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My feedback on Entecavir +Interferon combo
I live in France. End of 2004 (I was 37) I discovered that I had chronic hepatitis B when my doctor saw a suspect ALT flare and asked for an additional blood test.
These are the results I had in January 2005:
Transaminases: AST: 95 UI/l, ALT: 216 UI/l
HBsAg +, HBcAb +, HBsAb -, HBeAg +, HBeAb -
ADN VHB: > 35000000 IU/mL
Liver biopsy result: A1F1

In February 2005 I started taking Hepsera.
Transaminases lowered to normal values in July 2005. HBV DNA values also lowered.
Phosphorus went down due to Hepsera.

In December 2005 the HBV DNA started to raise again showing that Hepsera was no more useful. My doctor added Lamivudine (Zeffix) on top of Hepsera.

In June 2008 the HBV DNA became undetectable. My doctor decided to move to Entecavir (Baraclude) 1mg.

In September 2009 I had HBe seroconversion: HBeAb +, HBeAg -

In September 2011 HBsAg was 4087 UI/mL. HBV DNA was always undetectable.

In September 2012 my doctor convinced me to add interferon (Pegasys) on top of Entecavir (even if I was really afraid by the possible side effects). After three months (Week 12) of entecavir + interferon combo the HBsAg was around 700 UI/mL (I don't have here the precise figure). After six monts (Week 24) HBsAg was 39 UI/mL.

My next blood test will be end of May.
I have some side effects due to interferon and sometimes I feel very tired. Neutrophils are very low (once they went down to 600/mm3). But the results I had until now convinced me to continue my weekly injections (even if I don't like at all to do injections all alone).






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You are right stef missed reading between the lines for CSi-B-vac sold only in isreal according to the info in:

http://www.chemrar.ru/eng/i-news/index.php?ELEMENT_ID=14012


Oh the good news i work in brasil and according to bellow they have Zadaxin in brazil the only issue is 2 shots every week and i can t have the shots while on the ship so in my case it will be 8 shots in the month i am home. The other issue is if i buy them in brasil and tempreture to be at for this 02 to 08 c and it takes me 24 hrs to get home would they be ok out of fridge for this period.
Zadaxin location in the world:

http://www.sciclone.com/product-portfolio/zadaxin/

The other good news that the lab i am using still have my blood to perform HBSag quant so i should have the result next tuesday unfortunately not enough blood in there to be sent to france for genotype have to wait till 17 august.
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Intersting stef observe the finding in the link bellow. If you remember i mentionned if jessner and kanof has anything to do with hep b. my feeling was right. While they were doing trials in isreal for Sci-b-vac 10 persons taking the shots develop systemic lupus erythematosus.
Jessner & kanof  is a dermal variant or form of lupus cutaneous. This latter since 2005 was imparing my imune system by attaking body cells and tissue resulting in inflamation that weekened my hbs ab resulting in hbv positive with low figures.

http://www.tasmc.org.il/sites/en/Research/Clinical-Trials/Pages/clinical-research-center.aspx

http://connection.ebscohost.com/c/reports/57467154/jessner-kanof-disease-induced-by-leflunomide-dermal-variant-cutaneous-lupus
  

http://bmctoday.net/practicaldermatology/2012/02/article.asp?f=lupus-erythematosus-tumidus-vs-jessners-lymphocytic-infiltrate-of-the-skin

what you think stef

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Stef more findings which makes you wonder which one happen first Hep b or c or jessner and kanof / lupus. Look at this statement bellow.

http://*****.****************.com/showthread.php/8999-lupus-hep-c

So in my case that jessner and kanof symtoms came back on 1 st july i am so keen to get of the ship and have my blood tested against hep b and i have a feeling that will be neg this time TBC on the 17 august.

