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Is any treatmene needed? hbs+ hbe+ dna+
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Is any treatmene needed? hbs+ hbe+ dna+

Hi everyone,

first of all I’d like to  introduce myself to this community: I’m 23 years old, male – Italian (so sorry for my poor English)!!!

I’ve been having HBV since my birth (my mother is a Hbsag+ carrier) but I’m very healthy and I’ve never had digestion problem or anything else. I’m used to have a bier (0.4) during the weekend twice a month and I’m not a smoker nor a drinker.

Here is my current situation:
Hbsag + / Hbeag + / HBVDNA >100.000.000

These values never changed from my birth. Transaminasis have been always in the range ALT sometimes during the last 2 years reached up to 74 (range 0-55), AST and GGT have been always ok.

I had a liver biopsy in 2007. Everything was good, they found F1 (Metavir) but doctors said there’s nothing to be worried about. I had also ultrasound test once a year and no liver damages were detected.

I saw my doctors in May and they forewarned they would treat the disease despite the values are not so high. The suggestible drug should be Peg-IFN (up to now I do not know if in mono or combo mode).

I was pushing on antiviral treatment but they told I’m so young and I should not take drugs which I may continue to take for my whole life.

Why was I pushing on AV? I’m really scared about IFN side effects, I move every month out of Europe for job and I’m not sure I’ll manage to do it again if I’ll take it!

What do you think? Am I in the immune-tolerance or immune clearance stage?
Should I be treated? May I seroconvert the eAG without drugs, I read it may take up to 3-4 decades? Should I wait some years again and then evaluate what to do?

When you convert the eag form positive to negative do the VL be low for the rest of the life or it can also flare up again?

In case I went for IFN and it didn’t work, would I have another possibility of cure? I’m also scared about disease flares during treatment..
What about if the same happened with Antiviral?

Is there anyone who can share experiences with IFN side effect and job activity? Is there a relation between my age and such effect (may I easily tolerate them?)

As you see I’ve a lot of question which are running around in my mind… I’d be very pleased if somebody answers me or cans share his experience…

Ciao ciao from Italy  
Tags: hbe, job, side, birth
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44 Comments Post a Comment
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Avatar_m_tn
When your ALT is elevated, you may be in immune clearance stage and treatment may be appropriate.  Are you Caucasian?  If you are and you are young, it makes a lot of sense to choose IFN treatment if you can handle the side effects for 12 months or so: 1. you may be cured once and all; 2. there is no issue with resistance; 3. you still have antiviral drug treatments as options when needed.  If you read Chinese or have friends who read Chinese, there are many experience sharing treads about using IFN at hbvhbv.com.

>>>May I seroconvert the eAG without drugs

Some carriers do, some don't.

>>>When you convert the eag form positive to negative do the VL be low for the rest of the life or it can also flare up again?

Some carriers do, some don't.

>>>In case I went for IFN and it didn’t work, would I have another possibility of cure?

Yes.

Best.

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Avatar_m_tn
Yes I’m white Caucasian male 23 years old.
Do you really think it would make sense to go for IFN? What about side effects? I noted there are some of them which I cannot cope with my job activity (I’m an international traveler – I move once a month to Us , Australia or Singapore…) and with the fuse…
Do you think young guys handle the side effects in an easier way? I read that a lot of non-responder carrier are part of the ones who have the hBS+ since their births… is that right?

Many thanks for the link.. unfortunately I do not understand Chinese….

Ciao
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Avatar_m_tn
The best responder to IFN is Caucasian, genotype A, elevated ALT, relative low DNA.

Of the above, you have most.

Some doctors may think your VL are high for IFN and you may wait for treatment.

Both IFN and antiviral treatments have cure % less than 50%.

>>>What about side effects?

It was for the same concerns that I was unable to choose IFN.

>>>Do you think young guys handle the side effects in an easier way?

I am not sure.

>>>I read that a lot of non-responder carrier are part of the ones who have the hBS+ since their births… is that right?

I read it had more to do with genotypes and the simple fact that both treatments now have low cure ratio.

