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Pegasys + Tenofovir (TDF) Therapy
Dear Doctor,

First of all, apologize for my poor English.
I am an Asian male 27 years old.
I was diagnosed with hep B chronic infection in early of 2008. Since then I am regularly visit specialist doctor for medical check-up. After monitoring my hep B panel and liver condition for 4 years, my doctor decided to advise me for therapy due to my ALT level was elevated for this past 3 years (around 2 twice of normal range).
The option that suggested by my Doctor at that time was TDF alone or TDF combo with Pegasys. After a though consideration, I finally agree to start a combo therapy of TDF + Pegasys on mid of March.

Here is my recent history of records:

End of February result:
Hbs Ag (Quant) : 44575.47
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 440771328

==========================================
Decided to go on Combo therapy TDF + Pegasys
==========================================

Baseline result (mid of March), after baseline, start taking on medication
Hbs Ag (Quant) : 44977.03
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 570484864

April result (week 4 after started weekly injection of Pegasys and daily dosage of TDF)
Hbs Ag (Quant) : 32384.55 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 148485 (going down)

Now I am on week 8, just did my medical check and wait for the result to come out.
I will gladly appreciate your view and opinion on my result

Thank you and best regards,
AsianMale1985
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HI, i'm doing the same your tx.. i'm also 27yo eag+... any sides? I

'm now on week 13 my hbsag quant baseline was 5800iu/ml now I'm waitign for the hbsag quant afetr 12wks..

DNA is under detectable limit due to TDF..
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responding weel but to early to say, week 12 and week 24 hbsag, ast/alt and hbvdna will tell

check also your vit d and if less than 50ng/ml i tis best to supplement until you reach 80-90ng/ml, test is vit d25oh
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when should the eag seroconvesrsion expected in such cases as average?
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Hi Grmr, I don't feel any side effect so far, i hope this condition continue till end of treatment.
Do you have any side so far?
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Thanks Stef for your post.
I notice that i my vit D is slightly low, it is 55ng/ml. But my doctor mention that it is not clinical significant.
Do you know how this HbsAg (quant) works? Seems like it is going down, but i don't know how does it effect on my treatment result.
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Hi Guys,
Anyone know how to delete the duplicate post.
I do some mistake when posting my question, and it is duplicating now.
Apologize for that, i am new to this forum.
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Do you know how this HbsAg (quant) works?

if your genotype is D levels below 1500iu/ml means you achieved immune control of hbv, at very low levels like 10-20iu/ml you dont need drugs to control hbv and it gets cleared slowly by immune system or fast by pegintf
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HI Stef,

Thank you for your prompt reply.
My Genotype is B. Now my HbsAg (quant) is 32384.55, but i am not sure if it is in iu/ml or some other parameter, there is no explanation my medical report.

I notice that this HbsAg (quant) is going down, is it because of i am injecting Pegasys?
Apologize for so many question at the same time.
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genotype B needs hbsag around 100-300iu/ml to achieve immune control, geno B responds better to intf


I notice that this HbsAg (quant) is going down, is it because of i am injecting Pegasys?
of course it is pegasys
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Thanks Stef.
I will update to you guys once i have latest result of my medical report.

Hope that it is getting better :)
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do check that unit is iu/ml, there are still absolete tests with the number with no unit and those tests are useless.
most labs report the method (at least those who use new machines and have nothing to hide), hbsag quantity is done by abbott architect or roches elycsys only
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Hi All,

I have received my latest blood test result.

Here is the complete list:

Baseline result (mid of March)
Hbs Ag (Quant) : 44977.03
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 570484864
AST : 37
ALT : 84

April result (week 4)
Hbs Ag (Quant) : 32384.55 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 148485 (going down)
AST : 43
ALT : 99

May result (week 8)
Hbs Ag (Quant) : 18709.00 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 11338 (going down)
AST : 85
ALT : 190


May i know what is your opionion on my result?
I notice my ALT was up and down, does it normal to expect ALT increasing when we are on Pegasys?

Also what is the normal period to reach viral load Undetected? Looks like my first 4 weeks result was very good because the viral load was dropping so drastically. But on my week 8, it does not show the same.

Kindly help me to share your view on my latest result.

Best Regards,
AsianMale1985
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I am not a doctor. I would say your levels of hbvdna and HbsAg are trending down and is a good sign. As for your ALT,  a rise in ALT, followed by a drop in hbvdna is also a good sign. 8 weeks of treatment is too early to predict, especially for non-expert like myself. Since you have minimal side effect, you should go on to complete your course of treatment.

BTW, in which country are you being treated?
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Hi Stephen,

Thanks for your feedback. It made me determined to finish the course :)
Currently, I am being treated in Singapore, but i am not a citizen there, just a regular medical visit.
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Hi Stef,
I checked with my doctor, the HbsAg (Quant) is in iu/ml.
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good results, hbsag is still to high but as long as it declines it is good.losing hbeag by 24 weeks is a strong predictor of hbsag clearance

is your therapy tdf+intf?(sorry i dont remember the whole thread)
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TDF + Pegasys from mid of March
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it seems good.. by the way how was the hbsag decline from

32384.55 (going down)

to

18709.00 (going down)

expressed in terms of log? Is there anyone doing the conversion?