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Also Stef knowing that i have jessner and kanof and the Sci-b-Vac trial resulted on having 10 people developing systemic lupus erythematosus i will just cancel my trip to Isreal to have this shot done and instead i will get the other vaccine b. Do you agree with this decision after the findings above?
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Hi Im from the Philippines, also had a chronic hbv, are the medicine you've discussing here in the forum are available worldwide? if so, how much you've spending in those medicines? hope to get response from you guys.
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Hi stef i rcvd an email from med help stating we are not allowed to put any links which i didn t know but now i know. So here is one of the statement :
In 1996 I was finally diagnosed with Lupus erythematosus, and It took years to diagnose it. I did have a second opinion from a prominent doctor in NYC. The medications I was taking got me so sick. the last and worse was Methotrexate. I gave myself a FDA pharmacy medication break and actually I felt better for a little while.
Five years ago my lab work said I had Hep C. Since then I have had many blood test and a couple of major surgeries. Hep C was gone from the diagnosis and the Lupus diagnosis was back. Two years ago I had to have four vertebrae fused. I have degenative disk disease. I walk with a cane and I'm usually in pain. I accept what I have and just deal with. I always had jobs that required physical strength and stamina. I'm not angry but occasionally sad that I cant do the things that I enjoyed.
I recently divorced and relocated with my children. I'm under a lot of stress. I have not been feeling well. I have sudden flare ups, my skin, joints and muscles are exploding in pain, my vision is sometimes blurred, I have ringing in my ears, my hair is thinning a lot, my fingers on my right hand is tingling and I have an uncommon skin rash lately even for Lupus. I have a new symptom my head is shaking. So...I started with a new rhumatologist. A full Blood test (non fasting) was immediately taken and Hep C came up as positive but Lupus was gone. The doctor feels definitively that I have Hep C and nothing else!. He told me that depression and stress cause pain. I know they exasperate pain, but I'm not a hypochondriac nor am I hysterical woman. I am going for another blood test tomorrow to confirm the Hep C result. This doctor does not have the best personality but I will finish with the testing he requested.
Could it be possible that Hep C masked itself and gave false / positive reading? If so, why was I treated by the other rhumatologist with methotrexate for so many years? Can anyone shed some light on this situation? I'm only 51 and sometimes I just want to be gone from this world and the pain. But I have responsibilities, children and a very demanding parrot that needs my care, ill work this out.
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Stef any answers to my questions above.more findings which makes you wonder which one happen first Hep b or c or jessner and kanof / lupus. Look at this statement obove.

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it is best you post to hcv community this is hbv

hcvrna is needed to confirm hcv infection, which is fully and easily curable
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You miss understood me stef i am HCV negative. this is for the HBV guys i might be the only one having both HBV and jessner and kanof. i was only making the comparison between the exemple or case above stating HCV while having Lupus. on soflab case my case i am having HBV and jessner and kanof king of familly of lupus. and both sikness have to do with imune system HBV T cell and lupus B cell mulfunction so my primary understanding to this when a T cell is missing one of its element that was stolen from B cell HBV occurs and jessner and kanof vanished for 2 years. I will be confirming this once i have my blood tested on the 18th of august and since this jessner and kanof is present on my skin that means to me that B cell got weakened by T cell stealing B cell element so i should be HBV negative to be confirmed on the 18th of august test. if both HBV positive and Jessner and kanof are present after the next test i will understand B & T cells disorder  meaning to double check if i have auto-imune disease.
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oh come on, never think of going from this world. one day all our pain and suffering will be treated by god.  be optimistic and you should be, after all there is good progress in research is going on. not the best but we will have good treatment options in next 5 years. enjoy whatever we have thats the key.
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Newtr the obove words are not mine from a sick female living on the state i was only searching the net and found the obove statement to compare it with my case to see if there is any connections betwn hep b and lupus since my self i have both hep be and jesner & kanof family of lupus. I am always optemistic and never let hep b nor lupus take my smile away and beleive in god who helped me clear prostate infection after 5 years of suffering at the age of 25 to 30 while the all medicine and medical interventions failed and with simple herbs from a herbist cured my infection with god s will so i am so trained on how to deal with any kind of sickness since.
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very encouraging.
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A few weeks ago I received the results of my blood test at week 48 (I made the test in August but I see my doctor only every three months now, so I receive the results very late).

HbsAg is still positive but very near to the threshold: 0.09 iu/ml (was 2.25 three months before).
I had good news for HbsAb: 40 miu/ml (was 6 three months before). So HbsAb is positive now.

Neutrophils and platelets are still low. ALT level is normal, it never increased with intf.

I'm still taking entecavir, according to my doctor I can stop it six months after the HbsAg clearance. I hope that I'll be able to start the countdown with the results of the blood test I've just made. I'll have the results in February. I could call the hospital to have the results earlier but I prefer having my doctor in front of me reading the results. So I'll wait.

I stopped intf in August and I'm very happy because I'm slowly finding again my previous energy, even if I did not suffer so many issues with it (but I was really stressed making my shots each friday).

