Need advice on starting the treatment

[Windflow420]

I am 57 years old and have had Hepa B since birth. I only used some Chinese medicine when ALT/AST elevated - it's been normal in recent years. I have never used antiviral drug before.
Just recently I am loosing weight and having very hard time to sleep at night. That is why I visited doctor's office and had my blood panel test done last week. Just got the results back today. Here are abnormal ones (everything else are normal):
RBC - 4.07 Mil/mcl (<4.3)
Hgb - 13.1 gm/dl (<13.4)
Hct - 38.1% (26)
Platelet - 114 K/mcl (110)
BUN - 6 mg/dL (<7)
Hep B DNA PCR - 4.51 LogIU/mL
Hep B DNA interp - Detected
Hep B DNA - IU/mL - 32200 IU/mL
I will have my MRI done next week

I will revisit my doctor in two weeks and start the antiviral drug treatment. Problem is my doctor here has never treated Hepa B patient before (he only has Hepa C patients). I guess he will just follow the guidelines. I believe we have experts & doctors here who are much better & knowledgeable. Please jump in and give me some advice as regarding to how to proceed with my treatment:
1. Any more test needs to be ordered?
   I know I need to check "Intact Parathormone" and "Vitd25oh" for Vit D3 deficiency based on my reading here
   I probably need to do the "Fibroscan", but I am not sure if I really needed - I am sure I have some degree of fibrosis - the result may not impact on my treatment option
   Do I also need to check HBe(c,s)Ag, anti-HBe(c,s)?
2. What antiviral drug should I use? I think it is between Tenofovir and Entecavir. Which one is better choice for me?
3. What should I do when taking the antiviral drug?
4. Any supplement, food, or diet I should pay attention to?
   I am currently taking Vit B12, just started Vit D3 (10,000 iu daily) and Selenium (200 mcg daily). I eat pretty health, I think (lots of raw juices and very little meat)
  Two supplement I am thinking to add are Vit k2 (Menaquinone-7) and Glutathione based on reading here

Please help. Any suggestion is greatly appreciated!

[Windflow420]

Thank you very much, mustthink.

[mustthinkpositive]

By looking at your HBV DNA, I am pretty sure you are HBeAg negative and HBeAB positive. Get that checked out regardless.

Fibroscan should be checked out because you will most likely get into a raw alkalise diet if you learn you are F2 or F3. Stef can guide you on how to reverse fibrosis. Starting Vit D3 daily is a start, selenium and gluthathione is also good. TDF should be the starting treatment.

You probably need to increase your intake of leafy greens such as spinach, eat more dark chocolate, and add cashew and pumpkin seeds, exercise daily and take Vit B supplements.

[Windflow420]

Perfect. I will talk to my doctor to start the treatment with Tenofovir in two weeks. Wish me good luck.

[StephenCastlecrag]

I think you heard it wrong, both drugs are almost 100% effective in HbeAg negative patients.

[Windflow420]

Thank you again, Stephen.
Yes, I do have my liver panel results. I test it once a year. They are all in the normal range, but fluctuated a little (for example, last time was 48/34, and this time is 27/23). I am not aware of having any kidney, diabetes, and fatty liver issues.
One question on taking drug - I heard the drug is about 70% successful to suppressing the virus. What happens if it is not effective to me? Let say if I take Tenofovir, and become 30% unlucky one. What should I do then?

[StephenCastlecrag]

I don't know whether you have done a liver function panel, so it is difficult to comment. Personally I think you should test your HBeag status and get a Fibroscan as they will provide you with a useful baseline record.

Tenofovir and Entecavir are both recommended front line drugs. In a recent meta-analysis, researchers conclude: "For HBeAg-positive patients tenofovir is the most effective at increasing efficacy, whereas for HBeAg-negative patients, either tenofovir or entecavir is most effective." If you have kidney issue, you may like to consult your doctor regarding taking Tenofovir.

Being 57, make sure any diabetes and fatty liver issues are being dealt with, otherwise lead a healthy life style like we are all supposed to do, whatever it is.

[Windflow420]

Thank you, Stephen.
Any other advice please. The question is if I were you, I would .....
Thank you.

[StephenCastlecrag]

I notice you are from the USA. do visit www.hepb.org, The Hepatitis B Foundation website. They have a directory of all the liver specialists in the USA, you may be able to find some that have experience with HBV.