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i'm also eag+ on TDF+IFN and am colleting in the next days hbsag qquant after 12wks..
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Hi Stef,

I am on Pegasys combo tdf since mid of march. Next month will be my week 12 blood test.
I am glad that the HbsAg is declining, but i am little bit confuse on how this HbsAg decline in that figure. Will it keep decline 12k+ iu/ml a month? seems like my HbsAg is declining that way from 44k to 32k and latest to 18k. Does it shows a good decline figure? or it is just normal to have that.

In other side, my HBV DNAlooks like slowed down in declining from 500M to 100k and then 10k.
How long normally for people that taking TDF to reach UND from the baseline time?
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I am not that good in math, but i guess if we want to know in term log declining, i think first we have to convert both to log.
For example on my result:

Baseline: 44977.03 = 4.65299 log

Week 8: 18709.00 = 4.27205 log

So if we want to see how much it decline, then it will be:
Total decline = 4.65299 - 4.27205
Total decline = 0.38 log iu/ml

Please someone correct me if it is not a good way to calculate
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dont look hbvdna too much, when it reaches low numbers 100-2000iu/ml it is not so important, just look at hbsag only.

i think these are good results
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so what is the conversion coefficienf from iu to log???? really not good in math...
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http://forum.corriere.it/fegato/31-05-2012/news-dal-congresso-europeo-di-epatologia-2012-riguardanti-lepatite-b-e-d-2071866.html

INTERFERONE PEGHILATO + TENOFOVIR
-In soggetti affetti da epatite cronica B trattati con Interferone Peghilato e Tenofovir per 48 settimane è stata osservata una risposta virologica sostenuta del 30% e una perdita dell’HBsAg nell’11%. Il livello basale di HBsAg inferiore a 2000 UI/ml predice un’alta percentuale di risposta. Una mancanza di riduzione superiore al 10% di HBsAg quantitativo alla settimana 12 e 24, identifica i soggetti non responsivi. (Marcellin P et al., S209).
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do you have a baseline hbsag value before starting intf add on?

you may know for sure if there is no intf response at 24weeks, at least 10% hbsg decrease is required.
keep in mind that the chart we see are mainly the everage so up and downs are common, the trend is what matters
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here s a sum of hbsag meaning from 2012 easl
http://forum.corriere.it/fegato/31-05-2012/news-dal-congresso-europeo-di-epatologia-2012-riguardanti-lepatite-b-e-d-2071866.html

HBsAg QUANTITATIVO
-I genotipi dell’HBV, i livelli sierici di HBVDNA e la determinazione quantitativa dell’HBsAg sono eccellenti predittori per la comparsa a lungo termine di cirrosi epatica. Possono essere usati per avere un valido modello di rischio predittivo. (Lee MH et al., S186).
-I pazienti affetti da epatite cronica B con alti livelli di HBsAg quantitativo presentano una maggiore fibrosi epatica. (Martinot-Peignoux M. et al, S211).
-La determinazione dei livelli sierici di HBsAg durante il trattamento predice la risposta virologica sostenuta alla terapia antivirale in pazienti con epatite cronica B HBeAg positiva (Kim SS et al., S186).
-La determinazione dei livelli sierici di HBsAg gioca un ruolo significativo in corso di epatite cronica B specialmente nei soggetti HBeAg negativi. Il trattamento dell’epatite cronica B deve considerare sia l’HBsAg quantitativo che l’HBVDNA quantitativo in quanto forniscono utili informazioni complementari. (Liu J et al., S187).
-Nell’epatite cronica B, in soggetti in trattamento da lungo tempo con farmaci antivirali, il valore quantitativo dell’HBsAg dopo la sospensione del trattamento, è un predittore di risposta virologica sostenuta. (Suh SJ et al., S191).
-La riduzione intraepatica di HBsAg dopo trattamento con Interferone Peghilato in pazienti con epatite cronica B, HBeAg positivi e negativi, si associa con i livelli quantitativi sierici di HBsAg.(Arenz P et al., S196).
-La precoce riduzione dell’HBsAg quantitativo sierico durante il trattamento, si associa a più rapida riduzione conseguente dell’HBsAg stesso in soggetti con epatite cronica B HBeAg negativo. (Chan HLY et al., S199).
-Nei soggetti con epatite cronica B HBeAg negativo con predominanza di genotipo D trattati con Interferone peghilato, il declino dell’HBsAg quantitativo dopo 12 e 24 settimane, si associa a più alte probabilità di risposta sostenuta 6 mesi dopo la fine della terapia. (Gouis J et al., S201).
-In soggetti affetti da epatite cronica B, HBeAg negativi e genotipo D, il trattamento con Interferone Peghilato guidato dai livelli sierici di HBsAg alla settimana 12, 24, 48 migliora la risposta terapeutica (Lampertico P et al., S207).
-In soggetti con epatite cronica B con soppressione virale causata da farmaci antivirali, l’aggiunta di Interferone Peghilato migliora la cinetica dell’HBsAg. (Lampertico P et al., S207).
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potrebbe essere utile anche hbeag quantitativo, giusto per vedere se anche questo antigene sta scendendo, per l hbeag ti fanno le analisi quantitative?
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Hi,
for genotype A how much hbsag count should come to achieve immune control. In my case i m going through PYG+TDF from last two week and my current HbsAg Count is 37903 IU/ml(Method- By chemilumiscence).
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if you are hbeag pos it is more important to start with tdf alone so that both hbsag nad hbvdna start to go down and then add intf when hbvdna und and less hbsag