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did you check your vitd levels during pegintf?did you supplement? and are they optimum ranges now 60-80ng/ml?
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very happy to see that the combo etv or tdf plus peg is clearing or near clearing hbsag for many of us even with the high hbsag ranges baseline
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Amazing how rapid and fast the hbsag drop can be when you have it in thousands and how long it takes to clear when titer falls to very low, say below 10 iu/ml. I hope you have cleared  hbv by now already.
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You will be rid of HBSaG in 6 month or less.  The positive antihbs will get rid of the hbSag in time.  Thank you for sharing your treatment story.  it is quite useful to all of us.  
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Thank you for sharing your experience. I hope you will get HBsAg clearance in 1-2 months.

What is your fibrosis level and HAI before and after treatment ?

My fibrosis is 3/4, HAI is 11/18 and DNA is 559 million. Is there any person similar to my situation in your trial group?

P.S. I started Enteavir 0.5mg 1 week ago.
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I only checked vitd once, in August 2012 (before starting interferon). It was 29.4 ng/ml. I never supplemented it, my doctor being skeptical about it. But anyway I have a small deficit (vitd should be higher than 30 ng/ml) so it would be wiser to start taking it. I'll read the related posts in the forum to have more information on vitd, unless you have a suggestion on the most suitable dosage.
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Thanks SafiSifa.
My fibrosis level was Metavir A1F1 in February 2005, before starting the treatment. When I made a fibroscan last year my liver was in very good shape, the doctor said that I have a "foie de bébé" (a baby's liver).
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yes you started with normal vitd levels and those levels are correlated with response to peg (levels less than 15-20ng/ml are danagerous for non response)

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I stopped intf in August and I'm very happy because I'm slowly finding again my previous energy, even if I did not suffer so many issues with it (but I was really stressed making my shots each friday).

If anyone is not stressed about making their shots each week, then you are not human.

I am happy to see a success story. Anytime HbsAb appear, then it is a success. Although how do you get neutrophils and platelets up.
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what is you current situation? I mean hbsag, hbv dan, alt etc.
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you finished one year PEG already?  what was your dna after treatment?  did you manage to do hbsag level?
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No, that was a quote from paris2013.

I am on week 20. Viral Load Undetectable at week 12. Still have not measure HbsAg.

ALT has risen to 184 on last visit 3 weeks ago. GGT was up as well to 64. Platelets and neutrophils still low. Fatigue and lack of energy as per usual with all on IFN.







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Hello everybody, I'm sorry for this long period of silence.
I don't have good news to share. As you remember, after 48 weeks of interferon + entecavir combo I ended up with positive HbsAb and HbsAg still positive but very near to the threshold: 0.09 iu/ml (I quote from my earlier post). That was in August, last year. That's when I stopped interferon as foreseen in the trial where I had been included.
Stopping interferon didn't bring any good to me. HbsAb became negative and HbsAg started to increase (now they are around 300 iu/ml).
That's a big deception. My feeling is that being in a trial is somehow good because your health is constantly checked. But it means also having some constraints like no therapy adjustement. My doctor could not clearly say it to me but I think he wanted a different therapy for me with respect to the one foreseen by the trial. At that time he told me about a "no-nuc" therapy where patients with very low HbsAg level (like me) must stop taking nucleoside treatment and see if thay can heal after an ALT flare. That seemed incredible to me. Anyway he was tied to the therapy foreseen by the trail so I continued taking entecavir only.
Now I suppose that HbsAb will raise up to my previous value when I started the itf+etv combo, i.e. 3000 iu/ml.
I asked my doctor if I should start again taking interferon, he said that it will be useless because it seems it has no permanent effect on me, according to the  results of my blood tests.
So for the moment I go on taking entecavir only. But I still think that I missed a very good opportunity to heal. I still ask myself: is my doctor wrong and did I stop interferon too soon?
I also had some news about the results of the peg+antiviral combo trial. In my hospital 64 people have been included in the trial. Among them 6 people cleared HbsAg. At the same time in another group of 64 people taking antiviral only (no peg) they had 1 case of HbsAg clearance. These are disappointing results according to my doctor. But I don't know the HbsAg levels of the participants before taking the peg+antiviral combo. Maybe HbsAg was high like in my case. So this is not in contraddiction with different results saying that the combo works well when HbsAg level is low.
By the way, is anybody aware of this "no-nuc" therapy?
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Very sad and disappointing news! But could you share what was your anti-hbs titer when you stopped interferon treatment? Did you boost it with vaccine?According to your doctor will entecavir be able to hold your hbsag around 300 iu/ml as it is now without further increase?
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At week 48 when I stopped interferon HbsAb was 40 miu/ml.
I did not boost it with vaccine.
According to my doctor entecavir alone will not be able to hold HbsAg as it is now (300 iu/ml), he thinks that it will go as high as it was before starting interferon.
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I would like to help you with advice but frankly have no idea on what is best for you now.

