45.1 U/L (Males: 11 - 50 U/L)
Protein Total : 7.67 g/dL ( Cutoff: 6.4 - 8.3 g/dL)
Albumin : 4.54 g/dL (Cutoff: 3.8 - 4.44 g/dL)
Globulin : 3.13 g/dL ( Cutoff: 2.6 - 3.9 g/dL)
Albumin/globulin Ration: 1.45 (Cutoff: 1,0 - 1.7)
----------------------------------



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Avatar_m_tn
Thanks for Your response brother. I will not have Lamivir HBV tablets.
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Avatar_m_tn
Your tests are fine, people take pills for years to have blood tests like yours. You do not need any treatment at the moment, but to be 100% sure you should do liver fibroscan and ultrasound.


With such low hbsag and  dna under, you may clear by yourself, just keep healthy lifestyle to have good immune system (alcohol and smoking are not recommended, exercises 3h-5h a week will be good) . Also blood tests every 6 -12  month and fibroscan with ultrasound once a year.
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Avatar_m_tn
I am not a doctor by the way and there is no ones on this forum. You should make up your own judgement, and find a real doctor that you can trust, the one that you have now is obviously a fraud.
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Avatar_m_tn
Thanks for the info. It seems you are in the inactive phase(it is the disease that is inactive, not your immune system) and no treatment is necessary. Get another doctor to look after and monitor your Hepatitis B.  
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Avatar_m_tn
Thanks Bro for the useful info and tips
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Avatar_m_tn
Thanks Bro for the info.. The disease is inactive but not the immune system.. I was thinking the other way as The virus and immune system both are inactive.. That was worrying me.. Now you have cleared my doubts.. Atleast I can live with less fear for some months.. These 2 yrs of being jobless really made me worse about the disease. I was found HBsAg during the medical process of getting visa and was sent out of the middle east. Being jobless and being the HBsAg carrier really worsen the persons life economically and mentally.
May God bless You both for helping me..
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Avatar_m_tn
HBsAg : 64.77 IU/ml ( 10 mIU/ml is reactive) as on 27/11/2012

you are very lucky to have such low hbsag, when it is so low you can clear hbv definitively by peginterferon (immune system booster), response to peginterferon can be boosted by nizonide500 and simvastatin 20mg or simvastatin 40mg

another member did peginterferon+simvastatin 20mg and cleared hbv in about 12-16 weeks, i do suggest you use peginterfron to clear hbv, this chance to clear it may not come again because hbsag can both rise again
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Avatar_m_tn

if you start peginterferon+simvastatin let us know hbsag results and if you clear by about 12 weeks and develop immunity antibodies hbsab
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Avatar_m_tn
Thanks Bro,
              Are the below medicines are injections or tablets
peginterferon
nizonide500
simvastatin 20mg or simvastatin 40mg
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Avatar_m_tn

peginterferon are injections, this is what clears hbv by boosting your immune response.it is a weekly injection.in india you have also generic interferon which is very cheap vs pegintf but generic intf needs 3 injections per week

nizonide500, tablets to take with meals every 4-5hrs

simvastatin, tablets to take with meals

i think that pegintf+simvastatin is enough, once hbsag starts to go down and alt to go up you can stop simvastatin and keep pegintf only.peginterferon therapy is minimum 24weeks but it is best to do the normal course of 48weeks even if you clear at 24 weeks just to be sure hbv can t come back
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3156104_tn?1357284795
great Stef2011.......requesting you please let me know is there any protocol of infn & simvastatin combo. kindly provide me any confirmed study......waiting.


RGDS
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Avatar_m_tn

no just vitro studies and trials with statins on hcv but the member of our community tried it and ishe cleared hbv superfast.if you search the community there are posts about simvastatin and alinia (nizonide500) since 2010
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Avatar_m_tn
thanks Bro,
simvastatin, tablets once in a day after meal right.
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Avatar_m_tn

yes and it is best at night it works better if taken at night.the doses working on hbv are from 40mg up but you have to check if you can tollerate that dose usully muscles pains, if you cannot tollerate go back to 20mg
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Avatar_m_tn
hey i am also in the same situation
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Avatar_m_tn
I also found it while applying for job
Never had any symptoms
LFTs ok
HBsag +
eAg -
anti HBe +