Best.
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Avatar_m_tn
Why do you say my genotype is A? I thought there were just 2 types: eag+ and eag-.. was I wrong?
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Avatar_f_tn
All carriers start out e-antigen+.  The e-antigen is a protein that attaches itself to the virus and makes the virus stronger.  Your genotype is an entirely different thing.  At this time I believe they have identified 5 main genotypes: A, B, C, D, E.  Those are broken down further in sub-genotypes.

Genotyping isn't necessarily that important right now.  As we learn more about them, they may be.

If I were you I would read Anna Lok's discussion on "Who to Treat and When" from earlier this year.  Maybe Cajim has it or just google it.
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Avatar_m_tn
Anna Lok's discussion on "Who to Treat and When" is somewhere in here:

http://www.medhelp.org/posts/show/492008
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Avatar_m_tn
thank you all for support...so do you believe I'm suitable for a pegIFN treatment?  
Could The side effectsmake me able to work during 48weeks?
I'm a  concerned about it... Do you think I may also wait some years to see if I'll seroconvert to eag-?

As you see I'm pretty young and have a lot of life projects.. family job...adno wouldn't lije they might be compromiese for this...

Hope you'll understand me... thx
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Avatar_m_tn
>>>Could The side effectsmake me able to work during 48weeks?

I can't comment from experience.  From what I read, the worst side effects were in the beginning, then the side effects were still present but less.

>>>so do you believe I'm suitable for a pegIFN treatment?

This is a treatment with a time limit.  You receive the treatment and there is an end point.

Best.
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Avatar_m_tn
many thanks jim for your prompt reply... so would the end point be the eag conversion? what if it did not work? would my hepB become worst?
what is the percentage of succesfull outcomes for patients like me?
further are there any side effects concerning the fecoundation? would i and  my wife be able to have a healthy baby after the treatment?

thx a lot

ciao
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Avatar_m_tn
>>>so would the end point be the eag conversion?

For IFN, the end is 6 months or 12 months whatever the length of the treatment course.

>>>what if it did not work?

You still have antiviral drugs available.

>>>would my hepB become worst?

Usually no.

>>>what is the percentage of succesfull outcomes for patients like me?

Best I have read is about 37%.

>>>further are there any side effects concerning the fecoundation?

Not sure.

>>>would i and  my wife be able to have a healthy baby after the treatment?

Many people do.  You need the doctor follow you when the time comes.

Best.
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Avatar_m_tn
Thx again..

I read from the pegIFN brochure taht teh max period of time is currently 48 weeks...
are you saying that if you seroconvert within 6 months then the meds would be stopped?

May i have troubles even  months or years after the tretament in having babies?

37% is a rather low percentage.. do you think this meds are worth?

are you on IFN or antivrials? can you share a few of your experience?

thx again for you availablity....

what's the weather like there in CA??? here in Italy it's a hot sunny afternoon ;)


ciao
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422881_tn?1257607179
I know it must be a hard decision whether to try PegIFN or not, but it can be the most effective treatment and should give you your best chance.

I have HBV and HCV. To treat HCV I did not have an option and had to use Peg IFN so my choice was basically made for me. If I had ONLY had HBV….I can’t really say what decision I would have made.

I have been on Peg IFN for 20 weeks now. The first 2 shots were there worst  but have gotten better over the course of my tx. My side effects have been moderate but I’m not sure how much of it I can blame on the anti-viral pills that I have to take for HCV. I can tell you that after 4 weeks on Peg IFN, my HBV DNA was Undetected and my ALT was back to normal in about 2 months.

IFN side effects vary from person to person. Some people don’t have any side effects or very minimal side effects. Usually the people that don’t have any problems with side effects are not on the message boards looking for help and support with symptoms so you will tend to see a lot of posts about the negative side effects. The only way to know how you will personally react to the IFN is to try it. If the side effects are bad, then you could consider switching to an oral med if needed.

There may be some information you might find helpful in the post about my tx:
http://www.medhelp.org/posts/show/564902

Best of luck in whatever you decide.
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Avatar_m_tn
>>>are you saying that if you seroconvert within 6 months then the meds would be stopped?