the most important parameter is hbsag at 12 and 24 weeks of intf

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http://cdn.f1000.com/posters/docs/249814820

good poster about hbsag declines to see if there is response or no response

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Thanks for reply.
My doctor told me that I should not wait for down the HVB DNA, more wait may cause of more liver damage so i started PYG+TDF same time. At the Start my HBV DNA was >1.10x10^8 IU/ml and HbsAg Count was 37903 IU/ml. Is my Dr was was wrong?
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if he wants to repair liver tdf is the good choice to start immeditely in combo, are youf3 or >10kpa?
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My Fibrosis-1  and  Fiboscan 3.5 kpa.
I already start combo from last 3 weeks so i don't thik i should stop pyg now until its clear my virus. What do u think stef?
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mmm search for another doctor......you have a better liver than non infected people, nothing to repair, probably better liver than your doctor too

i think that a serious doctor cannot say anything wrong to a patient especially you have a liver to repair when there is no damage.the medium fibroscan for males non hbv infected is 4.5-6kpa.....

anyway you cant stop it now, if you like you can add alinia to boost interferon response and see hbsag at 24 and 48weeks
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Hi All,

I have just received my week 12 result. Here is the complete history to the latest of my result:

Baseline result (mid of March)
Hbs Ag (Quant) : 44977.03
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 570484864
AST : 37
ALT : 84

April result (week 4)
Hbs Ag (Quant) : 32384.55 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 148485 (going down)
AST : 43
ALT : 99

May result (week 8)
Hbs Ag (Quant) : 18709.00 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 11338 (going down)
AST : 85
ALT : 190


June result (week 12)
Hbs Ag (Quant) : 5806.99 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 198 (going down)
AST : 64
ALT : 134

Kindly give your opinion on this result.
Do you think i have a chance to clear the virus?

Thank you and Best Regards,
AsianMale1986
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it is a very great result in just 12 weeks, let's wait to see 24 weeks results of hbsag, if they reach close to 1000iu/ml you should lose hbeag

those clearing hbeag by 24 weeks have highest chances to clear hbsag by 48weeks
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Hi Stef,

Thank you for your prompt response.
I am happy to know that it is a great result.

Another question, how do I know if i am clearing HBeAg?
Does it related to HBVDNA level?

Thank you and best Regards,
AsianMale1985
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Your qHBsAg and hbvdna numbers are looking good. According to published literature, you are responding to treatment and should definitely continue.
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when hbsag gets close to 1500iu/ml or lower hbeag is lost

best way to know is to have hbeag quantification too but i d just follow hbsag in the end hbsag is hbv
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Does it related to HBVDNA level?

no hbvdna has no meaning at all except that if it gets to low like now the virus has less possibility to mutate and escape your immune response
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Hi Stef,

"when hbsag gets close to 1500iu/ml or lower hbeag is lost"
What happen if HBeAg is lost?

Will it increase my chance to be 'cured'?
I read some article that the closest state to be called as cure is by HBsAg lost and appearing on ANTI-Hbs.

Do you think i have a chance to achieve that state where i am really cured?

Thank you,
AsianMale1985
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Hi Stephen,

Thanks for your reply. I will try my best to finish this treatment.
Hope i can get a best result from the treatment.

Thank you,
AsianMale1985
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dont focus on hbeag just conitnue to monitor hbsag the key to clearance is hbsag


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Hi Stef,

Thank you for your advice.
i will keep you and all people here informed on my Treatment progress.
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It seems medicine  is working good. Are you taking any other medicine along with TDF+Peg? Till now faced any side effect? what is your diet?
Thanks in advance.
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Hi Nihi120,

No. I dont take any other medicine beside Peg+Tdf.
So far, i have been in week 15, no real side effect that i feel yet. Hope that this condition goes on.

I dont have a specific diet, but i will try to share some of my eating habbit:
For drink, i dont drink any kind of alcohol, and if possible, i will try to avoid any kind of can drink.
For food, normally i will try to avoid deep fried and spicy food (food with a lot of chili and spice).

By the way, are u on the treatment as well? If yes, can u share some of your result to us?

Thank you,
AsianMale1985
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Thanks for reply.. Yes I am also on same treatment. I am waiting for test result of week 4, once I will get, definitely I'll share.
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Hi Nihil,

How about your treatment? do you feel any side effect?
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i was reading and this is def positive news. i just found this site today and this is my post
http://www.medhelp.org/posts/Hepatitis-B/Start-peginterferon-a-2a-and-tenofovir-combine-treatment-trial/show/1762500

this is the same treatment as Asianmale1985?? why is my doctor recommending clinical trial for my husband for combine treatment when we were going to get pegasys only? I thought combine treatment was new??
also is treatment  subsidised in other countries as in Australia?
thanks
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Where do you get treatment?
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both drugs are approved already so you can get them anyway, no need to go on trial

trials are just to study better and gather more data but interferon+antivirals have been studied since early 2004 or even earlier, the best response is tenofovir first and then interferon add on few years later
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the trials can be chosen to have the drugs for free because intf is very expensive so some insurances or healthcare can be "not so happy" of the charge
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As we are in Australia, treatment is nearly free. ($35 per month), my hubby chose to try interferon first as he not like idea of tablet for life. And thats why he was booked in interferon next week. Maybe combine treatment is not as cheap as we could pick either interferon or antivirals. I am trying to research into the best treatment for hubby and Asianmale 1985 is very positive.
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if you add intf to a stable antiviral then the antivirals can be stopped even if hbsag is not cleared

antivirals biuld up no immune response at all so this is the reason they cant be stopped safely althouth it looks like stopping tdf allows to clear hbv in a high percentage
intf makes the contrary it builds up immune response so when you combine both you ll have the ideal result to weaken hbv by antivirals and build an immune reponse that allows to stop antivirals safely, the worst can happen is you get back to baseline

if you do intf alone the response is just 7% at 48weeks...
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Hi All,

