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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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I am sure your doctor knows what he is doing.I do not have a clue, as you know, many patients seroconvert after stopping Interferon treatment. But in your case, you also take TDF which normally requires a period of consolidation before stopping. So close monitoring is the way to go.
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do not stop therapy whatever the doc says, change docotor if needed, if you stop you ruin all the response and hbv will mutate........absolutely do not stop until you have hbsab to protect you from relapse, being hbsag und and hbvdna und is useless without the immunity antibodies hbsab to protect you

talk to your doctor in advance, his initial plan was likely to never consider hbsag clearance so maybe this is the reason for the stop

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Hi Stephen,

Thanks for your valuable input. I will update to you guys if i have any update on the plan.

Best Regards,
AsianMale1985
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Hi Stef,

Thanks for your feedback.
I will try to talk to my doctor and see how is his plan.

Changing doctor may sound difficult in my position as he has been a good doctor for me at least for this past few years. He also know my condition very well since he has been monitoring it for quite some times.

Once again, thank you very much for your support. i will take your opinion in deep consideration.

I will keep you guys updated for any new situation.

Best regards,
AsianMale1985
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stopping treatment will not necessarily cause HBV mutation.  Since there is no antiviral in your system, the HBV will just go on reproducing as normal since there is no medication preventing it from reproducing.  The HBV will not need to mutate, as there is nothing to overcome.
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hbv will mutate to escape immune system response, there is no mutation for tenofovir...
it will be an hbsag mutant to escape hbsab pressure which is present to lower hbsag, this same mutation happens during intf monotherapy
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to all:
asian male response to tdf+intf is of course easier because hbv was not yet mutated to escape immune response to hbeag and hbsag, he started while still immune tollerant (very high hbsag, hbeag, hbvdna)
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3156104 tn?1357284795
Not able to control myself for next update from Asianmale, i would love to wish him really happy new year for his escape from viral world.

Simply gr8 recovery kudos !
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Hi everyone. Found this article about Tenofovir: Hepatitis B treatment: Current best practices, avoiding resistance
. Worthy of read:
http://www.ccjm.org/content/76/Suppl_3/S14.full
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14 months on TDF Alone,
on most recent one FEb 12th 2013
AST 24, ALT 34
Hepatitis B virus DNA 31 IU/mL
Hbs ANtigen reactive
Hepatitis BE Antibody Non reactive
doctors worried i have very slow reacting of DNA level.
down from 180IU/mL  in November. 2012  ASt 24 alt 35

consulted with 3 doctors in LA all not recommending add INF.
over here no test for Hbeag Quant, maybe i should go to somewhere else?
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for hbsag quant you just send the samples to labs i europe or india, just so simple

add intf is the smartest thing after you know hbsag quant, if you have chances to get doctors out of US is better, looks like most are corrupted or ingnorants there
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Dear All,

I have already receive my latest report up to week 48 which is end of my treatment.
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

February 2013 result (week 48)
Hbs Ag (Quant) : 2.66 (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 : 43
ALT : 70

For quick information:
HbsAg still reactive by end of treatment.
HbeAg become negative as a result of treatment (with anti Hbe appeared)
HBV DNA is undetected (<15)
ALT getting better.

As per my doctor suggestion, we have stop this treatment as per initial plan, so now i am off treatment.
The next action now is close monitoring every 2 weeks and see if my body is continuing to clear the infection.

Kindly give your comment.

Best Regards,
AsianMale1985
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sorry you have such an ignorant doctor if hbsag is 2.66iu/ml and you stop peginterferon now you may lose all you achieved and not clear hbsag while 2 years of pegasys (which is going to be routine in responders) will clear hbsag 100%

the minimum you can do is start tenofovir as soon as you can to avoid relapse if you dont want to keep peginterferon, hbsag clearance by peginterferon with such a low value was just weeks apart once hbsag is negative you need to wait for hbsab antibody and then if low antibody make hbv vaccine and keep tenofovir until immune system can keep clearance of hbv

see otan posts
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a good percentage goes on clearing hbsag off treatment but hbsag negative is not enough you also need to develop a good value of hbsab because hbv is still there and only a high value of hbsab can protect from relapse.a good value is a stable 500miu/ml or even better 1000miu/ml

it is discusses in otan and the use of antiviral plus vaccine plus zadaxin to boost antibody, according to your country you may also use zadaxin  plus tenofovir if not keeping intf
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Hi Stef,

Thanks for your reply and input.
I have highlighted this to my doctor to continue pegasys, but my doctor refuse to do so as he mentioned that he is following the guideline of normal pegasys treatment (on the country) which is up to 48 weeks.