I have read treatments of 6 months also.

>>>May i have troubles even  months or years after the tretament in having babies?

I have not heard of that.  Some antiviral drugs yes.

>>>are you on IFN or antivrials? can you share a few of your experience?

I am about to start Baraclude, not IFN due to the fact that I have to drive to work which the side effects do not allow.

>>>what's the weather like there in CA???

Foggy now.

Best.

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Avatar_m_tn
Many thanks, NashPred.

Your sharing is really what grmr needs and we learn from it too.

Best.
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Avatar_m_tn
Thank you NashPred thank you cajim

NashPred:

thanks for the link. I’ve just taken a look to that thread. In my opinion some for your side effecter may be due also to Riba pills.. I’ve also read that Pegasys side effects are lower in patients HBV+ than in people with HCV+. Your UND HBV DNA after 4 weeks med I think it’s great result!

But is there anyone who can say how long have it to remain UND after the treatment end to say you gain the recovery?
How were your first two shoots? What kind of effects did you experienced? When do you usually take your shoots? Are you able to have a normal life style on treatment?

I’m in your same opinion about message boards and forum to which people needing supports and help usually take part.

Cajim:

I drive to  work every day .. it usually take me about 20min … and I’ve never heard about side effects for driving activities…. What about you?

Thank you all guys. CIAO from ITALY
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Avatar_m_tn
and.. I'd like to obtain another info.. how can i detect my GT?

I'm HBs+ Hbe+ DNA+ since my birth..

thx
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Avatar_m_tn
GT?
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422881_tn?1257607179
The side effects of my first 2 shots were a fever of 103 (you may need to convert that to Celsius), Headaches, nausea, and feeling like I had the flu. It lasted for 1 or 2 days and then I started feeling better as the week went on until time to take the next shot. Shots 3 and 4 were a lot better. After the first 4 shots, I stopped feeling any different after I took one… except for some irritability for a day or so.

I take my shots on Tuesday nights but I would NOT suggest that day. Most people take their shots on Friday night so they can rest and recover from any possible side effects over the weekend and feel better for work on Monday.

As far as ME living a normal lifestyle, I had a side effect they call “Brain Fog” for the first couple of months. Brain Fog makes it hard to concentrate and things seemed like a dream. Driving was a strange experience and when I got to where I was going I couldn’t really remember much about the drive and wondered how I made it sometimes. Just typing this reply would have taken me hours. The Brain Fog did go away and I don’t really think it was due to the IFN. I think this was caused by the HCV Ribavirin pills I have to take and not the IFN. I don't have any problem driving now.

If you were to have any side effects, they usually get better as time goes on and if you work a physical type of job, they may be harder to handle and they should be easier to handle if you work in an office.

Again I want to stress that many people don’t have side effects that are as bad as what you see on message boards. I don’t want to scare you away from trying this tx and I’m not trying to talk you into it either. You will never know unless you try it.

I think that I read so much about the negative side effects that I actually convinced myself that I was going to have some of them too, and so I ended up having them. I now have a different outlook on things and try to only think positive thoughts. I believe a positive attitude can have a lot to do with it.

BTW…I don’t know what part of Italy you are in…but I went to Rome 2 years ago. Beautiful city.
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422881_tn?1257607179
Your GT (Genotype) can be determined by a blood test.

If you are Caucasian and in Europe, you are probably GT “A “ and should be one of the better responders to tx.
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422881_tn?1257607179
Cajim,

Glad to help. I have been helped so much by everyone on this board and I try to help when I can but I'm still learning too.

Diagnosed at the end of last year and now only 5 months into tx it has been a continuous education.

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Avatar_m_tn
Got my laste labs made on August:
ALT: 84 (0-55)
HBVDNA: >100.000.000
despite this I'm felling very good.

What do you think about? Is now the right time to start IFN or may I am on immuno clearance phase and become eag - by myself?


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Avatar_m_tn
From what I read, a good time to start IFN is elevated ALT and low DNA.

