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Please help me decide
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Please help me decide

Hi All,

I am 41 years old female from SEAsia. I knew I have hep B for about 7 years but I think I was infected when I was younger as my youngest uncle, my younger aunty & my oldest aunty died of liver cancer 17, 7 & 2 years ago repectively.  They all have hep B but only the oldest aunty knew she was infected.  I was and am still very frightened by those deaths in my family and fear very much I will suffer the same fate. I see my doctor regularly and never miss the appointment and all the tests. As my alt, ast levels are always a little bit high ( eg. alt= 62 & ast 46 when the upper limit is 52 & 36 ) for about 2 years now and he wants to start the treatment.
But he only told me about Peginterferon and when I ask about oral medication he just said it will take long time to treat with oral medication. As I read minimum once a day this forum I have some knowledge about antiviral drugs and I prefer antiviral drugs rather than INF as it is also very expensive ( 350 US$ per week ). And if it doesn't work I have to continue with oral medication anyway. I know that the goal of the treatment is to make HBV UND, right? I am very confused, cannot concentrate at work and feeling very miserable.
I would appreciate very much if somebody could share their thoughts on my situation, whether to go with Peginterferon or oral medication like Baraclude.
One question is, could my chronic hep progress into cancer if I do not choose Peginterferon?? I do not know my Genotype. It was never checked.

Test Results for the last 2 times are as follows:
21.11.08   Albumin,  Bilirubin(Total),  Alpha-Foetoprotein --- Normal
                Alt  55 ( Ref. 9-52 u/l ) ---- High
Ast  47 ( Ref. 14-36 u/l ) ---- High
HBsAG  6340 ( Ref. < 1.0 ) ---- Reactive
HBeAg  -------------------------Negative
Anti-HBe------------------------Positive

11.3.09 HBV DNA  446,574  copies/ml

01.06.09 Albumin,  Bilirubin(Total),  Alpha-Foetoprotein --- Normal
Alt  62 ( Ref. 9-52 u/l ) ---- High
Ast  43 ( Ref. 14-36 u/l ) ---- High
HBsAG  5440 ( Ref. < 1.0 ) ---- Reactive
HBeAg  -------------------------Negative
Anti-HBe  0.77 ( Ref. < 1.2 )----Negative
Blood Report--------  RBC,  Platelet --- Normal
WBC -------------Monocytosis

26.10.09 HBV DNA   977,760  copies/ml

Thank You




Related Discussions
17 Comments Post a Comment
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Avatar_m_tn
april, my sympathy goes to you.

i think with the last two readings, you are defintely a candidate for treatment. you should have started treatment sometime ago.
keep in mind that with your e antigen readings, you will be on meds for life. there is no way around it until one day - if ever,  a cure is found for this disease..
you are  hbeag negaqtive with eab postive so you've seroconverted with a very high level or virus dna in your blood.
as for INF vs oral treatment, there is one very very tiny slim chance that with INF you will get rid of the virus altogether but thats like a chance in millions.. i kind of understand why your doctor may be suggesting INF..
lisen, i would probably start with something like baraclude and monitor very very closely both my LFT and HBV DNA .. if baraclude does not settle those two down then maybe INF will .. i think baraclude will do just fine if u ask me

good luck and keep us posted
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Avatar_f_tn
Thank you so very very much for answering me. Whenever I talk about this I always get emotional.
This evening I'll go for alt, ast blood test and I'll see my doctor tomorrow.
And I have to insist that I'll go with baraclude as the first treatment. Although I read some articles and answers from this forum about hep b, I really don't understand deep enough.
Thank you once again and I'll keep you posted.
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Avatar_f_tn
Yesterday I had the alt, ast results which are within the normal range.
alt = 44 ( 30-65 u/l )
ast = 29 ( 15-37 u/l )
My doc told me that he'll not start the tx yet. He wants to see the next month's blood test again. And he ordered me the usual blood test again with Albumin,  Bilirubin(Total),  
Alpha-Foetoprotein, ultrasound, HbsAg, HbeAg, Anti-HBe antibody...etc. When I asked about the treatment, he said as long as alt, ast levels are back within the range for about 2/3 months although I have high HVB DNA I have time to wait with the treatment. And he said once I start the tx I cannot stop anymore, like you told me,  it's for life ( in his words, "we don't know when to stop").  He assured me that I am not yet the candidate for tx as my alt, ast is not 2x the upper limit. As he is monitering my alt, ast levels every month, he suggested me the tx with Peginterferon on September because alt and ast shot up to 93 and 65 in that month. But in October, it comes back down to 55 and 53 and this month back to normal again. One way I feel a bit better but I still feel that I need to do something. I still don't know what to do. I just have to wait until next month , I guess. At the moment, I am just trying to be happy. Any advice?? Thank you.
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Avatar_m_tn
be carefull check your liver with fibroscan before saying everything is ok, normal alt/ast doesn't mean no liver damage in all cases especially if hbv-dna is not very very low almost undetactable.

