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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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Avatar universal
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.
Helpful - 0
Avatar universal
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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Avatar universal
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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Avatar universal
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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Avatar universal
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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Avatar universal
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
Helpful - 0
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