Not sure.  Better ask your doctor.
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Avatar_m_tn
I read the same too... so what should be the best route now?
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Avatar_m_tn
It could be just monitoring.  Ask doc.
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Avatar_m_tn
I'll ask him for sure next month. I've been monitoring since 18 yo.. (5 years ago) and e -status has not changed yet..

Do all the hbv carriers start eag + and then it th e antibodies light up? .. I mean.. is it just a matter of time?

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422881_tn?1257607179
I’m pretty sure everyone does start as eAg positive and it can take decades to convert to eAb. I think that certain medications can help you to reach eAg Neg and eAb Pos status faster than you would on your own.

I’m not sure if it is ALWAYS just a matter of time before you convert or not.
I could use some clarification on this myself.
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181575_tn?1250202386
It the traditional sense, yes, you start off as eAg positive.  It's the wild-type (kind of like, the virus left alone in the wild to do its thing) strain that releases the eAntigen on viral replication.  And if you infected with the wild-type, then it usually takes its course, and for some they get the mutation (PC, BCP) at seroconversion.

But what's interesting is that there are newer and more variations to HBV now.  For example, those with PC, BCP, and antiviral resistance strains.  So let's say, someone with eAntigen - disease that turns out to have a PC mutation.  This person infects someone, that new infected person will be surface antigen positive but are they eAntigen - to begin with ?  They could be but we need a HR type person to confirm that.  So I think as they are more variations, it could get more confusing in the future.  
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Avatar_m_tn
PC? BCP? what do you mean by this?
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181575_tn?1250202386
PC = Precore
BCP = Core Promoter

These are the common (BCP are more common) HBV mutant strains that could escape during the seroconversion process and lead to eAntigen - disease.
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Avatar_m_tn
Hi everyone,

i’ve just met doctors who had suggested me some months ago a pegIFN tx and this morning they was on that same opinion… I told them about sx which can be very difficult to match with my job.. and I also did ask for antivirals, especially entecavir and tenofovir.

They would not suggest antivirals tx at this time, i’m 23 years old,  due to resistance that may rise during thay period.. the only solutions they proposed are pegIFN or just keep on monitoring every 3 months for 5 years.. then have a biopsy and evaluate what to do afer it.
In this light I assume my liver does not need an immediate tx therefore I keep on wondering why they were hardly pushing on it..

Anyway they did propose me to take part to a sperimentation with the aim yo evaluate results in patients taking Entecavir monotx or combo tx ETV + TFV (tenofovir). I just have to put my sign on the docuemnts they gave me and then the trial should start and last 100 weeks approx…at that time I’ll know if I will be taking mono or combo tx..

Now I’m a bit concernded about this… what if antivirals did not work? Would I still have the chance to go for IFN? What may happen when I’ll stop taking them… would my HBV become stronegr than now?

I keep on hoping that I’ll gain the E seroconversion by myself…

I’m very confused…

Your comments are needed and greatly appreciated..
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422881_tn?1257607179
I really don’t know as much about when is the best time to start tx as others on this forum do. I have only known about my HBV for less than a year so I don’t really feel qualified to give much advice other than my own personal experiences.

As far as Peg IFN goes, there are no resistance issues with this drug so it will always be an option. Also, if you read the post by Peteshine titled “No Questions”, he says that he really didn’t feel many side effects from Peg IFN mono-therapy. You may not have any side effects either but unfortunately you can never be sure unless you try it because everyone reacts differently to Peg. (Zelly, what does your magic 8 ball say? Lol)

TDV and ETV both have excellent resistant profiles so far, so if you were to get into the trial study, you would be in good hands whether or not you got mono or combo therapy (unless there is a control arm of the study were both pills are placebos) However, as your Dr said, these drugs don’t have a long history either so there may be some resistance issues develop as the drugs get a longer history of use.

It sounds like you are in good health now, so if you were to continue to monitor, you may very well convert your “e” antigen on your own and/or better drugs may come along by the time you need to tx.

I wish I could help more with your decision to tx or not to tx. Others may be able to give you a better idea about that decision.

