Aa
Just got my genotype result back...
See photo attached.
Can someone explain what does BCP mutations mean?
Also, is this genotype considered better to treat or more chances to seroconvert?
Where is the origin of D in the world?
Thanks!
Can someone explain what does BCP mutations mean?
Also, is this genotype considered better to treat or more chances to seroconvert?
Where is the origin of D in the world?
Thanks!
A little off subject but USA are ran by lobbyist and corporations. They fill the pockets of politicians with campaign funding. It is a known fact that whoever spends the most money on political campaigns win the presidency 95% of the time in the USA
I will ask my doctor about this and someone on this forum told me i think it was luckyman that qhbsag actually get populated by the lab but they are not allowed to give the result to doctors or patients
I doubt whether qHBsAg assay requires FDA approval
yes the whole things is extremely strange, i dont think FDA can choose what blood tests can be done or not, there are many research level tests like nagalase that can be made in US although they just draw blood and ship to europe for testing.
all labs can easily do this too shipping where they want for testing and a doctor pres for hbsag quant should be normal to do if the doctor thinks it is needed, i guess they are free to do what they think best for the patient
why would FDA hold them back?
i think it is for the max profit of gilead from tdf, etv should now be out of the game since patent was not valid in US and BMS lost the trial
yes the whole things is extremely strange, i dont think FDA can choose what blood tests can be done or not, there are many research level tests like nagalase that can be made in US although they just draw blood and ship to europe for testing.
all labs can easily do this too shipping where they want for testing and a doctor pres for hbsag quant should be normal to do if the doctor thinks it is needed, i guess they are free to do what they think best for the patient
why would FDA hold them back?
i think it is for the max profit of gilead from tdf, etv should now be out of the game since patent was not valid in US and BMS lost the trial
Roach and Abbott are hardly small companies, why would FDA hold them back? I doubt whether qHBsAg assay requires FDA approval.
if you look at the horror stories about FDA you d not be so surprised, check the 15 doctors killed in few weeks in US....after fda raids in their clinic, the fact these agencies work for other entities is becoming extremely clear and scary
Thank you both for the clarifications.
Hard to believe it is a FDA issue, since it is only a blood test, reputed to be cheaper than hbvdna assay, and it has been available for so many years in Europe and elsewhere.
Hard to believe it is a FDA issue, since it is only a blood test, reputed to be cheaper than hbvdna assay, and it has been available for so many years in Europe and elsewhere.
Stephen, dr lok when i told her about my qhbsag result last year she noted that and she didn't disregard it. However she told me that fda for some reason they dont't want to approve qhbsag and we have to work without it but she wouldnt be unhappy if i do it in germany
I dont know about studies, as the way he told me was from personal patients. Also, in the US there are mostly HCV, which I have heard sides seem worse for them. I wonder if US doctors relate Interferon HCV sides to HBV, even though they are clearly different.
I do not have an issue with Interferon, I am just reiterating what I have been told by specialists here. Believe me, if I could find out what my Ag quant is I would push harder for it if mine was not super high.
I have a great repect for those of you that are trying it, knowing your Ag quant, and wish you much luck!
I do not have an issue with Interferon, I am just reiterating what I have been told by specialists here. Believe me, if I could find out what my Ag quant is I would push harder for it if mine was not super high.
I have a great repect for those of you that are trying it, knowing your Ag quant, and wish you much luck!
I am aware Dr. Gish has been advocating for quant HbsAg, I was referring to Interferon only. Sorry if there was confusion.
It is about the cost-benefit analysis (in addition to some countries being corrupt) in which we are trapped sadly, like many others with different diseases.
When they go ahead and make guidelines, what they do is create guidelines according to the cost-benefit analysis. They off course do take into account population health in general but this is put in the larger picture of the "cost-benefit" analysis. They create the guidelines which are not obligatory per say, but which large majority of doctors follow, guidelines which are not benefiting the patients to the fullest but benefit them to the extent which is not too expensive for the government.
The guidelines are created for the 2 reasons:
1) to guide doctors how to treat the patients with the certain disease,
2) to guide treatments to be cost-effective.