I am undergoing treatment of TDF+PEG. I have just received my week 4 result. Here is the complete history to the latest of my result:

Baseline result (mid of May)
Hbs Ag (Quant) : 37903 IU/ml
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs:Non-Reactive
HBV DNA : >1.10x10^8 IU/ml
AST : 42
ALT : 65
June result (week 4)
Hbs Ag (Quant) : 22583.7 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs :Non-Reactive
HBV DNA : 320735 (going down)

@AsianMale1985- Till now no major side effect. only loss of appetite & CBC little bit affected.
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thanks, looks like combine treatment for hubby but will get new bloods on monday to decide. Or what we thought was to try the interferon for ?6 months and if no improvement then antivral? Or if bloods ok then wait till trial and do combine as intital treatment? I know its hard to say what is best but good to hear from others...=)
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great input and good results. BTW what is CBC?
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sorry to hijack your post but due to same tretment, great to get people's input and so many positive results. I am a registered nurse so also very interested to learn but my specialty is child and family health so all this is great learning to get best for my hubby...
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results are very very good, if you have a chance and not expensive add hbeag quantitative too (both pei or s/co unit is ok)
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Hi Mim168,

No problem. it is always a good thing if we can share our experience together. It helps us a lot in fighting this "thing" together.

Cheers,
AsianMale1985
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Hi Nihi,

I am glad to see your result, seems like we show similar figure. lets hope your next test result will be even better.
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Hi asianmale1985

i am on TDF for the past 7 months now. my viral load goes down 336 . from 1.7X10^8iu
AST 28 ALT 52
i am considering to add interferon as well.. very soon once goes down to undetectable.
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HI All,

Latest Update on my treatment result has been out.
Here is my latest history record up to week 16:

Baseline result (mid of March)
Hbs Ag (Quant) : 44977.03
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 570484864
AST : 37
ALT : 84

April result (week 4)
Hbs Ag (Quant) : 32384.55 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 148485 (going down)
AST : 43
ALT : 99

May result (week 8)
Hbs Ag (Quant) : 18709.00 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 11338 (going down)
AST : 85
ALT : 190


June result (week 12)
Hbs Ag (Quant) : 5806.99 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 198 (going down)
AST : 64
ALT : 134


July result (week 16)
Hbs Ag (Quant) : 1195.62 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 38 (going down)
AST : 55
ALT : 106


I notice that now HbsAg is already below 1500 IU/ML, but HbeAg is still Reactive.
Beside that, anyone have an idea under which value HBV DNA consider as undetected? Now mine is 38
Kindly share your opinion on my result.


Thank you and best Regards,
AsianMale1985
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hbvdna is of no use, better if no undetected but low so there is continous immune response request

WOW!16weeks already less than 1500iu/ml you are going straight to hbv clearance, dont worry about hbe too it is hbsag which keeps all the hbv thing up, probability is that hbsag at 24 weeks is very low like 500iu/ml or less and hbeag negative and those with these values clear hbsag

keep going and dont stop intf until hbsag is undetactable even if that requires 2 years (96weeks), what about sides?
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do you also have your vit d25oh values?just to see if vit d made any difference in your case

by the way intf+tdf looks like the best hbv treatment indeed
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that sounds great!! I'm also on same therapy.. pls share expereince with sides as so far I did not have any big side like flu, and so .

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Hi Stef,

I am glad to hear that. What worry me is about the cost if i have to continue for 2 years. Do you think if 1 year of treatment is enough for me?

For side, i don't feel any side effect. Everything seems very normal. Except i have red rashes on the injection side, but that doesn't disturb me.

I checked for vit d before, my level is  55ng/ml. But i am not sure if it is same Vit D like you mentioned.

Thank you & Best Regards,
AsianMale11985
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Hi grmr,

I dontt feel any side effect so far. There is small red rashes on the injection area, sometimes it is itchy. But i am okay with that.

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yes i have the same... what about hair??
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yes that s vit d and 55ng/ml is normal/optimum range

2years is very very unlikly, once you reach hbsag less than 100iu/ml (the lower the better) you may stop intf and continue to clear

normal intf, not peg, costs less and vietnam has both versions generic and very cheap, also imiquimod may be able to keep intf but we have to wait my tests results
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Hi grmr,

I dont have hair lost, only those red rashes. Btw, noticed that you are on same treatment. How is yours?
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Hi Stef,

Thanks for your information, it is really helping me. Hope that i can reach 100iu/ml by the end of treatment.

By the way, what is imiquimod? is it a new medicine for Hep B?
Are you using it now?