i have been waiting from 2002 because i was with f2 mild fibrosis with alt/ast normal, low hbv-dna and doctor said we have more than 5 years before serious damage to the liver.

this year we have checked liver by fibroscan because i had alt-ast at 500 and we have found fibroscan at 15.9 which is cirrhosis (early and compensated in my case) so i have immediately started entecavir and hope to reverse cirrohosis by 6 years treatment (cirrhosis have higher rates of liver cancer).

so my suggestion is check by liver biopsy or even better by fibroscan to choose if it is better to start treatment or not (alt/ast alone means nothing), entecavir has 1.2% resistance at 5 years so why not to cure, especially if you have entecavir free by insurance or your government?

also consider that high hbv-dna put you at risk for liver cancer esecially high hbv-dna, i would wait only if you are immune tollerant fase.what is your hbv-dna and hbe-ab?
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Avatar_m_tn
also interferon is a good choice if you have little liver damage because you can stop treatment
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Avatar_m_tn

sorry i saw now your results at the begining and they are getting worst (hbv-dna and liver damage are the important points not alt/ast), hbv dna has got very high and you are losing hbe-ab antibodies (you are not in the immune tollerant fase anyway), i would check immediately with fibroscan and start cure as soon as possible.
if liver damage is low i would start interferon plus entecavir or tenofovir to see if you can achieve hbs-ab, if you have more damage to the liver (f3-f4, fibroscan 11-12 or higher stiffness) i would start entecavir immediately, these are the indication for treatments in italy, treatments are free here so the only point doctors consider is to have the best results from treatments.
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Avatar_f_tn
Thank you for taking the time to advise me on my situation.
I have done the fibro scan on 10.March. 09 and result written there is 5.2 KPa for stiffness.
I know I have to do something; I do not want to wait until the damage is done. You are absolutely right. Next month I'll visit neighbouring country which is more advance than my native country and I'll consult with the doctor there and make all the blood test and fibro scan again. In my country there is no insurance or any support from anybody. You have to pay everything by yourself.  I am at least one of the lucky ones who can afford all these tests. But still 350 us$ per week for 48 weeks for peg interferon is too much and I do not want to burden my family for this amount of money. (Of course, if we sell some of the family belongings then we can afford it).
That's why I am thinking very carefully.
I'll decide next month after knowing all the results and what would be the best tx for me at what cost and if I cannot afford it what would be the second best tx...something like that. But I'll start the tx whether it is the second best or third best. My doctor says he could treat me with tenofovir when I need it.( he decides now that I don't need it )
Thank you "stefano". Your info is very precious to me.  
I wish you to have the best possible outcome from your treatment. Take care.
I'll post again when I have the results and let you know what I decide so that the people who are in the similar situation like mine could learn from it.
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Avatar_m_tn
you have no damage at all to the liver so you can wait and monitor every 6 month blood/fibroscan because there are a lot of therapies on pipeline

interferon would be the best for you because you can stop it anytime, antivirals are very very dangerous to stop and even if tenofovir is not as expensive as interferon you cannot stop it safely, so i would suggest wait or interferon because of your costs problems and in any case follow doctor advice
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181575_tn?1250202386
Given your family history of HBV, it's farily certain that you were infected at very early age, probably via vertical transmission at birth.  At 41, with elevated ALT and increasing HBV DNA, it fairly certain that you have an active eAntigen - disease.  I think there is no point in waiting for treatment, especially given the family hsitory of liver cancer.  I think you should be proactive in treatment, instead of the "wait and let's see".  

It is very unlikely that INF will help you clear the virus or to give a sustained response after 1 year of treatment.  You need continuing treatment to supress the virus since the virus escape your natural immune control.  If I were you, I would ask to start Entecavir or Tenofovir quickly and monitor the response to make sure you reach UND DNA quickly.  The quicker you reach UND, the higher the chance of the med will continue working.  If you could get it UND quickly you may be able to do monotherapy for some time.  At a later point, you may have to consider combo treatment (to minimize risk for resistance).   You have to keep in mind that you will likely need life-long treatment.

