Results after 24 weeks of Peg+TDF+NTZ

[April9903]

In March 2012 (Before Treatment)
---------------------------------------------------
HBV DNA --  450,897 copies/ml
HBsAg (Quantitative) --  3054.03 IU/ml (cut off= 0.05 IU/ml)
HbeAg  -- Neg
AntiHbe -- Pos
Fibroscan =  4.2 Kpa
Geno Type C
Precore BCP ( T 1762 / A 1764 ) Mu
PC codon 28 Mu



22-October 2012 (After 12 weeks of PEG + TDF + NTZ )
-------------------------------------------------------------------------------------
HBV DNA --  186 copies/ml
HBsAg (Quantitative) --  2869.70 IU/ml (cut off= 0.05 IU/ml)
25-OH vit D3 --61.3 ug/l
ALT - 81 u/l
AST - 89 u/l
Platelet Count is low - 140



31-December 2012 (After 24 weeks of PEG + TDF + NTZ )
---------------------------------------------------------------------------------------
HBV DNA --  UND
HBsAg (Quantitative) --  2606.72 IU/ml (cut off= 0.05 IU/ml)
25-OH vit D3 --   46.1 ug/l
ALT - 52 u/l
AST - 63 u/l
Platelet Count is normal - 150
Fibroscan =  6.1 Kpa

My Hbsag is going down really slowly (which is disappointing). What I am worried right now is my fibroscan results increased from 4.2 Kpa (9 months ago) to 6.1kpa. Is it because of Peg tx?  My doc assured me that it's still in the normal range. I shouldn't take HepTec products right now because of tx, right? What should I do to reduce fibrosis? Advice please.

[April9903]

Thanks for the quick answer.

[stef2011]

Should I stop NTZ and take Sim or ezetimibe?

ntz+peg+tdf+ezetimibe(zetia), no sim for now

What should be the dosage?
ezetimibe is only 10mg a day dose with or without food, it has no interference with other drugs

Can I take Heptoboost and Heptoshield from HepTech products?
yes, only fibroguard is controindicated but since you are slowly responding i wouldn t mix too many things now

[April9903]

Should I stop NTZ and take Sim or ezetimibe? What should be the dosage?
Can I take Heptoboost and Heptoshield from HepTech products?

[Jeff912000]

Can also do sequential therapy if one year interferon not enough. Then Hbsag can slowly come down to zero.  

[Jeff912000]

Looks like a continuous HBsAg decline which is a good sign.  No rebound in HBSag.  

[stef2011]

slow responder but a responder....

Can I take Sim even if my colestral level is ok?

yes, the effect against hbv is not correlated to cholesterol in the blood but to intracellular cholesterol which is different.

my guess for what i understood from the studies is:
simvastatin will lower intracellular cholesterol so that virions are made of poor quantity of lipids/cholesterol in hbsag surface antigen, this will make virions less infective (hbsag is needed to enter and infect other cells)

another effect could be that many virions in circulation will have no hbsag couting but just hbcag which is very immunogenic (contrary to hbsag which prevents detection from immune system)

my understading of ezetimibe is:
this blocks cholesterol absorption by blocking a receptor that is used for hcv entrance and maybe hbv entrance too because it has been found to lower cccdna/hbsag

[April9903]

I am relieved to know that I am a responder. Can I take Sim even if my colestral level is ok? I am thinking to take 2g of NTZ as I am still on 1.5g

[stef2011]

I shouldn't take HepTec products right now because of tx, right?
no it is best not to take them with intf, especially fibroguard

What should I do to reduce fibrosis?
vitamin d and use of a statin will prevent any build of fibrosis, a statin n your case of genotype C is also important for HCC prevention which is high with geno C

[stef2011]

that is good you are a responder, slow hbsag decline is normal with hbeag negative and precore/bcp mutation.also be aware that the big decline will be at 48-72 weeks with your hbv mutations and hbeag negative

the difference of fibroscan between 4 and 6 is meanless, you have nothing to worry

you may try to see if intf response can be increased by ezetimibe (zetia) or smvastatin.i tried both and sim increased sides effect on muscles pains but zetia is having no sides