I have try to seek another doctors opinion, but they give same opinion where my treatment should stop at week 48.

Perhaps if i have to take another pegasys course, i will need to find other doctor from other country (Indonesia perhaps a place where Otan live).

I will keep in check on this close monitoring session and see what is the output. Will keep update you guys for further action.

Best Regards,
AsianMale1985

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you need a very expert doctor no a dumb stupid who follow guidelines, an expert doctor personalize treatment the guidelines are for the dum ones

definitely look for a researcher or an expert doctor, in the end you may not menthion you were on peg 48weeks if all doctors are like that in your country....also check european guidelines maybe they updated with longer pegintf course on responders

i guess you don t even need prescription in some asian contries so you may keep pegintf or norma intf and just have the doctor  monitor results, maybe vietnam/india are the most advanced on this
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Pretty good result. The question is: can the response be sustained? I think close monitoring is a good idea. Don't be alarmed by a rise in hbvdna in your first test after stopping - the rise may be temporary.

Good luck and all the best.
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He is having his treatment in Singapore which is the best country in South East Asia. And if even doctors there simply follow guidelines without personalizing the treatment, how can we, South East Asians, get personalized treatment? Do we really have to go to Italy? I am happy and frustrated at the same time for him. Really.
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just a question of expert doctors or not, you may find such doctors in italy too
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contact otan i think he/she found a doctor/researcher very very expert in vietnam or singapore
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Dear All,

As promised, here is my latest result up to week 50.
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

February 2013 result (week 48)
Hbs Ag (Quant) : 2.66 (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 : 43
ALT : 70

==================================================
Treatment stopped.
==================================================
March 2013 result (week 50)
Hbs Ag (Quant) : 2.39 (still going down but not significant)
Hbs Ag : Reactive
Hbe Ag : Non-Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
Anti-Hbe: Reactive
HBV DNA : UND: Ref <15
AST : 30
ALT : 55

For quick information:
HBV DNA is undetected (<15)
AST normal.
ALT getting better.

Treatment have been stopped for 2 weeks.

Continuing monitoring action till next 2 months.

Kindly give your comment.

Best Regards,
AsianMale1985
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if you have no high hbsab antibodies it is useless to stop you will relapse, see otan experience she really did the right things

are you on tdf mono?you can add ezetimibe even if we dont know if it is able to stop reinfection, i will be able to confirm if this work in april by my second hbsag test

as suggested eralier you should restart pegintf and keep it until hbsag is formed and if it does not reach good stable levels at hbsab 250-500miu/ml hbv vaccine and zadaxin are needed to keep response.it is also very very important to keep hbvdna undetactable so that the virus cannot mutate hbsag and make hbsab antibody useless
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Thank you for that excellent history. It seems you have also successfully seroconverted your e-antigen. So you have stopped both Tenofovir and PegIFN? Please keep up posted.
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as suggested eralier you should restart pegintf and keep it until hbsag is formed

sorry i meant hbsab is formed to levels 250-500miu/ml stable
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Hi there,

I am Asian Male infected with Hep B too.

Really glad that you have managed to seroconvert HBeAg and I pray that you are going better everyday...

Thanks....
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Hi Stephen,

Yes, now i am not taking any medication. It has been 1 month since i stopped  both TDF and Pegasys. Now i am waiting for my next blood test result post treatment.

I will keep u posted for any improvement.

Best Regards,
AsianMale1985
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Hi Stef,

are you on tdf mono?you can add ezetimibe even if we dont know if it is able to stop reinfection, i will be able to confirm if this work in april by my second hbsag test

No, I am not on TDF mono now and it has been almost a month without medication. Now i am waiting for my latest blood test result (1 month post treatment).

as suggested eralier you should restart pegintf and keep it until hbsag is formed and if it does not reach good stable levels at hbsab 250-500miu/ml hbv vaccine and zadaxin are needed to keep response.it is also very very important to keep hbvdna undetactable so that the virus cannot mutate hbsag and make hbsab antibody useless

Yes, as per your advise,  in the monitoring status, i am still looking for a doctor that can advice me for restart of Pegasys. Seems like every doctor that i visit refuse to do so. Will keep u posted on this.