A liver biopsy is probably a good idea to get an initial baseline look at your liver before treatment.  Then after some time you doctor will have something to compare it to if needed.
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Avatar_f_tn
Thank you all for your advice and the support you have given me.
I feel lucky to get in touch with the people like you who are helping total strangers.
Next month I will surely get the treatment I need and I want. The hospital I am going to visit next month is an internationally well-known one and I am sure I will be able to discuss the treatment plan with one of the doctors there. Then I would feel safer as I am treating my condition and I hope I will be 100% happy again. Since the time I know I have HBV whenever there is something to be happy about, in the back of my mind, I said to myself  " you cannot be happy, you are a hep b carrier ". I think you know what I mean.
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Avatar_f_tn
Hi All,

Though it's a little bit late, I wish all the best, health and happiness to you and your families in 2010. I was in the neighbouring country and made fibroscan and it shows 3.7Kpa for stiffness and doctor said that my liver is ok. Because of the HBV DNA result done in October 2009 which is 168,000 IU/ml ( 900,000 copies /ml ) she prescribes me entecavir, but I haven't started taking them yet. ( Eventually I have to , I am sure) Blood test in my home country shows HBsAg+, HBeAg-, Anti-Hbe-, and the rest - Alt,Ast, Albumin,Bilirubin ( Total ), Alpha-Foetoprotein - is within the normal range and my HBV DNA is   5376 IU/ml  checked in 18-12-2009. My alt, ast is within the normal range for 2 months straight now. My doctor told me to check alt, ast again and come back to him end of February. I was of course happy and at the same time wonder, whether it's possible that it becomes very low within 2 months. Another thing is October 2009 test was done in neighbouring country hospital and the one from December was done in my home country. Different machine different results, is it possible? I must admit I watch what I eat. Cabbage, shallots and lemon salad, fresh pineapple, 250 ml of fresh carrot juice, fresh aloevera gel (white gel from aloevera leave as I have lots of aloevera plants in my garden) and vit D3 and calcium for my bone density. I just found out from one member's post that vit D3 is also good to boost immune system. The last thing I add in my diet about 2 weeks ago before I make the HBV DNA test was some herbal medicine which my mother found out. I know herbal medicine could harm my liver but the story my mother told me was great so I said I'll try for some time. I don't know what is working or not working. I just want to share my experience with you.


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Avatar_f_tn
I am trying to find out what the herbal medicine call in English. At the moment I only knew it in my own language. As soon as I know the name in English I'll post it. It's dried plants, I have to boil it and drink it like tea. It tastes very bitter.
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Avatar_m_tn
hi april, your liver is more healthy than most of the people without hbv, i strongly suggest not to start antivirals tx at the moment because you will have to take them all your life and they are not tested for toxic/cancer issues over a life time.

It is absolutely better to wait because there are a lot of trials going on or try interferon at least you can safly stop it whenver you like and also have a high chance of clearing the virus when you stop it

you can take cofee 2-4cups a day and green tea, both are proven to stop or delay liver fibrosis

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Avatar_f_tn
Hi Stefano,

Thanks for your suggestion. At the moment I will not start any antiviral drug yet.
I found some web sites which says about "Liver flush" or "Liver cleansing" programs with EPSOM salt and olive oil and apple juice, etc. Do you know whether it is safe for the people with hep b to try this out? Or any benefits by doing it?

April  
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Avatar_m_tn
dear April be very carefull when you search internet, i work myself on the internet and sell goods and there are a lot of frauds even with false forums linked to websites.....
everything good and healthy in general is good for you and you don't need to search internet for special secret herbs or cocktails....all anti free radicals nutrients are good for you and for the liver in general and whenever possible buy fresh foods close where you live.
at the moment i am using cofee (which i always liked very much), melatonin, vitamin d3 (but i make blood test to check deficency, too much vit d3 can be toxic) and green tea because there are trials that prove they have a positive effect.
Also silymarin is very good for liver damage prevention but it is not good to use it when you are under antivirals tx because it interferes with antivirals, so i don't take it.

i also take omega3 and soia lectin to lower colesterol and it works for me and also check weight and make at least some regular gym (i will start swimming again when i get und).
fat and colesterol are proven to repress immune system for any illness, too much fat can also damage liver (fatty liver..).if you like italian/mediterranean cuisine that is very good for health and liver.

also make regular ultrasound and alfa protein every 6 months because hbv carriers have higher risk of liver cancer especially after 35-40yo


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Avatar_f_tn
I understand what you say.  Thanks. At the moment I don't make any exercise. There was one month I exercised 1 hr a day and that month my alt went up to 93. I searched internet about the relation between exercise and high alt and found out that people with liver disease should not make strenuous exercises. I also noticed that every evening I felt so tired and I was in bed already at 8 pm. Since that time, I was so afraid and stop exercising. My BMI is 20.7 so my weight is ok.
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Avatar_f_tn
hi there!
i have been on Baraclude for 2 years, so far so good with my blood test every 6 months, the only thing i would like to ask anybody knows any program to support for Baraclude 's patient who can't not afford the cost of medication, i am afraid of losing my job soon, and without insurance of course i wil be unable to afford my medication, thanks for your help
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