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Low Incidence of HBeag Seroconversion with nucs in Routine Practice
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Low Incidence of HBeag Seroconversion with nucs in Routine Practice

http://archive.mail-list.com/hbv_research/message/20130116.233638.54354562.en.html
Source

Pacific Health Foundation, San Jose, CA, USA.

Abstract

BACKGROUND/AIM:

Treatment endpoint of therapy for patients with hepatitis B e
antigen-positive (HBeAg) chronic hepatitis B (CHB) includes HBeAg
seroconversion, which ranges 15-22% after 1 year of oral nucleos(t)ides
according to clinical trials. Our goal was to determine the incidence
and predictors of HBeAg seroconversion in such patients in routine
clinical practice, since it may differ than reported rates.

METHODS:

We conducted a retrospective cohort study of 333 consecutive
treatment-naïve HBeAg-positive patients who were treated for CHB between
1/2000 and 6/2010 at 3 gastroenterology and liver clinics in the United
States. Primary study endpoint was HBeAg seroconversion - loss of HBeAg
and antibody to HBeAg (anti-HBe) development.

RESULTS:

The majority of patients were Asian (96%). Median treatment duration
prior to HBeAg seroconversion was 50 (range, 26-52) weeks. Of the 333
study patients, 25% received lamivudine (LAM), 16% adefovir (ADV), 51%
entecavir (ETV) and 8% tenofovir (TDF). HBeAg seroconversion at month 12
was 8.2%. On multivariate analysis inclusive of age, gender and
antiviral agents, independent predictors for HBeAg seroconversion at
month 12 were HBV DNA  1.5 × upper normal limit (HR=2.86 [1.05-7.81], p=0.040), but
not the choice of nucleos(t)ides.

CONCLUSIONS:

The HBeAg seroconversion rate seen in clinical settings for oral
nucleos(t)ides appears much lower than those reported in pivotal trials,
especially in those with lower ALT and higher HBV DNA levels.
HBeAg-positive patients should be counseled about the high possibility
of the long treatment duration required to achieve recommended treatment
endpoints.
22 Comments Post a Comment
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Avatar_m_tn
the intf combo or staggered strategy is a must here
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Avatar_m_tn
Stef ..

Iam under antiviral (baraclude .5 mg) ..
iam male 39 y .. hep b carrier ..

if the pcr is undectable and the alt is aound 30 .. sometimes 26 up to 33 ..

do these two indications (pcr "hbvdna" and alt) mean 100% guarantee .. and the liver will be protected from fibrosis, cirrohisis and hcc?

my close relative he is in last stage of cirrohsis ..also  he has ascite .. his abdomen is very big  .. he knew he has cronic (chronic)  heb b 2 years ago .. now he is 52 y .. in spite he started baraclude .5 mg since he knew the infection.. now he is 3 days in Hepatic encephalopathy .. he is in coma ..

as i undderstood from doctors in the emergency department .. the ammonia in his blood is more than 130 ..
now we are thinking to implant liver .. what is your suggestion?


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Avatar_m_tn
????????

any feedback?
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Avatar_m_tn

that's too advanced stage for liver transplant too, refer to the doctos at the hospital and try to contact hepatitistechnologies to know if they have data and experience of heptech at that late stage

the antiviral with hbvdna und and normal alt is a must but recovery from such stage is very very difficult.
just check that the antiviral is entecavir (baraclude) but no previous exposure to lam, if there was exposure to lam it is best to add on tenofovir when stable (no switch), a resistance to antiviral at cirrhosis stage can be deadly
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Avatar_m_tn

do these two indications (pcr "hbvdna" and alt) mean 100% guarantee .. and the liver will be protected from fibrosis, cirrohisis and hcc?

no, just lowered risk to very low if proper diet and adding sim

i hope transplant is still possible
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Avatar_m_tn
Very sorry to hear about your relative. The prognosis is not good, especially with hepatic coma. Still, he is only 52, he may pull through.
I just want to ask - how long had he been on Entecavir before he was hospitalized?

My best wishes.
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Avatar_m_tn
Thank for your reply ..

unfortunately .. hepatitistechnologies products  are not available in Saudi Arabia .. even if we order it online it will be banned due to too strict law that ban any drug online order ..

"the antiviral with hbvdna und and normal alt is a must" ..
do you know .. stef .. that he is und hbvdna since a year from now .. also alt is 33!! .. i remembered some of your posts that alt is not good indications ..

when he started treatment .. he only used baraclude 0.5 mg .. as naive ..
the baraclude satisfied the goal to make hbvdna zero .. but after liver almost damaged ..





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Avatar_m_tn
"no, just lowered risk to very low if proper diet and adding sim"

can you tell me the daily dosage of sim? what is the commercial name of simvstatin? any side effects on liver or kidnies?
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Avatar_m_tn
Thank you stephen for your reply .. i appreciate your words ..

