Hepatitis B Community
The best place for treatment of Hepatitis is India
About This Community:

This forum is an un-mediated, patient-to-patient forum for questions and support regarding Hepatitis B. Topics in this forum include but are not limited to, Causes, Diagnosis, Family and Relationships, Living With Hepatitis B, Research Updates, Treatment, Success Stories, Support, Symptoms.

Font Size:
A
A
A
Background:
Blank
Blank
Blank
Blank Blank

The best place for treatment of Hepatitis is India

Hi,

If anyone can suggest me the best place for treatment of Hepatitis B in India? I have tried hard but could not find a hospital is specialised for such treatment.
Related Discussions
270 Comments Post a Comment
Viewing 1-200 comments:
Blank
Avatar_m_tn
no doctors seems to be well updated. Very updated hepatologist or medical gastroenterologist. try to find a doctor who attends all liver meetings or having friends attending lives congresses. And it is better the hospital which conduct clinical trials. Above all, keep follow the forum keenly and try to discuss with your doctor. Most prbably they wont hear you. You better discuss your tests here. If you are in delhi area go to the ILBS hospital. Fibro scan is available there.
Take care..
Blank
Avatar_m_tn
Thanks. Indeed, doctors do not hear. I have a feeling that there are no experts available in India for Hep B treatment. They have some idea but it seems there is no treatment protocol available with them.

I am 45 years old and Hep B +ve since last 10 years (at least). I visited CMC vellore 3 times and recently visiting Asian Institute of Gastroenterology, Hyderabad from last 1.5 years. But so far no medication has been started.

My test results are as follows:
HBVDNA Quantitative: 6603(IU/mL), 38429 copies/ml,
Total Biluribin             1.3 mg/dL (Normal 0.3-1.2)
SGPT (ALT)               47 U/L (Normal 0-40)
SGOST (AST)            35 U/L (Normal UPTO 40)

Can you suggest something based on my report.
Blank
Avatar_m_tn
you should check the hbsag quantification to know about the chances of eradicate the virus. The test is available in hitech labs chennai. And in ramakrishna hospital coimbatore. If it's low around 1500 iu/ml, you can try alinia (nitazoxanide). Also check vitamin d and cholesterol levels. See other posts here to understand how vitamin d and cholesterol interfere hbsag. Take care.
Blank
Avatar_m_tn
And considering your age, stefano would suggest you to go for antivirals. The reason for suggesting antivirals is it's better being undetectable to avoid HCC   and other consequences. Anyway before start them take hbsag first and post it here, stefano ll guide you. Asian Institute of
Gastroenterology, Hyderabad.
Do they have fibroscan there?
Blank
Avatar_m_tn

in your case if fibroscan shows no relevat damage just monitor and see if our tries with alinia, gcmaf, interferon combos work.
as suggested hbsag quantity in iu/ml and fibroscan are necessary to know chances and if therapy is needed

nucs are suggested if:
liver fibrosis >7.1kpa or >f3
hbv mutations and genotypes with high risk hcc or family history hcc (see old posts for all mutations and genotypes)

interferon, alinia and possibly a nuc combo if:
hbsg less than 1500iu/ml
low or undetactable hbvdna
normal or high alt

nucs: only tenofovir and entecavir are safe after resistance test is done to be 100% safe even on these drugs.these drugs are useless on virus and can only stop liver damage or decrease hcc risk so a perfectly heathy liver has no need of these drugs
Blank
Avatar_m_tn
Thanks. I am not sure  whether Asian Institute of Gastroenterology, Hyderabad  has fibroscan, but they have Elastography test for liver (I do not know if it is the same test).

However, I will get the hbsag and fibroscan done and post you the results for your further views.
Blank
Avatar_m_tn
Thanks,

I will get the tests done and post the reports for your further views.
Blank
Avatar_n_tn
Dr.Nageshwar Reddy of Asian Institute of gastroentology  is an expert in liver ailments...he should surely help you regarding the disease
Blank
Avatar_m_tn
But he is heading Medical Gastroenterology department
Blank
Avatar_m_tn
Can you suggest me some place in eastern region where fibroscan can be done.
Blank
Avatar_m_tn
Hi stef2011,

You are suggesting to start interferon, alinia and possibly a nuc combo if:
hbsg less than 1500iu/ml. (is it hbsg or hbsag?)