The large majority of doctors in the highly medical legislated countries such as USA follow the guidelines even if they don't sometimes agree with them,
as by following guidelines they are protected. If they don't follow the guidelines and something goes wrong (like for example someone develops a major side on interferon) then they could be in troubles. So for them going off the guidelines is a risky behaviour. However, the doc from the Mayo clinic is a good doc, one with morals. He is aware of those risks, but yet after explaining the patient possible risks (and documenting his explanation and his stance on it - to protect himself to some extent), he still is going to treat the patient as it would be advisable to treat her (because he would treat himself the same way if he would be in the same position).
For example:
"HBV carriers at high risk for HCC such as Asian men over 40 years and Asian women over 50 years of age, persons with cirrhosis, persons with a family his- tory of HCC, Africans over 20 years of age, and any carrier over 40 years with persistent or intermittent ALT elevation and/or high HBV DNA level >2,000 IU/mL should be screened with US examination every 6-12 months."
AASLD Guidelines
They wrote this guideline like all others in line with "their" "cost-benefit" analysis. According to this guideline most of us would never be screened, and many lives would be wasted.
Same with all other guidelines...
When they go ahead and make guidelines, what they do is create guidelines according to the cost-benefit analysis. They off course do take into account population health in general but this is put in the larger picture of the "cost-benefit" analysis. They create the guidelines which are not obligatory per say, but which large majority of doctors follow, guidelines which are not benefiting the patients to the fullest but benefit them to the extent which is not too expensive for the government.
The guidelines are created for the 2 reasons:
1) to guide doctors how to treat the patients with the certain disease,
2) to guide treatments to be cost-effective.
The large majority of doctors in the highly medical legislated countries such as USA follow the guidelines even if they don't sometimes agree with them,
as by following guidelines they are protected. If they don't follow the guidelines and something goes wrong (like for example someone develops a major side on interferon) then they could be in troubles. So for them going off the guidelines is a risky behaviour. However, the doc from the Mayo clinic is a good doc, one with morals. He is aware of those risks, but yet after explaining the patient possible risks (and documenting his explanation and his stance on it - to protect himself to some extent), he still is going to treat the patient as it would be advisable to treat her (because he would treat himself the same way if he would be in the same position).
For example:
"HBV carriers at high risk for HCC such as Asian men over 40 years and Asian women over 50 years of age, persons with cirrhosis, persons with a family his- tory of HCC, Africans over 20 years of age, and any carrier over 40 years with persistent or intermittent ALT elevation and/or high HBV DNA level >2,000 IU/mL should be screened with US examination every 6-12 months."
AASLD Guidelines
They wrote this guideline like all others in line with "their" "cost-benefit" analysis. According to this guideline most of us would never be screened, and many lives would be wasted.
Same with all other guidelines...
I am not defending the unavailability of qHBsAg assay in the USA.
I read some of Dr Gish's lectures on HBV. He is certainly very aware and in favor of knowing a patient's qHBsAg because most of his Chinese patients know their qHBsAg. Gish is also the consultant to Arrowhead(ARC520) and the objective of ARC520 is to reduce qHBsAg through RNAi.
Dr Anna Lok is also a very hands on researcher. She would most certainly be aware of qHBsAg. Have a look at the following clinical trial:
https://clinicaltrials.gov/ct2/show/NCT01263587
"To verify whether a baseline HBsAg below 1,000 IU/mL and HBV DNA below 1,000 IU/mL is an accurate predictor of people who are, or who will become, inactive carriers, defined as people who are HBsAg positive, hepatitis B "e" antigen (HBeAg) negative, have normal Alanine transaminase (ALT) and HBV DNA under 1,000 IU/mL on at least two occasions over a period of at least 6 months"
United States, Michigan
University of Michigan Health System Recruiting
Ann Arbor, Michigan, United States, 48109
Contact: Anna Lok, MD 734-936-7511 ***@****
I also read here that someone claimed that they do not do qualitative HBsAg in the USA anymore, the result is actually based on qHBsAg?!
