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Results after 44 weeks of TDF+Peg+NTZ
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Results after 44 weeks of TDF+Peg+NTZ

In March 2012 (Before Treatment)
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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 )
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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 )
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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

15-May 2013 (After 44 weeks of PEG + TDF + NTZ )
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HBV DNA --  UND
HBsAg (Quantitative) --  2612.48 IU/ml (cut off= 0.05 IU/ml)
25-OH vit D3 --   54.8 ng/ml
ALT - 84 u/l
AST - 80 u/l
Platelet Count is normal - 177

Last week, I had the last shot of Peg. I am very disappointed with my HbsAg results. It's not going down anymore. Doc said the effect of Peg will stay on very long even after the last shot. I continue taking TDF but stopped NTZ now. My Alt and Ast is also still high. Very disappointed!
27 Comments Post a Comment
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Avatar_m_tn
Must be patient.  Can continue with serial treatment to prevent HCC and cirrhosis.  TNf is very good drug.  No resistance.  The next generation of drugs will be out in a few years.  
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Avatar_m_tn

we do know that pegintf non response is due to t-regs suppressing hbv specific immune responses and probably other parts of immune system too.use of antivirals lower t-regs and rescue specific hbv immune system response so i do suggest to keep tdf for about 2-3 years at least and when there is some hbsag lowering again add on pegintf again.
non response after use of thf or etv for more than 3 years is very rare, 10% but this was not even on tdf or etv but on lam+adv

it is also probable hbsag will lower a little after pegintf is finished, you may try some maitake too and see if it works.in vitro maitake improves pegintf response 9 folds and if you start it right now it is kind of an add on to the peg effect which will remain for about 1 year
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Avatar_m_tn
No need to be discouraged.  You gave it shot, but there are no guarantees in getting results.  Peg should continue to benefit you for years.  Did you do labs just prior to starting treatment (March to October >12 weeks)?  with regards to Peg, they have very clear stopping rules now as to whether you have a chance of SVR.  I have been researching because my doc wants me to go on Peg.  If >/10% HbsAg drop coupled with >/2 logs drop in HBVDNA at week 12/24 has high correlation with response.  Obviously in your case TDF obscures HBVDNA drop.  

If you don't mind me asking, what was your Doc's rational for prescribing both TDF and Peg?  I understand the studies from Add-On point of view after several year on TDF, but not sure starting them together.  Any research that you are aware that would increase SVR chances?  

Also your AST are constantly higher that ALT.  That is strange for someone with healthy liver.  That may be result of working out or something.      
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Avatar_m_tn
add on has about 50% clearance at 48weeks and hbsag lower than 300iu/ml on the rest of 40% patients, just one failure 10% but no using tdf or etv but adv+lam

pegintf plus tdf all at once is much much lower results, but it is possible to retry after few years on etv or tdf
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Avatar_m_tn
Who prescribe NTZ? Does the Dr know you take NTZ?
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Avatar_m_tn
What's worrying is the Fibroscan result : you went from 4.1 to 6.1 within ~6 months of treatment that should help this result not worsen it from what Ive read.
You need to stay positive IFN will help despite the HBsAg result, there are studies that it lowers HCC risk a lot despite no SVR. I'm on IFN week 40 now and my HBsAg results behave similar to yours - it stays on same levels.
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Avatar_m_tn
yaksss, I feel for you sorry..

Guys, you know we need to all go to Canada and sit in front or Replicor building, have them read all these stories...

That is what what we should do...
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Avatar_m_tn
I understand the add-on to nucs, but according to Lampertico presentation in January 2013, de novo therapy with nucs and peg does not increase SVR.  As far as I can tell, he is one of the biggest proponents of using Peg initially on patients, and he does not recommend combo.  
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Avatar_m_tn
Hi, what's your number in HBSag? Maybe IFN is good for preventing HCC because it's an immune booster. Boosting immune system naturally should have good result also but it's different for everyone. Always want to add new antioxidant to the regimen.

I feel for April.
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Avatar_m_tn
I agree combo treatment does not increase SVR but does  not hurt.  
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Avatar_m_tn
You do realize that you'll still need to use Peg with Replicor right?  Provided that the drug is ever approved in current state.  
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Avatar_m_tn
You are wrong, there may be some nephrotoxic sides if you add painkillers people use to cope with IFN side effects. Remember not everybody handles IFN the easy way.. some have strong fevers/flu effect.  It would be perfect of you link a study result to what you say about combo results. I think that most options on combo treatments here are based more on theory rather than actual med trials. Gilead is currently running a combo trial of IFN/TDF and results will be available around 2015. Its too bad they don't have a sequential arm just combo combinations. I think that what stef does has more sense than a combo: keeping TNF for a few years and then starting IFN.
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Avatar_m_tn
Everybody should have one try with interferon just in case they are lucky reponders. I remember Steff also said this before.   I did not recommend April to do the combo.  I also think she should do serial treatment.  But just giving her support.  It is kind of her to share her treatment experience.  I do not think April needs any painkiller for her PEg.  
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Avatar_m_tn
Sorry.  I have to take back the last sentence about not needing any painkillers.   I am not sure whether she took more medication than panadol for the side effects.  
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Avatar_f_tn
Thank you all very much for your support . I am feeling a bit down at the moment. Throughout the tx I lost a lot of hair and had flu like symptoms and tiredness, wired headaches, sometimes more, sometimes less. I used paracetamol when I cannot stand it anymore but I tried not to use it often.