Maybe studyforhope can join discussion and give some advice?

maybe starting interferon would be best for her even doing it against her doctor?
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I would like to help you with advice but frankly have no idea on what is best for you now.

Maybe studyforhope can join discussion and give some advice?

maybe starting interferon again would be best for her even doing it against her doctor?
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I don't think you should be too disappointed. The effect of PegIFN has a very long tail, so the benefit may come later.
Can you please check your message:"Now I suppose that HbsAb will raise up to my previous value when I started the itf+etv combo, i.e. 3000 iu/ml. "
Is there a typo?
I think the "no nuc" referred to observations by doctors that after prolonged treatment with NUC and achieving undetectable hbvdna, some patients who stopped NUC had a ALT flare and then managed to clear HBsAg. There is an on-going clinical trial to test this:
http://clinicaltrials.gov/show/NCT01320943

So I don't think it is a therapy that will work for everyone.

Thank you for letting us know the results of your trial. We await details that may identify which candidates (those with low baseline HBsAg?) can achieve a cure using PEG + NUC.


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is it right that you continued taking entecavir after stopping interferon on w48?
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bonjour
désolé pour c nvlls  vraiment c est etrange ,j ai croyez  qu une  fois les anti corps  apparaissent , c est bon ,puisque le system immunitaire a connue le virus et commence a lutté contre
vous etes en qu elle region de France?
mo aussi j ai l hepatite b et je crois que je vais bientôt entamé un traitement
bonne chance

  Hello
sorry for the bad news it is really strange, I have believed  that once the anti bodies appear,  the immune system is known the virus and begins fought against
you are in wich area of ​​France ?   I have the hepatitis b too and I think I'll soon start a  treatment
good luck
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i think the wrong in your case was stopping pegintf before complete hbsag clearance and stable hbsab, and this is a clear rule of hbsag guided therapy of hbv.of course being in a trial is very bad because you cannot adjust or add.the biggest mistake is also stopping pegintf at 48weeks and all studies showed that maxium effect of pegintf on immune system is between 48weeks and 96weeks (not less and not more).in mono peg 48weeks has about 7-10% of clearance while 96weeks goes up to 20-30%

anyway these are my suggestions and maybe studyforhope can add more:
keep etv now and monitor hbsag, you should not go to more than 1000iu/ml because there is immune control at these low levels

keep an eye on your vitamin d levels and keep them at 90-100ng/ml

restart peginterferon in 6-12 months according to your willing and sides had during peg

to avoid relapse it is mandatory to get hbsag und and hbsab to high stable levels like 250miu/ml, as suggested by studyforhope when hbsag is undetectable there are still millions of it in the circulation so high hbsab needed

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the other good thing is that by restarting pegintf you will get hbsag undetectable for sure.i dont know if waiting or restarting as soon as possible can make a difference on results maybe studyforhope has an answer on this
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as to the stopping all therapies now i think it is risky because you may clear or relapse badly both hbsag and hbvdna, in the second case all the years of nucs making hbsag lower and immune control are lost/wasted
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Hello Stephen, yes, there is a typo. I wrote HbsAb instead of HbsAg.
HbsAg were at 3500 iu/ml when I started the combo trial.
Thanks for the link on the no-nuc clinical trial, I will check it. Your statement on the ALT flare corresponds exactly to what my doctor said.
About the results of the combo trial, the information I have is that people who had HBsAg clearance had also experienced a previous HBe seroconversion before starting the trial. I suppose that also having a low baseline HBsAg is an important factor, my doctor being surprised by the result I had (only until week 48, unfortunately...) starting from 3500 iu/ml.
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Hello Stef, thanks for these explanations. At the hospital they also said that HBsAg must be kept lower than 1000 iu/ml. But it is increasing fast: at week#48 (when I stopped interferon) I had 0.09 iu/ml; then at week#60 it was around 6 iu/ml; at week#72 it was 30 iu/ml; finally the last results I had (week#84) was 300 iu/ml. Sorry, I don't have exact figures, results are just communicated orally to me.
Anyway I try to concentrate on the good news: peg-interferon seems to work well for me. So I'm ready to start it again if necessary, also considering that I didn't have heavy side effects.
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Hello Andrey, yes, I continued taking entecavir after stopping interferon.
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if no relevant sides go for it again or change doctor, the response when hbsag is so low are very very high

i understand that if sides are severe it is not possible to keep it for more than 48weeks but in your case the only side can be expense if peg is not free

dont worry about the rise if it is less than 500-1000iu/ml the virus has very little strength
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Your situation is unfortunately not untypical.
Restarting ifn now might bring you a more permanent control of HBV remnants in the end, possibly depending on the length of ifn therapy.
While the immunological reasons behind these different outcomes are basically known, it is currently impossible to analyze this in an individual patient.  Availability of effective TCell epitopes combined with presence and proper activation of TCell clones is the true reason behind success or eventual failure of ifn mediated immune activation, a complex battle with numerous critical parameters.

