Peg-Ifn Tx - dose reduction

[grmr]

Hi mates,

just started the 2nd ifn course + TDF and i'm now at the week#8. I had the last two 135mg shots instaed 180mg due to low white cells count.. and I believe i'll go on this way..

So the question is: considering my BMI (21 - 65kg x 1,73cm) would be there a hiegr tx failiure if I needed to stay for all 48/72wks on 135mg shots?

thx to every1

[grmr]

gonna stop TDF in some weeks and keep ifn (135mg) for some additional weeks/ months..

still eag+ and recent ALT flares...

[grmr]

@ quang

first course was in2008/2009 7month of pega mono (no tDf)  I had no side but no response so I quitted afert 28/29 shots...

i also do intake approx 45000iu VitD3 weekly.. by WBC is very low, approx1,4x 10^3

[veteranB]

What is  LDN?

[Quang]

My WBC is low but at ok level for 180 mcg ifn.  Here is my daily activity that might help.  I drink a cup of fresh vegetable juice first thing every morning; take 4000 to 6000 iu of Vit D3 daily; 30 minutes light (walk, stretch) to medium (light weight, kicking) exercise

[Quang]

What was the gap between your first and second course of ifn?

[stef2011]

latest blodd test show ALT 47 and GGT 56 increasing by 15/20pt

this is good if pattern keeps like this with alt flare this is immune activity, hbeag seroconversion has a big flare usually

too bad you had to lower peg dose, maybe you got hbsag increase due to lowering of peg dose but low WBC and plts are dangerous and there is no other choice

[grmr]

i'm now at week 32 and injecting 90mg pega/week  and tdf pill daily ,due to very low wbc and platelets count.. so docs are wondering if go on 90 or 135..

point is i m still eag+ and eab- no hbs decrease at weeks 12 and 24 so it seems i could stop it according to the guidelines.. but docs want me to go on.. i do not have any big side (only some hair thinning and nervousness but so far so good) so this is not an issue for me.

latest blodd test show ALT 47 and GGT 56 increasing by 15/20pt since last time... that's strange..

[veteranB]

Alinia is also interferon booster? So why arent they are using it?

[stef2011]

maybe LDN, which is extremely cheap, can do more than zadaxin if combo with intf and antivirals,

a friend tried it time ago and alt rose but at that time hbsag quant was not available so it could have been useless but at least its so cheap who cares and also sides are none or very lgiht

[stef2011]

the problem of zadaxin is that it is very expensive and almost no effect on hbsag rates

[veteranB]

Stefano, thank you for sharing all your knowledge my friend. Good info you provide.

What about Zadaxin is that something one needs to consider? They say it is good + antiviral to clear HbsAg..

What have you heard about it?

[stef2011]

intf can be then retried after 2-3 years because during nuc therapies there is slow immune rebuild which will allow response to intf in the future

[stef2011]

wait and see both hbsag and hbeag, then if no response by 24 weeks you may try interferon boosters like alinia and simvastatin, if still no effect in 48weeks go for tdf mono

[grmr]

and what the issue then?? should i stop ifn and go on tdf???

[stef2011]

hbsag will tell, usually there is a hbsag decrease, alt increase and hbeag seroconvertion
if hbsag is on the rise there could be no seroconversion

[grmr]

collected labs week 24.. Normal ast/alt... VL und and still EAG+...

Stef do u have any clue about when the secovneriosnto occurs normally while on treatement?

[grmr]

ok will ask what the machine brand is..

[stef2011]

at this point hbsag is the main test and if you like hbeag too (anti E non necessary) but use always same lab and be sure they use abbott architect, no other machines so you know for sure everything is correct

also in my case they want same lab or their lab all the time

[grmr]

.. well thx again for replies stef... I've benn tested also anti-hbc total +ve but it's normal.. do not know why they presribed me such test..

[stef2011]

no it is not high for hbeag pos

[grmr]

then.. is 8000 i/ml a high value for eag+?

[stef2011]

yes it is nnon responder but 24 weeks will tell if intf is useless and can be stopped

i d wait the 24 weeks result and add alinia to activate intf response possibly

[grmr]

hi all,

just gotten labs after 12 wks TDF + IFN135mg

No good news

February 2012 HBSAG quant 5787iu/ml (before tx)
May 2012  HBSAG quant 8000 iu/ml (afetr 12wks). this value seems strange to me as is 8000 round..

ALT are in the range and DNA undetectable due to TDF

Monocites are always high 15.5 (3.4-9)
Platelests 81 (130-400) low
WBC 1.92 (4 - 11) low

HBEAG +ve
Anti HBC +ve (do not know why they tested this.. I believe it's a typing mistake as i get normally anti hbe tested)..

Does it means I'm not respondign right?

Thx to all

Does it mean i'm not respondifn

[stef2011]

normal alt is due to our immune system not capable to detect infected cells and hbv, hbvdna und in the blood should increase both alt and immune system compentence but this rarely happens on us

when rep9ac will be available the block of hbsag will make the alt flare which will enable immune system control