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it is an intf inducer (it makes your own immune system make intf and much more than the injectable), it is called aldara and it is very cheap compared to intf inj
2 caps as suppository a week are able to make high quantity of intf, still to confirm if this has an effect on hbv

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I'm pretty well thx.. this is the 2nd course i went through as the first one 4 ys ago was stopped at 30wks as still immunotoeralnte..

I had not had any sides neither that time nor with this ongoini course.. yes i'm a littel tired, maybe some pains at muscles when i play sport but they're acceptable...

I'm also eag+
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GRmr, and Asianmale 1985: How old are you both? Just wondering if age has anything to do with the fact that you feel no sides? About to start mine, and i am 37.
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It sounds great if we have medicine that can induce interferon production. With that, we can have an alternative solution to increase interferon compare to current pegasys which less convenient and more expensive.
I hope that it will shows a good result.
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Hi Joc,

I am 27 years old. I am not sure if age have relation with side effect, but i hope that you don't feel any side effect too. Just don't worry to much and think positive. Good luck!
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hows much po injectine pegasys?? thank you../
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Hi All,

I am undergoing treatment of TDF+PEG. I have just received my week 12 result and very disappointed.Here is the complete history to the latest of my result:

Baseline result (mid of May)
Hbs Ag (Quant) : 37903 IU/ml
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs:Non-Reactive
HBV DNA : >1.10x10^8 IU/ml
AST : 42
ALT : 65
June result (week 4)
Hbs Ag (Quant) : 22583.7 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs :Non-Reactive
HBV DNA : 320735 (going down)
August result (week 12)
Hbs Ag (Quant) : 36915.98 (going up)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs :Non-Reactive
HBV DNA : 13825 (going down)

I unable to understand that why HbsAg goes up? What i do next?
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it is best to use sequntial treatment tdf first and peg 1-2 years after hbvdna und, anyway 24weeks result will tell if intf doesn t work now if so you can keep tdf for 1-2 years and retry intf then

after years of hbvdna und on etv or tdf (usually at least 3 years) intf can work
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thanks for reply. Could you please explain me why HbsAs goes up once it already down in first 4 week by 15000 IU/ml. Should i go for other test?
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your immune response on hbv has probably lowered i guess

hbsag, hbeag and hbvdna full virions suppress immune response but some parts of the virions also stimulate immune response so while hbvdna goes down you also lose some response towards hbsag

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thanks again stef.
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Hi Stef

I also undergoing the TDF+PEG treatment.However, I started experiencing some side effect per my Week 4 results.My Leukocytes (Now 2.71,average 3.60-10) and Neutrophils ( Now 1.17,average 2.10-6.90)fall below the average level.However, the doctor suggested I continue for the treatment,I am worrying if it is dangerous for Leukocytes and Neutrophils fall below the average level?Does anyone experience this?

Thank you

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that s normal for intf and your levels are tollerable

immune system cells get low because they concentrate in the liver where they are needed, not in blood flow where it is useless for them to stay.also platlets get low in blood flow to concentrate in liver so they help immune cells to stay attached to them and stay longer inside the liver

there are minimum ranges for all these and your doctor will tell you when they are too low, just hang in there because your immune system is fighting now and if you change intf dose it may stop working
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Hi stef ...

     I am going thru interferon lamba posts in this forum ..what are the updates about lamda ?? also can you look at my thread and reply
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it is going slow and no data about hbv, one thing is certain less sides but no data on hbsg clearance

second thing absolutely clear is that peintf is going to lose patent by 2014 or 2015.
my guess is we wont need this since myrcludex trials in russia are going pretty fast and wont wait 2015 for sure
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what will happen for us if pef loose its patent ? will it be good for us ??
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price will fall immediately to very low
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hi Stef2011,
9 Months on TDF Alone.
planing to start INF
My Most recent diagnosis,
August 10th 2012
AST 29
ALT 51
didn't go down in from july
AST 29, ALT 52

DNA Viral load 120 IU/ML
HBsAG  Positive
ANTI HBs 1.09   MIU/ML
HBe AG Positive
AFP 3   NG/ML
Still waiting for results for HBV Genotype.
My Docotors said for certain type of genotype the INF doesn't work.
Please advise.
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Dear All,

I have already receive my latest report up to week 24.
Treatment with pegasys + TDF.

Here is the complete history till date:

Baseline result (mid of March)
Hbs Ag (Quant) : 44977.03
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 570484864
AST : 37
ALT : 84

April result (week 4)
Hbs Ag (Quant) : 32384.55 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 148485 (going down)
AST : 43
ALT : 99

May result (week 8)
Hbs Ag (Quant) : 18709.00 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 11338 (going down)
AST : 85
ALT : 190


June result (week 12)
Hbs Ag (Quant) : 5806.99 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 198 (going down)
AST : 64
ALT : 134


July result (week 16)
Hbs Ag (Quant) : 1195.62 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 38 (going down)
AST : 55
ALT : 106


September result (week 24)
Hbs Ag (Quant) : 94.52 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 22 (going down)
AST : 68
ALT : 121

Noticed that HBV DNA is still not undetected yet and there ALT still high. But HbsAg is going down.
Kindly share your opinion about my result.