PCR undetectable
HBSag 19 IU/ml 06 months ago
HBsag 13.7 3 months ago

tried to get alinia but could not find it in pakistan
Now i ll repeat my HBsag quantitative in a few days
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Avatar_m_tn
I also found it while applying for job
Never had any symptoms
LFTs ok
HBsag +
eAg -
anti HBe +

PCR undetectable
HBSag 19 IU/ml 06 months ago
HBsag 13.7 3 months ago

tried to get alinia but could not find it in pakistan
Now i ll repeat my HBsag quantitative in a few days
Dont know what to do
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Avatar_m_tn

you may have acute hbv and clearing naturally, hbsag on acute hbv can be cleared by 12months, it is not all cases that clear by 6 months
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Avatar_m_tn
Hi Bro,
                I just got peginterferon alfa 2a 135mcg last week and had completed 2 doses of it.. These injections are available with doses of 135 and 180 mcg.. I cud get only 135mcg.. Is it ok. Seems that I dont have any side effects also.. I'm also having simvastatin 20mg at night and Nizonide 500mg in the morning..
                  One more doubt, I heard that this HbsAg reduces vitD in the body.. Hope that VitD is the main vitamin sources for better immune system. If Yes then shall I start VitD supplements long with this or shall I wait for some time, Please suggest me bro..
              
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Avatar_m_tn
Hi Bro,
                I just got peginterferon alfa 2a 135mcg last week and had completed 2 doses of it.. These injections are available with doses of 135 and 180 mcg.. I cud get only 135mcg.. Is it ok. Seems that I dont have any side effects also.. I'm also having simvastatin 20mg at night and Nizonide 500mg in the morning..
                  One more doubt, I heard that this HbsAg reduces vitD in the body.. Hope that VitD is the main vitamin sources for better immune system. If Yes then shall I start VitD supplements long with this or shall I wait for some time, Please suggest me bro..
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Avatar_m_tn

try to get pegintf 180mcg, sim 20mg is ok, nizonide must be 1,5g at least so take 500mg pill at breakfast, lunch and dinner

vitd3 5000iu daily and then check your blood levels within 2 weeks, normal range 50-100ng/ml
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Avatar_m_tn

please report results hbsag 13iu/ml should be cleared by 12 to 24 weeks, also check hbsab
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Avatar_m_tn
Hi Bro,
               Please find my latest reports as per the date below.

VitD (25-Hydroxy)  - 12.21ng/ml    (>20ng/ml  Normal) as on 31/01/2013

HBsAg:

32.85 IU/ml (<.05 IU/ml Non-Reactive)  as on 04/02/2013
39.60 IU/ml (<.05 IU/ml Non-Reactive) as on 10/02/2013
35.20 IU/ml (<.05 IU/ml Non-Reactive) as on 16/02/2013
28.24 IU/ml (<.05 IU/ml Non-Reactive) as on 22/02/2013


Lipid Profile as on 15/02/2013

Cholesterol Total 124 mg/dL   Desirable <200 mg/dL
Cholesterol HDL 27 mg/dL (40-60 mg/dL)
Cholesterol LDL 75 mg/dL (85-150 mg/dL)
VLDL 22 mg/dL (7-35 mg/dL)
Triglycerides 122 mg/dL Normal: <150 mg/dL
TC/HDL Ratio 4.6   (3.9 -5.0)



LFT as on 22/02/2013

Bilirubin Total: 0.95 mg/dL  (Cutoff : upto 1.0mg/dL)
Bilirubin Direct : 0.13mg/dL (Cutoff : upto 0.25mg/dL)
Bilirubin Indirect : 0.82mg/dL (Cutoff: 0.25 - 1.0mg/dL)
AST : 60 U/L (Males: upto 37 U/L)
ALT : 116 U/L ( Males upto 40 U/L)
Alkaline phosphatase : 62 U/L (Adults 30 - 120 U/L)
Gamma Glutamyl : 51 U/L (Males: 11 - 50 U/L)
Protein Total : 7.0 g/dL ( Cutoff: 6.4 - 8.3 g/dL)
Albumin : 4.2 g/dL (Cutoff: 3.8 - 4.44 g/dL)
Globulin : 2.8 g/dL ( Cutoff: 2.6 - 3.9 g/dL)
Albumin/globulin Ration: 1.5 (Cutoff: 1,0 - 1.7)
----------------------------------------