In my opinion, the svr rates will increase once frequent vaccinations with an HBV core containing vaccine will be added in the phase of low virion presence (UND DNA LEVELS). This will add the missing stimulus to increase TCell recruitment in the periphery.
At this time such a core vaccine is in development in cooperation between Cuba and a french company, but availability is possibly far out.

Using available hbsag vaccines in the phase of low hbsag to boost hbsAB levels is likely only marginally effective. It must be understood, that even a high AB level is never completely protective against localized reinfection in close proximity of an infected liver cell. The core vaccine will hopefully trigger Tcells that attack the slowly growing clusters of reinfected cells in that situation, leading to a permanent control of the remnants.
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What a complicated head screwing disease we have. I just pray one day we can have a cure and not need to wrap our heads around what is trying to eat us from the inside outwards.
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never mined hbsag will be over.
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Are you taking any supplements like Vit D3? What's your D level in your blood?

I really think your immune system must be tip top, pre, during and after IFN. D3 levels must be at least 50ng/ml pre-IFN treatment.

Even with the boost of IFN (which is integral), your own diet and vitamins intake (selenium, D3 and zinc) must be consistent.

However, having said that, you are a responder to IFN. Just need another oomps! to get that HBsAb up high. Vit D3 supplements might just be the ticket. I was lucky to have my HBsAb going up every month from 55 (when it first appeared) to over 200 and now over 300.




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No, I'm not taking any supplements. Two years ago Vit D was 29.4 ng/ml. According to your post this is too low. But my doctor once said that Vit D has no influence on VHB (and it's difficult to insist with him and he stopped the discussion). I'll try to discuss about it with my family doctor, to have a Vit D blood test.
Up to now I've taken entecavir during my breakfast. Reading old posts I saw that I should take it two hours before / after the meals. So I'll delay my breakfast to see if I'll be able to stop the HBsAg increase.
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i d change doctor too many obvious very wrong things said

just have vitamin d test in the lab, what's the doctor to do with having the test?

entecavir cannot be taken with meals, didn t doctor advise on this?extremely negligent doctor again
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it is dangerous to take etv with meals because absorption is low and this might induce resistance overtime,anyway you should be safe on this

the best possible thing would be:
start 10.000iu of vit d daily, this is a normal dose and half what healthy people can do in an hour of sun exposure.no tests required with this dose but i d choose a good lab and have the test.

vitd can be bought on uk online stores,bigvits uk is very cheap and fast delivery

entecavir 1mg or tenofovir or keep entecavir and start peginterferon as soon as possible
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again as an italian worldwide known good hbv research said:
most liver specialists are stupid and just follow guidelines with no knowledge of the disease

many french doctors are killers because many patients died on hcv trials.i admire the courage of this man for saying the truth at a conference

so trust liver specialists only when you see they said correct things about latest research and when they are not arrogant, they are there to cure you and not for themselves pleasure.switch to another one if they dont fit this
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Here is good presentation on hbsag kinetics after stopping nucs or intf (see page 18). Doctor is from Germany. Hope this helps.

http://www.aphc.info/pdf/2014/Luncheons_13012014/S-251/Jorg_PETERSEN.pdf
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You should still take regular Vit D3 as a general health, just 1,000iu a day (which is standard) can push up your levels.

Yeah, I was on ETV for nearly 2 years. I take them 1 to 2 hrs before breakfast. Someone here said taking them after dinner, when you are going to bed. So all these time you have been taking ETV with food? Not sure why you have to do that but the Dr and Nurses should point that out clearly when prescribing and also the Pharmacist should also point that out.

Yes, you can check your D3 levels with a family Dr. Most likely it has decline because I realised now that this vitamin is so deficient in many people that don't take supplements. When I was on ETV, my levels was 20ng/ml and I don't take any supplements. In 3 months before IFN (after reading it here from Stef - thank you Stef), I pushed it up to 51ng/ml by taking 5,000 to 10,000 iu daily.





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