Thank you & Best Regards,
AsianMale1985
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change doctor, how does he know intf doesnt work?he doesn t know genotype, he doesn t know hbsag quant......are you sure he is not just pushing to sell antivirals maybe paid by antivirals drug makers?

you need the following:
genotype, if you are A or B max response if youare c-d little less but not no response

hbvdna 120 very low good intf response
hbeag pos good intf response
alt 51 good intf response
hbsag quant in iu/ml. this will predict hbv clearance, check it before starting  intf and then at 12-24-48weeks.if no decrease by 24 weeks intf doesnn t work and you can stop it

you can boost intf response by:
increasing vit d3 to serum levels 50iu/ml or more by 5000iu daily
nitazoxanide (alinia, nizonide500) 4 weeks lead in, if nt available don t bother it just boosts response a little
vit b12 5000mcg daily, may be it boosts response it wont hurt to take, it worrked on hcv
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you are going to clear, hbsag less than 1500iu/ml by 24 weeks means clearance by 48weeks or follow up

continue this way, hbvdna has no meaning what counts is hbsag, also hbeag will clear soon and then will be followed by hbsag.do not miss a shot you re on the clearance way.....

by the way any sides?
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Thanks Stef for your reply,

I don't have any side so far.
Have some red rash on the injection site, sometimes it get itchy, but that doesn't bother me.

"you are going to clear, hbsag less than 1500iu/ml by 24 weeks means clearance by 48weeks or follow up"

Do you have any idea about my chance for 48 weeks clearance (in percentage)?
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Do you have any idea about my chance for 48 weeks clearance (in percentage)?

no but i do suggest to keep intf+tdf until you clear, minimum 96weeks of this combo
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Hi Stef,

Thank you for your suggestion.
Hopefully everything goes well according to plan.

Best regards,
AsianMale1985
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Do you also Live IN United States?
My test of HBsAG does not have count?  only positive or negative?
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I also did check, for Genotype A,B there's a better chance of clearing it. appr(45%) clearance.
but for C and D, seems only 7% of clearance.(Very low)
for most lifetime Carrier, in southeast asia, its usually Genotype C?
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sequential combos are the key for intf to work

, intf mono is ridiculously low clearance but in sequential you jump to 40% clearance at 1year combo
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regardless of genotype a,b,,d  for C i don t remember if there were patients on trials with C but i guess response is the same on seq combos
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i know Ribavirin in combination with PEGASYS cause birth defects.
but will pegasys alone cause birth defects? i am 27 years old, my gf is 27 too. plan to have a child in the near future.
doctor told me not to have kid even tho on pegasys alone.
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My doctor told me the same thing during my Pegasys treatment.  
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I too would like some definitive answer. INTFN is definitely contraindicated  for women who want to have babies and it is clearly stated in the label information. But for men? And what about oral antivirals?
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Dear All,

I have already receive my latest report up to week 32.
Treatment with pegasys + TDF.

Here is the complete history till date:

Baseline result (mid of March)
Hbs Ag (Quant) : 44977.03
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 570484864
AST : 37
ALT : 84

April result (week 4)
Hbs Ag (Quant) : 32384.55 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 148485 (going down)
AST : 43
ALT : 99

May result (week 8)
Hbs Ag (Quant) : 18709.00 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 11338 (going down)
AST : 85
ALT : 190

June result (week 12)
Hbs Ag (Quant) : 5806.99 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 198 (going down)
AST : 64
ALT : 134

July result (week 16)
Hbs Ag (Quant) : 1195.62 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 38 (going down)
AST : 55
ALT : 106

September result (week 24)
Hbs Ag (Quant) : 94.52 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 22 (going down)
AST : 68
ALT : 121

September result (week 32)
Hbs Ag (Quant) : 7.83 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 36 (fluctuated)
AST : 62
ALT : 118

I noticed that HBV-DNA is slightly went up, is that normal?
HBS-Ag is dropped till 7.83, hopefully this is a good sign.

Kindly share your opinion on my result.

Best Regards,
AsianMale1985
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Hi All,

Minor correction on the date taken for week 32. It should be on November 2012.

Thanks,
AsianMale1985
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wow you are close to clear!definitely you ll clear by 48-96weeks as soon as hbeag gets negative

hbvdna is not important it is meanless for clearance and so low, start to check hbsab too when hbsag gets lower than 100iu/ml antibodies hbsab can appear already
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Hi Stef,

Thanks for your fast reply. I am glad to hear that.

", start to check hbsab too when hbsag gets lower than 100iu/ml antibodies hbsab can appear already "

May i know if ANTI-Hbs (Quant): < 3.0 Non-Reactive  is the same like HbsAb that u mentioned?
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yes it is, didn t notice you had it already.at this point you just have to wait for hbeag to become negative and with hbsag 7iu/ml is just a matter of short time

remember to take tdf with food to improve absorption
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Thanks Stef for your advice.
I always take Tdf after i had my meal.

Btw, i have another question, for this 2 items:
Hbs Ag (Quant) : 7.83 (going down)
Hbs Ag : Reactive

Is it the same thing? does it means when Hbs Ag (Quant) become 0, Hbs Ag: will become non-reactive? i still dont really understand what is the meaning of HbsAg (does it reflecting number of virus? or something else).