LFT as on 13/01/2013



Bilirubin Total: 0.78 mg/dL  (Cutoff : upto 1.0mg/dL)
Bilirubin Direct : 0.36mg/dL (Cutoff : upto 0.25mg/dL)
Bilirubin Indirect : 0.42mg/dL (Cutoff: 0.25 - 1.0mg/dL)
AST : 30 U/L (Males: upto 37 U/L)
ALT : 47 U/L ( Males upto 40 U/L)
Alkaline phosphatase : 58 U/L (Adults 30 - 120 U/L)
Gamma Glutamyl : 40.6 U/L (Males: 11 - 50 U/L)
Protein Total : 7.66 g/dL ( Cutoff: 6.4 - 8.3 g/dL)
Albumin : 4.85 g/dL (Cutoff: 3.8 - 4.44 g/dL)
Globulin : 2.81 g/dL ( Cutoff: 2.6 - 3.9 g/dL)
Albumin/globulin Ration: 1.73 (Cutoff: 1,0 - 1.7)

---------------------------------


For VitD3 I'm consuming Caldikind 60,000 IU twice in a week.
Now my ALT, AST and Gamma Glutamyl Transferase is more than the normal value.. I remember once You said to stop Nizonide500mg and Simvastatin 40mg once my ALT values are 2X than normal.. I think now my ALT values are 2X normal..
So should I stop Nizonide and SImvastatin or shall i continue.. Why has the ALT and AST increase, Is the liver starting to get damage or what ? Please suggest brother because it is really worrying me after seeing LFT values..
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Avatar_m_tn

keep sim and nizonide with peginterferon if you can tollerate them

ast/alt are increasing because we are waking up your immune system which can see the infected ceels now and kill them

it is important to have baseline tests and then tests at 12 and 24 weeks, hbsag may rise at start instead of lowering and then fall at 12 weeks or 24weeks

as to vit d recheck in 4-5 weeks a dose of 120.000iu per week should normalize values by one months, once vit d>50ng/ml you can lower dose to 5000iu daily or 70.000iu weekly
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Avatar_m_tn

please report date you started pegintf and compare test resuts to the weeks of treatment, the most important 12weeks, 24 weeks results

you can sum up the posts like this:
which date did you start pegintf?
hbsag results at 12 weeks and 24weeks?
alt/ast baseline and at 12weeks and 24weeks?
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Avatar_m_tn
Hi Bro,
                Thanks for Your response.. I was witing for Your response.. I started Nizonide 500mg and Simvastatin on 01/01/2013 and my first Peginterferon Dose was on 10/01/2013.. So as per the Peginfr is conserned I have completed my 7th Dose as on 21/02/2013..
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Avatar_m_tn
Very good! Your numbers are low you have a good chance to cure it. Just make sure you are not getting any fake drugs or dirty needles.
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Avatar_m_tn
Hi Bro,
               Thanks and Hope Allah helps me out of this situation.. Insha Allah
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Avatar_f_tn
@jalakmohamed,i am in the same shoes as yours,i was kicked out from UAE after testing hbsag+.that was the first time i heard of hepatitis.we don't do such test in my country and i have never failed hiv,xray,tb,syhillis,and others coz i do those regularly and thought all was well with me until i travelled to uae and got a job and did medical and was sent home. Its so sad,no symptons since i was born and in my 30s now.i am jobless now coz of this ,i find it hard to even go for full lab test coz their is no money.all i am takin now is antiviral herbs .i am just taking them and since i was tested in uae ,i haven't done any test since i got to my country coz no much money,all money is gone on travelling.uptil now,i never fall sick,i still believe this thing will go on its own.i never had fun without protection,no tatoo,no blood tranfusion.since doubtful of what could have caused this.possibly from childhood and didn't notice.i am from nigeria.
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Avatar_m_tn
Hi Bro,
               Can You please explain why my hbsag is increasing. I'm confused