"I just want to ask - how long had he been on Entecavir before he was hospitalized?"

he was on baraclude 0.5 mg around 20 months ..
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Avatar_m_tn

they even banned vitamins?hepatitistechnologies is actually a diet since it is all derived from food vegetables

if you have no finacial problems you may even move to ucraine for stemcells transplant at emcell,
http://www.emcell.com/

they are the most advanced in the world with more than 10 years experience of therapy, they never banned stemcell transplant while western countries did, my guess is to protect drug makers since stemcell transplant can make so many drug useless

i know about them because two researchers, one from US and one from italy, made human trials for the cure of autism from children from italy and other parts of the world with gcmaf plus stem cell transplant.one of the researchers had himself a stemcell transplant for a bone leg problem
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Avatar_m_tn
http://drbradstreet.org/

i think you may contact him to know about stemcell transplant and outcome in decompensated liver

as to the worsening of the liver just taking an antiviral is not enough when the liver is severely damaged, the repair process is too slow, substances like those in hepatitistechnologies are needed to fasten the repair process or stemcells

decomensated liver experience of stemcell tranplants
http://www.emcell.com/en/list_of_diseases/liver-diseases.htm

you may also inquire about gcmaf there, gcmaf is produced by the liver and when the liver is damaged it goes very very low, gcmaf quantity is correlated to death too, so you may ask dr bradstreet or stemcell researchers if gcmaf can help too

i guess the main problem for your relative is travelling but trying to et info about what i posted is not bad so in case of improvment he may move to ucraine
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Avatar_m_tn

by the way check also how they are treating amonia (ammonia) for coma, the amonia (ammonia) is produced mainly by gut bacteria so the treatment must be done there, i am not expert on this but i guess they use transfusions and antibiotics to lower the bacteria producing amonia (ammonia)
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Avatar_m_tn
So did the patient take treatment when liver is already damaged or he started treatment when everythings ok and still ends up like this?
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Avatar_m_tn
travelling to ucraine is very difficult for so many reasons .. first of all the patient condition ..
thank  you for your reply ..

for the ammonia .. the doctors said they are trying to minimize ammonia by using antibiotics ..

for clarification in my above reply ..the patient alt is 33 .. however this result was in July 2012 .. yesterday the doctor told it is now very very high ..

also platelet 55,000 , wbc 2.2




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Avatar_m_tn
when he started baraclude .5 mg .. his liver was almost damaged .. was in cirrohisis stage .. informed by his son ..

one very expert doctor in my area .. hepatologist .. told him .. when he started baraclude .. you sould make liver transplant immediately .. another bad expert told him to use baraclude ..

the first is true .. the second is liar ..
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Avatar_m_tn

if alt is very high the reason of all this can be baraclude resistance, when liver go decompensated alt is normal most of the time because there are no cells left
ask them hbvdna and if detactable add on tenofovir, if the problem is not resistance to baraclude then there is an immune response to clear infected cells, or a superinfection with another virus, or something making alt elevated besides hbv.very elevated alt with decompensated liver is unusual there must be a cause

as to stemcells transplant that would be the best answer but i d not trust other places rather than emcell
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Avatar_m_tn

a low percentage of patients under antivirals of any type, entecavir and tenofovir included, starts with no liver damage and ends up with liver damage or cirrhosis despite hbvdna und
too bad they just reported this in the trials without studying the cause of this which could be viral mutants or unhealthy diet/fatty liver
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Avatar_m_tn
I think the patient is suffering Acute Hepatitis on Chronic Hepatitis (AHCH), the causes are not exactly clear. He was on Entecavir for 20 months and his hbvdna went undetectable. If you read the research literature carefully, some people on any viral treatment have breakthroughs, viral(hbvdna) or biological(ALT), or both, I am not sure. The reason for these breakthroughs is not stated and it is not drug resistance.
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Avatar_m_tn
hi etef how about my situation is possible to cure or hopless? tnx plz repply
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Avatar_m_tn
Stef, please wheres the easiest site to purchase the HepTech Comprehensive Medical Food Protocol. Registered as a user on their website (https://www.****.com/products/index.php?main_page=product_info&cPath=0&products_id=5) but my profile has been awaiting approval for the longest time. Hence cant even see their prices or purchase. Please advise
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Avatar_m_tn
http://www.advanceliferesearch.com/

you can find the same products here, i guess the problem with heptech is the fact they require prescription now or sell directly to doctors all this because of fda approval.
US fda is such a discredited agency tht it may be better not to have their approval

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Avatar_m_tn
Also please note that the concentration in advancelife research is 50 % less.
I.e. heptech 30 days supply = advancelife 45 days supply.

But if you order not for the US they will most likely sell you heptech products call them by phone and speak to them, they are actually very effective and customeroriented.
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