Thanks,
AsianMal1985
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Is it the same thing? does it means when Hbs Ag (Quant) become 0, Hbs Ag: will become non-reactive?

yes

i still dont really understand what is the meaning of HbsAg (does it reflecting number of virus? or something else).

infected cells and immune response

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Thanks for the explanation,

Seems like i have to read more regarding this virus :)

Best Regards,
AsianMale1985
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Stef,  why his ALT still high despite HBSag & HBdna is low ?
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because his immune system is working and detecting/killing infected cells, this action makes both hbsag and hbvdna deline.with normal alt there is no clearance and no hbsag decline
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i have hep B. in past months the lab result is reactive. i try to test again early this month then the result is non-reactive. what is that means? i try other test which is Anti-HBs the patient's count is 174.6 cut-off: 10.0 remarks: reactive please advice me... i need to be immunization?
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Hi Stef,

Talking about ALT, how do you think about my ALT that consistently high even when i am having TDF?
It has been on that range of value (2x u/ml) for almost a year now.
Will it be dangerous to me if this condition going on?

Last check on my fibroscan result is 4.7 kpa. I took the test on March 2012.

I read in some article, it mentioned that some people achieve ALT normalization when taking TDF, seems like it did not happen on me.

Can you help to explain my situation?

Thanks & Best Regard,
AsianMal1985
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Hi Axel,

Looking on the figure that u posted, it seems like u are being infected by hep b virus before, but your body manage to fight of the virus. And now u are immune to that virus.

If your body failed to fight the virus, it will stay in your body like what happened to me.

Lets wait Stef and the others comment about this.
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Talking about ALT, how do you think about my ALT that consistently high even when i am having TDF?
It has been on that range of value (2x u/ml) for almost a year now.
Will it be dangerous to me if this condition going on?

elevated alt is the reason why hbsag is declining and your immune system working, pray to stay like this.mildly elevated alt lik yours is not always correlated to liver damage, liver damage is the result of unbalance between damage and repair not the result of damage alone

Last check on my fibroscan result is 4.7 kpa.

perfect liver better than evearge non hbv infected
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thank you
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Hi, if it's ok with you, do you mind messaging me your doctor's name and which hospital is he with? I'm surprised you managed to do HBs quantitative there. Thanks!
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Hi,
Your result is very impressive.Please tell me brand of your medicine(both Pagasys & TDF) and also where you use to take injection, i mean which side of body? Thanks in advance.
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Thanks for posting your results and gratz on results.
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it is not the brands to make clearance or site of injection, any tenofovir brand or interferon brand is exactly the same
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Hi, do you mind messaging me about the name of your doctor and which hospital is he/she with? It is hard to find doctor and hospital who put patients first and not profit.
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Hi all. I have now got my HBSAG quantity result. Sad to say its quite high. Please find my full results below:
HBSAG: 15,102.85 IU/ML. HBDNA: Undetectable. HBEAG: Negative. HBEAB:Positive. SGPT (ALT): 94 and SGOT (AST): 40.  Have been taking TNF for almost 2 years now. Would like to stop TNF now as i think Pegasys should now be a better option. Would you suggest i start Pegasys to see if theres a chance to drop the HBSAG quantity?

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Update:
I just realised my HBSAG quantity test results is quoted in IU/ml and not in IU. thats why the number was reading quite high. I have made the conversion to IU (International unit) ( by dividing by 5.8). Below are my actual results:

HBSAG: 2603.93 IU. HBDNA: Undetectable. HBEAG: Negative. HBEAB:Positive. SGPT (ALT): 94 and SGOT (AST): 40.  Have been taking TNF for almost 2 years now. Would you suggest i start Pegasys to see if theres a chance to drop the HBSAG quantity further?
Many thanks Stef

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Update:
I just realised my HBSAG (CMIA) quantity test results is quoted in IU/ml and not in IU. thats why the number was reading quite high. I have made the conversion to IU (International unit) ( by dividing by 5.8). Below are my actual results:

HBSAG (CMIA): 2603.93 IU. HBDNA: Undetectable. HBEAG: Negative. HBEAB:Positive. SGPT (ALT): 94 and SGOT (AST): 40.  Have been taking TNF for almost 2 years now. Would you suggest i start Pegasys to see if theres a chance to drop the HBSAG quantity further?
Many thanks Stef


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Can you update your latest status..and I hope to see your cleared the Virus..(HBSAG)...
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Why do you need to convert it? Hbsag quantity is actually measured in iu/ml not in just international units. That is strange arithmetics to devide by 5.8. Unless we do not know smt. In this forum everyone wants to devide his hbsag by 5.8 give us that formula :) I think your actual hbsag is 15012 iu/ml and no need for any further calculations.
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Fair enough. I got advised by another member to do that. Ok. Thanks for the insight.
However, whats the best treatment option to follow from here? Would Pegasys be advised for me?
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I do not know as for interferon you need a doctor advise, the one who had much experience. As for me: My hbs level was 10 021 iu/ml month ago now it  is 9 950 iu/ml. Not much decline actually but on the otherhand who knows? I am defenetily going for 48 weeks of pegasys. It is also reported to clear hbs after 3 years of follow up after end of treatment. I think you also need to consider your ALT level and liver histology before deciding to start interferon but I think around 15 000 is rather high value, close to mine almost 10 000 to expect interferon lower it fast. On the other hand I believe to have very experienced doctor that is dealing with hep b,c from 1970 year, and she had really seen much and know much about viruses. Well she says that 10 000 im/ml is not really high but it is sule better to have it under 1000 I think.
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Many thanks. Pegasys is something i'd definitely go for next year. At the top of this post you would see that Asianmale had hbsag as high as 44,000 and was able to bring it to less than 7.83 iu/ml as at 15th november. This is definitely tremendous. I am sure he has cleared by now.
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asian male was hbeag positive it is all another story in his case, hbv has not yet mutated so it is easier to get hbsag to go down or clear it even on tenofovir only

in our cases where hbeag is negative we have a mutated virus which has escaped our immune response already, so getting hbsag to go down is difficult

adding interferon in your cases is a good try even though response may be low, the best hbsag ranges for intf response are 1000-3000iu/ml, but i d try anyway because there is a single case of hbsg almost 8000iu/ml which lowered to 300iu/ml by 48weeks on etv+intf.