Test Name Cuto OFF Base Line
1st Week 2nd week 3rd week 4th week 5th week 6th week 7th week 8th week
HBsAg : 10 mIU/mL 0.1 0.33
HBeAg : <1.00 S/Co Non Reactive 0.335
Anti HBe: 20 ng/mL 12.21
Cholesterol:
Total Cholesterol <200 mg/dL 124
HDL 40-60 mg/dL 27
LDL 85-150 mg/dL 75
VLDL 7-35 mg/dL 22
Triglycerides Normal < 150 mg/dL 112
TC/HDL Ratio 3.9 - 5.0 4.6
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Avatar_m_tn
Hi Bro,
               Can You please explain why my hbsag is increasing. I'm confused
1st Week 2nd 3rd 4th 5th 6th 7th 8th week
HBsAg :51.15,39.71,37.53,33.43,32.85,39.6,35.2, 28.24,39.84
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Avatar_m_tn
Hi Bro,
can i add gcmaf along with the combo of int+niz500+sim40mg. if yes can you give me the gcmaf brand name in india and where i can get it
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Avatar_f_tn
Hi! Any update on your results?
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Avatar_m_tn
Hi Bro,
Sorry for late update.. As You said I had been in interf, simvastin, Vitd3 and alina for a year.. My interf got completed on 9th Jan 2014... As on Jan my hbsag was 14.75 iu/ml.. After that I was maintaining Simvastin and Vitd3.. Now since 3 weeks my hbsag is 7.71iu/ml.. there is no variation in values.. Please suggest me how to proceed from now...
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Avatar_m_tn
Hi Bro,
Sorry for late update.. As You said I had been in interf, simvastin, Vitd3 and alina for a year.. My interf got completed on 9th Jan 2014... As on Jan my hbsag was 14.75 iu/ml.. After that I was maintaining Simvastin and Vitd3.. Now since 3 weeks my hbsag is 7.71iu/ml.. there is no variation in values.. Please suggest me how to proceed from now...
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Avatar_m_tn
you should not have stopped peginterferon once there is response at 12 or 24 weeks peginterferon must be continued as long as hbsag und and hbsab are formed.
48weeks treatment is an obsolete from the era of hbsag quantification not available and so 48 weeks were used whatever....today personalized treatment requires stop at 24 weeks if there is no hbsag decline and prolonged treatment until hbsag loss

if sides effect are tollerable it is best to restart peginterferon as soon as possible until hbsag und and hbsab>100miu/ml (hbv vaccine can be used to boost hbsab once hbsag is und)

you can also stay off treatment because hbsag<10iu/ml has totally inactive infection and will slowly clear by 3 or 5 years (dont remember which one) in almost 100% cases, but if you had only 48weeks of peg it is best to prolong it because the maximum effect of pegintf on immuen system is right after 48weeks
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Avatar_m_tn

of course keep monitoring hbsag because if you see any rise it is best to go back to peg as soon as possible

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Avatar_m_tn
sorry it is not 100% hbsag loess when hbsag<10iu/ml by 3-5years but very very high probability, some studies report 52% probability at 3 years
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Avatar_m_tn
Hi Bro,
                I was on peg interf for 54 weeks continuous. and now my hbsag is 7iu/ml and the cut off value is .05iu/ml.. You asked me to continue for 48 weeks of interferon therapy and i took for 54 weeks.. I stopped peg in jan2014.. Now I am on vitd5 60000 iu/ml weekly with nizonide 500mg twice a day. and simvastin 20mg daily.. Since 3 weeks Imy hbsag levels are unchanged.. please let me know because i am totally confused
      
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Avatar_m_tn
two choices:

keep monitoring for another 3 months because peginterferon keeps working even after you have finished when hbsag is less than 1000iu/ml at end of therapy.if you see it keeps going down do not start pegintf but if you see a rise of hbsag start peg immediately

start pegintf again for another 42 weeks (total 96weeks), the best response of pegintf is on 96 weeks when patients respond (respond means hbsag decline by 12 or 24 weeks).

what are your current vitd25oh levels?
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Avatar_m_tn
hi,,mmy hbsag 250 iu/ml.lft is normal. hbv dna is less then decattable.mr dr give liv52 hb.only and says it will be clear automatic ,,i am very  confused ,,what can i  do?? help me plz urgent
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Avatar_m_tn
hi i have been infected with Hepatitis-B 6 years back some  2 years am using Lamivir HBV (100 mg)  and am stopped now my liver is enlarged having 18.8 cm and sign of hepatomegaly now again started a bow tbs is it possible to  recover from this
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Avatar_m_tn
lamivudine is not an hbv drug anymore and makes extremely dangerous mutants and resistance

now the only drug for hbv that you can use is tenofovir (antiviral) or peginterferon (immune modulator)
the antivirals are never meant to stop, they only block liver damage and dont cure or clear hbv, so you have to take tenofovir for life unless hbsag becomes negative
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