My current Lab results

I was diagnosed with Hepatitis B since I was 13 years old (I'm 24 now). Started with Lamivudine when I was 17.
Then I moved to the U.S., and found a liver specialist and did a comprehensive blood panel to evaluate my current state of Hep B. My doctor told me that the virus mutated, and resisted to Lamivudine. My HBV DNA at that time was 24 million copies. I also did a liver biopsy, and that came up with a stage 2 (I think I was told there were some visible scar on my liver)

Started treatment with Truvada 2 years ago, got undetectable HBV DNA within 5 months. Also, my abdominal ultrasound came normal. AST, ALT, AFP, CBC in range.

My recent labs came up as follow:
These labs were done outside of the U.S.

July 2nd, 2010
Creatinin 1.19 (0.6 - 1.4 mg/100mL)
GGT 25.0 (3 - 35 U/L)
AST 35.5 (6 - 25 U/L) ********
ALT 30.9 (3 - 30 U/L) ********
AFP 3.7 (<20 ng/mL)
HBV DNA undetectable
FibroScan F0 (normal)
Abdominal Ultrasound (normal)

July 26, 2010
Creatinin 88.9 (62 - 120 umol/L)
AST 34 (5 - 37 U/L)
ALT 64 (5 - 40 U/L)
CBC normal range
ultrasound normal


July 28, 2010
Creatinin/Serum 1.00 (0.6 - 1.40 mg/100mL)
Glucose (FBS) 5.23 (3.9 - 6.1 mmol/L)
Triglycerides 1.51 (0.5 - 2.30 mmol/L)
GGT 29.0 (3 - 35 U/L)
Cholesterol,Total 4.03 (3.4 - 5.4 mmol/L)
AST 44.0 (6 -25 U/L) ********
ALT 68.4 (3 - 30 U/L) ********
AFP 3.30 (<20 ng/mL)
CEA 1.16 (<5ng/mL)
C.A 19-9 (Advia Centaur) 12.21 (<37 U/mL)

I noticed there is an increase in my AST & ALT. Everything else stays normal. I wonder why? I did consume some alcohol in early July, but then not anymore.

[stef2011]

do check hbvdna with very sensitive assay to 1-10iu/ml range. pcr realtime with detection 1-20iu/ml qualitative and <20iu/ml quantitative or taqman realtime quantitative to 3iu/ml

you never reached alt lower than 30 (which are the real nomral levels)?
is your diest healthy and alcool consum almost zero?
do you make gym a lot?
hbe pos or neg?

i'd suggest to add nitazoxanide to your regimen since active on lamR too and if hbe neg you might get hbsag very low or neg

[stef2011]

forgot to say in your situation do not miss any dose absolutely ever since lamR and these abnorml alt that might mean not enough suppression of hbvdna in the liver although und in blood, i write the dates on the blisters to make sure i never miss any dose

if you really have no source split the pills by half to cover those 2 days but again i d make sure not to miss any dose and in case i d buy tenofovir even if single to use those two days

[az12345]

it has been Hbe pos, and we are watching it turn Hbe negative every lab result, but it don't.

I did PCR realtime in the U.S. and it came back undetectable ever since.

I'm kinda think my diet is not healthy enough, and I do go to gym frequently.

I attended a wedding in July and was forced to drink some alcohols. I guess this might be why alt is increasing. My alcohol consumption is almost zero ever since I know I'm positive with Hep B.

Is there anything wrong with my liver? ALT was in the low middle 20 before July.

Because all other tests came back as normal, so I'm wondering what is happening?

[stef2011]

it has been Hbe pos, and we are watching it turn Hbe negative every lab result, but it don't.

try ntz since it has no sides and see if hbeag decreases faster (see other posts for the 1.5-2g doses how to)

interferon would be the best in combo with truvada but there are no trils on this combo although it has already been used successfully on hbv+hdv coinfection, plus interferon canhave many sides better try ntz first since no sides

I did PCR realtime in the U.S. and it came back undetectable ever since.
you should check sensitivity,1-5iu/ml is more safe


I'm kinda think my diet is not healthy enough, and I do go to gym frequently.
you should avoid fat and meat, keep fat diet only if you think to try ntz
excess gym canmake alt/ast higher especially ast which did 1 time in your tests

I attended a wedding in July.....
that's no problem if only one time and it gets cleared immediately if only 1 occasion

Is there anything wrong with my liver? ALT was in the low middle 20 before July.
well in this case you have to check everything that has changed, what is your bmi?bmi>25 have higher alt and can make fat liver disease

blueberries 153gr daily lower alt of 23% especially on fat liver disease or unhealthy diets

just to be ultrasafe:
recheck hbvdna with most sensitive assay in your area
recheck hbeag if still decreasing as usual
check hbcab Igm, it must be lower than 0.08s/co for 100% inactive, this is more sensitive than hbvdna and rise before hbvdna and alt on resistance breakthrough

[stef2011]

ntz in theory (we have no in vivo data, only vitro) should prevent resistance especially if it makes you hbe neg since active on adv and lam mutants

from the little trials data we have hbe positive on ntz monotherpy turned hbe negative in 3 months, 1.5 or 2g ntz dose is the best, 1g is not effective on most

[az12345]

my bmi should be less than 25, around 20 i think...

Couldn't really find a PCR test that sensitive in my area, I believe the cut off value is 100 IU/L... I guess since they all focus on Hep C.

I will double check with my doctor, and hopefully my ast/alt will be lower. I will also stop lifting weight when going to the gym, only mild exercise.

[az12345]

are you suspecting a resistance may be developing in my case? I thought tdf + emtricitabine is really safe...

[stef2011]

yes it is and resistance is very difficult to develop (your doc made the best choice combo for you) but in theory there is no data on lamR respose durability so better always double check although 99% gym/diet can be the cause

in any case consider ntz because truvada only lowers replication but doesn t have any effect for virus eradication and achieving hbe neg is very important because hbe has a very strong effect lowering immune response and inducing immune tollerance

[az12345]

Thanks stefano.

Could you also suggest a healthy diet for my liver?

Should I talk to my doctor about Alinia? Since you said it's off label, I might think she's not willing to let me try it.

Also, should I use generic Alinia or brand name? And where should I get it? (online Canadian pharmacy?) I'm looking for a more affordable solution. I'm in the US

[az12345]

One more question,

Is 100 IU per L sensitive enough? Because you were talking about 1-5 IU per mL, so when I convert it, it should be sensitive enough, don't you think so?

[stef2011]

Is 100 IU per L sensitive enough? absolutely useless, resistance happend even when und with sensitivity <12iu/ml so imagine with 100

best way to monitor most sens in order:
cccdn in blood, only very updated labs or research center (found one in hong kong and my research hospital)
hbcab igm quantity inactive hbv when <0.2s/co grey zone, <0.08s/co inactive
hbvdna sens 1-5iu/ml

[stef2011]

Could you also suggest a healthy diet for my liver?
what i said earlier, low fat and low meat, fresh food as much as possible

Should I talk to my doctor about Alinia?
almost useless since off label too much responsability for a doctor, a member found a doc in florida who prescribe it (actually also romark is in florida their studies are at standfor univ)

use lupn nizonide500 from canadian certified pharmacies, if you get pres you might get it from US distirbutors.romark is too expensive 1 month 2g daily is about 3000usd