Best Regards,
AsianMale1985

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Hi Kantaka,

Thank you for your prayer. Same to you, wish you and all the people here always healthy and happy.

Best Regards,
AsianMale1985
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just buy pegintf and have the doctor monitor you or at least buy tdf which is very safe and need less monitoring

keeping tdf you are safe from hbsag mutations which abolish any possible cure by hbsag negative/hbsab detactable, sorry the doctors acted out of any guidelines, they should have broght you to hbsab detactable not just giving drugs as dumb a.... we can do that ourselves not needed them

best thing could be at least tdf+ezetimibe now since very easy to buy, if you are in asia probably even with no prescriptions required....
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post your country here so maybe other members may help to find reputable and updated real doctors.usually those going at conferences like easl, aapals and so on are very updated and may help you finish to clear hbv  which is 100% now with hbsag 2iu/ml
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Hi Stef,

I am treated in Singapore (Southeast Asia). I have posted this info in my earlier post.

Best Regards,
AsianMale1985
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Dear All,

As promised, here is my latest result up to week 52 (1 month post treatment. Stop pegasys + tenofovir).

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

February 2013 result (week 48)
Hbs Ag (Quant) : 2.66 (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 : 43
ALT : 70

==================================================
Treatment stopped.
==================================================
March 2013 result (week 50)
Hbs Ag (Quant) : 2.39 (still going down but not significant)
Hbs Ag : Reactive
Hbe Ag : Non-Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
Anti-Hbe: Reactive
HBV DNA : UND: Ref <15
AST : 30
ALT : 55

March 2013 result (week 52)
Hbs Ag (Quant) : 2.47 (uncertain)
Hbs Ag : Reactive
Hbe Ag : Non-Reactive
ANTI-Hbs (Quant): < 3.0 Non-Reactive
Anti-Hbe: Reactive
HBV DNA : UND: Ref <15
AST : 19
ALT : 31


For quick information:
AST and ALT finally become Normal (After 3 years high ALT)
HbeAg is still negative (Anti-HBe sustained)

Treatment have been stopped for 1 month, no medication right now.

Continuing monitoring action till next 2 months.

Kindly give your comment.

Best Regards,
AsianMale1985
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normal alt with present hbsag and no hbsab is not a good sign, you stopped killing the infected cells which keep hbsag production and block hbsab

i strongly suggest to follow the posts about entry inhibitors and if my second test confirms hbsag decline you can use them immediately
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i'll follow stef..

regard to AsianMale I think eag-ve is very good and you may have UND DNA for the whole life.. would you consider taking immuno globin to get hbsab??
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Impressive result there. A success story and also noting not much side effect from the combo treatment. Well done.
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Great Job, Am happy to hear that this seroconversion is not impossible
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what's the latest result/update after 52 weeks.
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what's the latest result/update after 52 weeks.
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4981175 tn?1392612659
Hi there, whats ur latest result now? Hope that your okay now..
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Hi may i know the cost of your ifn treatment in sg? How much does each jab costs?
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hello asiammale, i am from asia too but form phil.  and i am a lady 23 years old. your story about pegasys treatment is inspiring, i am to start my treatmet nxt week too with pegasys alone. hope u already cleared the virus by now.
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What is your latest results?
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Any latest updates?
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i think he cleared....when you get cured you are very likely not to come back here or to look anything about hbv anymore.with an hbsag 2iu/ml you clear even with no drugs
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maybe he did not want to get confused anymore and yes maybe he got cleared and forget all the things about hbv.
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man, we need update :)
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Hahaha it seemed so poor wen Steff wanted him to continue beyond 48weeks on peg but that ignorant guy didn't listen and just kept on singing my doctor my doctor. He forgot the initial days wen he started his steps on Steffs guidelines. Miserable person, who knows wats his situation is.
Any other person on peg now currently?? Plz update ur results.
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people need to understand that there are doctors and "doctors" ...
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So stef2011 was wrong in this case?
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No Steff wasn't wrong, that person should have continued peg after 48weeks. But tell u it's very hard to bear peg and one may get avulsion from them after such a long therapy.
Nevertheless it's not the time to c wats right n wrong rather anticipate something big at horizon.
Hbv therapy is all just tdf+peg. U lucky enuff play ur chance that's it!
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