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Interferon treatment, shall I continue?
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Interferon treatment, shall I continue?

I have hepatitis B, and my doctor recommended interferon treatment. The treatment started in Aug. 2012, and it is now 23 weeks.
Before the treatment, my test result:
HBsAg 3000 IU
HBeAg neg
HBeAb pos
HBV DNA 3*10(3) copies
ALAT 70
Liver biopcy showed light fibrosis and mild inflammation

After 12 weeks treatment, HBV DNA declined to 4*10(2) copies, HBsAg was the same as before the treatment, but ALAT increased to 300. The doctor monitored ALAT more frequently.
After 23 weeks treatment, ALAT increased to 900. The doctor suggested to stop the treatment to avoid possible liver damage.

Shall I continue with the interferon treatment? Shall I start with the tablet?
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Avatar_m_tn

alt is dangerous only in cirrhotic liver (compensated) and alt over 1000, in this case decompensation can happen....i ve had 6months of alt 1500 and no liver damage in my life, exactly at 18-19yo

i suggest:
keep intf because with alt 1000 seroconversion is almost certain
recheck hbsag, with elevated alt it goes down
add staggered tnf to bring down hbvdna and alt instead of stopping intf altogether

in case of problems with liver function: lowering of plts, high bilirubin, abnormal pt and so on you can stop intf and start tdf and restrat intf when everything is ok

just google staggered use of intf+nucs and hbsag clearance, there are several clinical reports on this
10 Comments Post a Comment
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Avatar_m_tn

alt is dangerous only in cirrhotic liver (compensated) and alt over 1000, in this case decompensation can happen....i ve had 6months of alt 1500 and no liver damage in my life, exactly at 18-19yo

i suggest:
keep intf because with alt 1000 seroconversion is almost certain
recheck hbsag, with elevated alt it goes down
add staggered tnf to bring down hbvdna and alt instead of stopping intf altogether

in case of problems with liver function: lowering of plts, high bilirubin, abnormal pt and so on you can stop intf and start tdf and restrat intf when everything is ok

just google staggered use of intf+nucs and hbsag clearance, there are several clinical reports on this
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Avatar_m_tn

a very expert doctor is able to manage your situation, my guess is your doctor may not be very experienced since these flares are not uncommon on intf seroconverters, only bad liver function may justify to stop it like this

discuss the tdf add on or staggered tdf/intf to bring everything normal
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Avatar_m_tn
Thank you very much! I will bring your answer to my doctor, and I think you are right basing on what I have read.
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Avatar_m_tn
stef2011 kindly recommended you to me.
Could you please give me some suggestions about my situation,
especially about if it is dangerous to continue interferon without adding/staggering the tablet?
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Avatar_m_tn
Your situation requires careful management by a hepatologist. He will have to analyze your state of fibrosis and current liver function. While it is possible that your high ALT is a symptom related to clearance of infected cells, it could also be a reflection of a generally increased state of more unspecific liver inflammation, without the benefit of selective clearance. The speed of progression of fibrosis is individually quite different. Fibroscan followups would be higly useful. In the end it will be a question of if you are willing to take the risk.
Stefano had very high ALTs for a long time, it did not lead to clearance, but rather to cirrhosis over time, so be careful.
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Avatar_m_tn
Thank you very much for your advice! I will take the advice from both of you to my doctor.
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Avatar_m_tn
Could you further explain the probability of the two possibilities? I mean which is more often to see, the good one (clearance of viral) or the bad one (unspecific inflammation) in such a situation?

Here is more information about the change of ALT:
beginning of treatment: 70
12 weeks: 500
14 weeks: 500
16 weeks: 700
18 weeks: 700
20 weeks: 700
23 weeks: 900

The blilirubin is always normal
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Avatar_m_tn

try to get hbsag quant to understand if clearance has started or at least lowering of alt, since you started with light fibrosis i guess it is f1 so you may be able to go thru it as studyforhope said with close monitoring

if you see your doctor is not experienced with this it is best to stop intf and start tenofovir until alt gets little lower then resume in 1-2 months if fibroscan is below 7-8kpa
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Avatar_m_tn

sorry typed alt by mistake....
try to get hbsag quant to understand if clearance has started or at least it is lowering
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Avatar_m_tn
IFN induced hepatitis flares should lead to surface antigen clearance in about 15% of cases. Many e antigen neg HBV patients have repeated spontaneous or IFN induced flares without final clearance, mainly due to immune escape mutants that wiil remain and restart the hepatitis. Only surface antigen blockage with replicor type medications will break through that limitation, since the reserve epitopes in the surface antigen protein will be activated in that scenario.
Measuring the surface antigen now will give you a hint if specific clearance is happening. If it is lower by at least 30% then there should be a chance.
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