Finally, a doctor wrote sometime ago that qHBsAg is not yet ready for prime time. So maybe the US doctors consider the evidence for the use of qHBsAg to start, stop Interferon treatment is not yet strong enough to be standard clinical practice?
I read some of Dr Gish's lectures on HBV. He is certainly very aware and in favor of knowing a patient's qHBsAg because most of his Chinese patients know their qHBsAg. Gish is also the consultant to Arrowhead(ARC520) and the objective of ARC520 is to reduce qHBsAg through RNAi.
Dr Anna Lok is also a very hands on researcher. She would most certainly be aware of qHBsAg. Have a look at the following clinical trial:
https://clinicaltrials.gov/ct2/show/NCT01263587
"To verify whether a baseline HBsAg below 1,000 IU/mL and HBV DNA below 1,000 IU/mL is an accurate predictor of people who are, or who will become, inactive carriers, defined as people who are HBsAg positive, hepatitis B "e" antigen (HBeAg) negative, have normal Alanine transaminase (ALT) and HBV DNA under 1,000 IU/mL on at least two occasions over a period of at least 6 months"
United States, Michigan
University of Michigan Health System Recruiting
Ann Arbor, Michigan, United States, 48109
Contact: Anna Lok, MD 734-936-7511 ***@****
I also read here that someone claimed that they do not do qualitative HBsAg in the USA anymore, the result is actually based on qHBsAg?!
Finally, a doctor wrote sometime ago that qHBsAg is not yet ready for prime time. So maybe the US doctors consider the evidence for the use of qHBsAg to start, stop Interferon treatment is not yet strong enough to be standard clinical practice?
"He said most go on SSDI (disability insurance) before INF because they cannot work or after the INF has long lasting immunological effects after that changes their lives." - can he provide any studies about it ?
it probably works this way, you patient take what we think is good for you, dont try to get cured unless it is what we want....
dr are monitored and when they do something the system does not like little problems appear so that they are advised where they re going
dr are monitored and when they do something the system does not like little problems appear so that they are advised where they re going
Good point. You have to live in the US to understand. I have asked 4 Hepatologists (one being at Mayo, one that works with Dr. Gish who is another highly World renowned Hepatologist, a past Hepatologist, and one GI doc who treat HBV). The only one who said that I "maybe could talk him into it" was the doctor at Mayo but he made it very clear it was not recommended by him. He said most go on SSDI (disability insurance) before INF because they cannot work or after the INF has long lasting immunological effects after that changes their lives. He also said he feels with my labs I could have a 30% chance to clear (sounds ok to me!), but without HbsAg quant it is pointless to push at this point.
Also, the US has to have a Doc prescribe medication and then whatever your insurance company is has to approve the medication, since INF is a specialty medication which requires a prior authorization for coverage. Without insurance coverage it would be super expensive here.
So, Mike's doctor is in line with any other doctor I've met. They go off DNA. I too would go to as many doctors as I could if I were Mike and knew my Ag quant was that low, but just letting you know the background here.
Also, the US has to have a Doc prescribe medication and then whatever your insurance company is has to approve the medication, since INF is a specialty medication which requires a prior authorization for coverage. Without insurance coverage it would be super expensive here.
So, Mike's doctor is in line with any other doctor I've met. They go off DNA. I too would go to as many doctors as I could if I were Mike and knew my Ag quant was that low, but just letting you know the background here.
If I would be in your position I would find a doc that would give me peginf, as your hbsag is very low (unless you have some clear contraindication for taking it). It might be the case that your famous doc who wrote US Hep B guidelines doesn't want to break her own guidelines by treating you (she also can't take into consideration hbsag quant test because it is against her own guidelines).
Yeah, will keep trying and see how my body responds.
you have greater chance of clearing it. Have you been on entacavir or tdf ?
how long it has been since you got infected..
you have greater chance of clearing it. Have you been on entacavir or tdf ?
how long it has been since you got infected..
thx, I hope you cane make it bellow 1000 IU...that would reduce your hep b disease significantly
What i know is that genotype D are the hardest to respond so goodluck. Im also genotype D with porential to start on peginf soon as my hbsag is 147
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