Best of luck and keep us posted.
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181575_tn?1250202386
So to recap:

You are 23 year old, chronic HepB, eAntigen +, and high DNA  in the hundred millions, normal ALT until recently with one or two snapshot in the 70s.

You are very likely still in the immuno-tolerant stage, or very very early immuno-clearance stage.  I would chart the ALTs closely, like every 2-3 months (for about year) before treatment.  If ALTs (trend) goes back down to in range and stays that way, I would hold off on treatment.  If it goes back and forth from in range to the 70s or higher, I would treat.  I would treat either with combo, TDF and ETV.  Or INF to reach a low DNA, then mono with TDF or ETV.  The goal is to lower DNA to UND as quickly as possible to minimize risk to antiviral resistance.  Important since the eSeroconversion process could take years and for some they may need treatment for life.  I wish you good discussions with your doctor.  
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Avatar_m_tn
Is the e serocneversione a step which has to be done by all hbv carreirs? I mean: is everyoen starting eag+ and then becomes eag- eab+ with or without tx?
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Avatar_m_tn
.. my last "in range" ALT was detectec in September 2007 - 45 (0-55) and from thah date it' soncitnously increasing... I've been monitoring it evry months.this is the trend..
45 - 59 -62- 64- 68- 69- 71- 72- 73-84.... immunoclearance????
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181575_tn?1250202386
I answered your other post earlier:

It the traditional sense, yes, you start off as eAg positive.  It's the wild-type (kind of like, the virus left alone in the wild to do its thing) strain that releases the eAntigen on viral replication.  And if you infected with the wild-type, then it usually takes its course, and for some they get the mutation (PC, BCP) at seroconversion.

It looks at your immune system is starting to recongize the virus and is in very early immuno-clearance phase.  This could take years and you could stay eAntigen + for years with high DNA, which puts you at a higher risk for developing antiviral resistance.  It's very important to drop the DNA quickly if you decide to treat.  

So my thought is still the same.  I would treat either with combo, TDF and ETV.  Or INF to reach a low DNA, then mono with TDF or ETV.  The goal is to lower DNA to UND as quickly as possible to minimize risk to antiviral resistance.  By doing this, you may speed up the seroconversion process (hopefully).  So talk to your doctor...good luck.  And come back and keep us informed.
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Avatar_m_tn
would you treat righ now?
I'm a bit worried about the fatc that they'd put me on a trial combo tx etv+tfv.. and if I developed resistance (this may be likely due to my high hbvdna...right?) I would no longer go for this kind of antivirals for the rest of my life...In any case I'd prefer to avoid ifn.. do you have any experience on it??? especially about sx? are you still on av? thx in advance your help is highly appreciated
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Avatar_m_tn
hi all.. had a phone chat this afternoon with dr...she was still pushing me on IFN or just monitoring for other 5/6 years... she did not suggest me AV (etv and tfv) at this stage.. I'm pretty young and I may develop resistance to them if i stay on AV for a long time...this is her opinion.

she stated that I may also naturally seroconvert (anti hbeag +) without any drugs..

She explained me also thath it's very difficuly to stop AV and to do it you have to shift to IFN for a few time before stopoing those drugs... what do you think about this statement?...

Steven.. please share with me your experince on ETV.. what about you eag status? how is it currently?

many thanks in advance to you all
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181575_tn?1250202386
Now keep in mind, since you ask, this is my lay opinion.

No, I won't treat now if I were you.  Especially if you don't want to do INF.  For antiviral, you may need years and perhaps lifetime of treatment.  And I have no experience with INF.  I had experience with ADV mono, ADV and ETV combo, and currently on TDF and ETV combo now.  I tolerated all antiviral treatment well.  Don't feel any sides.  I start treating at 31 with good evidence of the immunoclearance stage.  And in reviewing my labs, this phase could have started 7-8 years ago.  My doctor think I bordering close to the eSeroconversion, so it made sense to treat.  But I am still eAntigen + and eAntibody -   So it could take time.  And knowing what I know how, I wouldn't have let my doctor started me on ADV mono.  So if you do decide to treat, fight to get combo treatment.  For more info on why combo, see this thread:

http://www.medhelp.org/posts/show/632664?personal_page_id=7068
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Avatar_m_tn
met dcs yesterday.. since my liver is still in good condition i'll just have to keep monitoring my alt and have a biopsy in 4/5 years.. at that time we'll have also more data about etv or tfv resistance issues... let's hope.. thx all you guys
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422881_tn?1257607179
Maybe you can convert you "e" antigen by then and not have to worry about meds. Let's hope. I'll keep my fingers crossed for you.