you have high alt on your side, the use of tdf for 2 years, so wait for another 1 or 2 years before adding intf all research reported at least 3 years of hbvdna und on antivirals before adding intf

another try before addding intf is use of alinia for 4 to 12 weeks and see if hbsag declines a little, at least less than 10.000iu/ml and as you see a decline add intf
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Many thank Stef. Will take ur advise, and keep TNF for another 1 year, monitoring HBSAG quantity every 3 months and then, bring in interferon. But just one question please, any known severe sides from proloned TNF use????Anything i should be be doing to reduce any impacts of this drug on my kidney and liver?
Thanks so much Stef for ur invaluable help on this forum!
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Many thank Stef. Will take ur advise, and keep TNF for another 1 year, monitoring HBSAG quantity every 3 months and then, bring in interferon. But just one question please, any known severe sides from proloned TNF use????Anything i should be be doing to reduce any impacts of this drug on my kidney and liver?
Thanks so much Stef for ur invaluable help on this forum!
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i had an increase of creatinine to above normal on entecavir plus alinia in 2010, started fibrogurad and it got normal.before fibroguard i tried nac and coq10 but it did not deacrease a lot by fibroguard it got even lower than baseline values since using fibroguard creatinine is ok even adding tenofovir to entecavir

so fibroguard, plus vit d3 and nac should be able to prevent any creatinine increase and these antioxidants will help liver too
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Many thanks Stef. Will keep this in mind. Tanx again
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Dear All,

I have already receive my latest report up to week 40.
Treatment with pegasys + TDF.

Here is the complete history till date:

Baseline result (mid of March)
Hbs Ag (Quant) : 44977.03
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 570484864
AST : 37
ALT : 84

April result (week 4)
Hbs Ag (Quant) : 32384.55 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 148485 (going down)
AST : 43
ALT : 99

May result (week 8)
Hbs Ag (Quant) : 18709.00 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 11338 (going down)
AST : 85
ALT : 190

June result (week 12)
Hbs Ag (Quant) : 5806.99 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 198 (going down)
AST : 64
ALT : 134

July result (week 16)
Hbs Ag (Quant) : 1195.62 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 38 (going down)
AST : 55
ALT : 106

September result (week 24)
Hbs Ag (Quant) : 94.52 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 22 (going down)
AST : 68
ALT : 121

November result (week 32)
Hbs Ag (Quant) : 7.83 (going down)
Hbs Ag : Reactive
Hbe Ag : Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
HBV DNA : 36 (fluctuated)
AST : 62
ALT : 118

December result (week 40)
Hbs Ag (Quant) : 4.42 (going down)
Hbs Ag : Reactive
Hbe Ag : Non-Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
Anti-Hbe: Reactive
HBV DNA : UND: Ref <15
AST : 63
ALT : 109

For quick information:
HbeAg is Non-Reactive now and Ant-Hbe is Reactive.
HBV DNA is undetected (<15)

Can you help to explain more details on my result?

Best Regards,
AsianMale1985
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Do you mind telling me which hospital you're going in Singapore? Also to which doctor? You can message me if it's too obscene or something and I'm not going to hold you responsible. I'm a carrier of Hep B as well, but now as it's inactive, I'm gathering as much info as possible.
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congratulations you are about to clear hbv but do not stop therapy until hbsab becomes detactable at good titer like about 400miu/ml, so if needed go bejond 48weeks of combo tdf+pegintf

once hbsag is und the antibody hbsab should become detactable, if not so you can also make hbv vaccine this will help with hbsab antibodies
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So you have seroconverted your HBeAg. Your hbvdna is undetectable and you HBsAg is almost zero. Congratulations, you are almost there. Your ALT is still elevated but with hbvdna undetectable, it should return to normal soon.
So I wonder what your doctor is going to do next? Continue combo until HBsAg turns negative? Stop Interferon, but continue with TDF? Or stop all treatment altogether?
Do keep us posted. We are keeping our fingers crossed that you will achieve Gold.
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Hi Stef,

Thanks for your feedback.
As per my doctor initial plan, the treatment will be 48 weeks combo therapy, after that stop all the treatment with close monitoring.
Do you think i will continue to clear if i stop the treatment after week 48? now i am on week 42, i have 6 injection left.

Best Regards,
AsianMale1985
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Hi Stephen,

Thanks for your feedback.
The initial plan is to do 48 weeks of combo therapy, then after that stop all the treatment and do close monitoring.
What do you think on this plan?

I will surely post every update on my situation to you guys.
Lets hope for the best.

Best Regards,
AsianMale1985
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