@celebz..I am very encouraged to know that "IFN will help despite the HBsAg result, there are studies that it lowers HCC risk a lot despite no SVR."

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Avatar_m_tn
April recheck that Fibroscan result.
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Avatar_m_tn
lampertico is doing many studies and the add on study after longterm nucs is his too

peg+nuc immediately work well on hbe+ but much less on hbe-, the add on sequantial treatment is the way to go
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Avatar_m_tn
Throughout the tx I lost a lot of hair and had flu like symptoms and tiredness, wired headaches, sometimes more, sometimes less

dont worry the hair will come back 3-4 months after you stop, i also had all that by imiquimod and i think pegintf was a good try anyway you will benefit a little while on tdf mono anyway
the paracetamol taken while on peg is no problem if doses are low and correct for liver disease

your fibroscan is not much different, 6kpa is still healthy rage and that is probably just a little inflammation by the immune response made by peg, this will go down in few months too

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Avatar_m_tn
http://www.mvlabyzh.fudan.edu.cn/admin/pic/uploadfile/2013052357155265.pdf

extremely interesting, especially the part of hbvdna intf alpha suppression, this is probably one of the reasons sequantial therapy works and pegintf mono doesnt
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Avatar_f_tn
@calebz..I'll again check with fibroscan in September.

@stef2011..Thanks for the link. I saw in other thread that you are taking Mitake muchroom supplement. Do you know about Lingzhi muchroom?
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Avatar_m_tn
i havent seen enough studies on this i prefer maitake only for now which is the most studied in vivo
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Avatar_m_tn
There are studies saying that prolonged 96 weeks is safe and has response rate of almost 30% against 7% comparing to 48 week of interferon. I think if you can bear sides and high cost of pegasys just give yourself a chance and continue interferon.
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Avatar_m_tn
no it is best to stop and restart it later on, she won t lose the effect of this 48weeks treatment if she restarts in 1-2years

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Avatar_m_tn
Here is another paper on how add-on therapy is supposed to work.  Very informative.  Nucs rescue CD8 and interferon does the rest.  Not sure if it has been posted here before.  

http://www.sciencedirect.com/science/article/pii/S0168827812008719

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Avatar_m_tn
thnaks this is extremely interesting article

it would be useful to gather also articles about effects of single nucs on immune system, i remember tdf, etv and telbivudine having different effects on immune system

it would be very interesting to see pretreatment of tenofovir plus telbivudine (since the strong effect of telbivudine on immune system) and then add on of pegintf with tenofovir only to avoid the sides experienced with telbivudine plus peg
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Avatar_m_tn
What I found interesting from the article though, is that theoretically it shouldn't take long on Nucs to rescue CD8 (months), but most of the studies done on add-ons are multiple years use of NAs then peg.  We are in need of some studies with different time intervals on NAs, then add-on peg.  Maybe the clinical data for GS-9620 will be able to shed some light on this, since they only required HBVDNA undetected for three months for the current trials.  

Some Canadian study that I saw, had HbsAg clearance at 30% for people with Hbe-negative based on several weeks of treatment with NA, add peg, keep NA for a couple of more weeks than continue peg only.  It was posted on the forum here somewhere.  These patients were exhibiting very high Alt at the time of therapy.  So it would seem to me that even if immune system is rescued during NA, it would still need a kickstart (so to speak) from Intf (or some immune modulator) to finally mobilize and clear.  But at the same time Intf, inhibits CD8, how exactly does HbsAg seroclearance occur in Intf mono therapy if no CD8 help?  

Another question would be for people with undetected (W/O therapy) HBVDNA, wouldn't they be the perfect candidate for therapy (vaccines, Intf, zadaxin) since their immune system should be fully recovered?  

The good thing is that we are acquiring the knowledge of how the virus works at a fundamental level and what mechanisms it uses to evade the immune system.  Is just a matter of time before we find the right combo to overwhelm it on a consistent basis for a high clearance rate.  

      
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Avatar_m_tn
how exactly does HbsAg seroclearance occur in Intf mono therapy if no CD8 help?  

i think the 7% who clears on intf mono had an active immune system response already before start of therapy, the annual rate of hbsag clearance on therapy naive hbeag neg is 4% and some studies even reported higher percentages
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