BTW...I've been off of Ribavirin for 1 week now. Only on Pegasys mono-therapy and already feeling alot better. So it's starting to look like a lot of my sx were  from the HCV pills. Just wanted to let you know incase you consider Pegasys tx again in the future.

Best of luck and keep us posted as to your progress.

Take care of yourself and your liver.
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Avatar_m_tn
I hope to conert it since my mum didi the same in the past.. I'm happy to realize that many sx are riba's fault.. please keep me informed about your tfv experience...
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Avatar_n_tn
hi i santosh lamani went for medical check up i found HCV postive any treatment
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Avatar_m_tn
ciao sono italiano come te, ho 40 anni ed anch io avevo l'hbv dalla nascita ed avevo una buona risposta immunitaria che teneva il dna negativo (il cosi detto erroneamente portatore sano).
consiglio di non fare nessun trattamento perche sei ancora nella fase immuno tollerante e non hai praticamente nessuna risposta immunitaria e anche se l'interferone la attiva questo significhera un inizio di danno al fegato elevato se il virus non viene sopresso totalmente (danno ora assente proprio perche non hai risposta immunitaria), per cui se il danno al fegato non è piu di f2 o fibroscan 9-10 non interverrei.Gli antivirali li escluderei assolutamente perche con un dna cosi alto solo il combo entecavir-tenofovir riesce a ridurlo e ce poi l incognita mutazioni dovendo fare il trattamento a vita.
io sto facendo l entecavir da un mese perche ormai avevo troppo danno al fegato e a 40anni il sistema immunitario ormai non bloccava piu il dna.
piuttosto qui in italia possiamo aiutarci nel senso di trovare qualche medico o centro ospedaliero che faccia la combinazione entecavir+tenofovir che è in sperimentazione con termine 2012 per cui la tendenza dei medici e di aspettare ad avere il quadro di questa sperimentazione pero la mutazione del virus è molto piu pericolosa perche gia si sa che i possibili danni ai reni sono solo nel 1% circa di chi ha solo hbv (senza hiv) e reversibili, mentre una mutazione virale mette a rischio la vita, segui anche i post di HR che è un ricercatore che ha sviluppato questi antivirali e che ha suggerito questa combinazione perche non ci sono nuovi antivirali in arrivo per molto molto tempo e chi sviluppa mutazioni si trovera senza scampo.
un altro consiglio è di fare il fibroscan ogni sei mesi perche io dal 2002 al 2009 ho sviluppato cirrosi con transaminasi quasi normali e basso dna perche il medico diceva che tanto ci volevano 5-10 anni per far danno, per cui meglio non fidarsi troppo ed esagerare coi controlli
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Avatar_m_tn
e chi sviluppa mutazioni si trovera senza scampo
ovviamente questa mia affermazione abbastanza pesante si riferisce al trattamento a vita perche una volta che ce anche una sola resistenza questa preddispone a una resistenza anche con tutti gli altri antivirali nel giro di un paio d'anni.
al momento solo il tenofovir sembra non dare resistenza e solo la combinazione tenofovir+entecavir porta quasi a zero le possibilita di resistenza

oggi mentre facevo le analisi ho sentito di un conoscente di un amica che facendo antivirali da piu di 10anni ora ha il virus mutato e dna a bilioni resistente a tutto e fegato in cirrosi terminale, ed in questo caso neanche il trapianto (se glielo fanno) da soluzioni perche il nuovo fegato verrebbe distrutto in breve tempo dal virus, per nostra fortuna oggi sappiamo che con terapia combinata questo non succede e le giuste scelte di oggi ci potranno salvare la vita un domani
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