What if it is more than 1500iu/ml
Blank
Avatar_m_tn
sorry. I dont know about eastern region. If i come to know, ll inform you in the forum.
Blank
Avatar_m_tn
You NEED treatment for sure start with ENTECAVIR .....Consult Dr PN RAO in asian ..or Dr Mahesh goenka in Calcutta.



Regards
Blank
Avatar_m_tn
Thanks.
Dr. P N Rao is a hepatologist at AIG, I will consult him.

Simultaneously, I will get the tests done as suggest by vijik & stef2011 and post it for your further views.
Blank
Avatar_m_tn
Dear Stef, vijik,

I have booked an appointed on 5th of Sep for Fibroscan & Other tests at ILBS Delhi as suggested by you.
However, my recent report about HBVDNA Quantitative PCR has come which is showing, 10625(IU/mL).

Based on this report my doc is suggesting me to start BARACLUDE 0.5 mg once daily for one year.

Is it O.k. or shall I get the tests done before starting any medicine.
Blank
Avatar_m_tn

hbvdna alone means nothing, that's not a good doctor at all if possible change with a more expert one

my sister had hbvdna over the detactable range (billions...) between jan and march after a stomach infection, researchers/doctors here suggested no therapy (i agreed too).hbvdna from march to june returned to 2 millions and now probably even lower.hbsag stayed about the same taking alinia.

this is to show you how your doctor is ignorant, there is no need to be a researcher to know hbvdna alone is meaningless, hbsag quant and liver damage are a must before chosing therapy

and even if so entecavir is not the best choice, tenofovir is more potent and safe
Blank
Avatar_m_tn

by the way ask the doctor directly why are you pushing me on entecavir since it is useless on virus if we dont know if i have any damage.....

also your hbvdna is not that high
Blank
Avatar_m_tn
MANY THANKS.

I will get the Fibroscan & hbsag tests done and see a Hepatologist at ILBS, Delhi.

I will post you the results and his prescription before starting the medication.

Regards
Blank
Avatar_m_tn
If you see no liver damage in fibroscan you can stay away from entecavir for sure. Dont waste money for things that deteriorate your health.
What about ilbs.? How much they charge for fibroscan and other tests?
Thanks.
Blank
Avatar_m_tn
please post the amount charged for fibroscan at ILBS
Blank
Avatar_m_tn
Dear vijik

Thanks a lot. You & Stef are a big help.

They will charge Rs.1000/- for Fibroscan, as they have told me over phone.

I have got an appointment at ILBS on 5th of September.  After my visit I will let you know the charges and all the other relevant details.


Regards and Thanks
Blank
Avatar_m_tn
Thank you. Post all results here in the forum. So other members, especially members from India in general and from north India in particular can use it.
Take care..
Blank
Avatar_m_tn
Dear stef, vijik

I have got the tests done at ILBS, New Delhi. They charged Rs. 1000/- each for Fibroscan & HBsAg Quantification.

The result of Fibroscan is as follows: Stiffness 4.0 KPa, Success rate - 61%.

The other blood test reports are yet to come. Once, I get these reports, I will post them for your views and advice.

I found many patients at ILBS, who are getting treatment for Hepatitis B. I also talked to a few them. They are getting better results and contented. The treatment protocol is similar to what you (Stef) has been advising. I will visit ILBS again on 16th Sept. to collect remaining reports.

Any comment on my Fibroscan report.
Blank
Avatar_m_tn
The result of Fibroscan is as follows: Stiffness 4.0 KPa, Success rate - 61%.

perfectly healthy liver so treatment is not necessary but according to hbsag quant it is good to try to clear hbv by interferon combos

Blank
Avatar_m_tn
"The treatment protocol is similar to what you (Stef) has been advising" - could you please be more specific about the treatment. What exactly is the protocol that ILBS is fallowing ?  (sometimes the details make the difference :) )
Blank
Avatar_m_tn
Thank you for posting.

As stef said,according to fibroscan, you don't need to take antivirals now.
Blank
Avatar_m_tn
Does anyone know fibroscan in Mumbai or in Newyork and a good hepatisis B doctor. I am a Indian leaving in US and just found out that I have hepatisis b.

Currently my result are as follows.



On July 27my Viral load was 200 millon
My ALT = 754
     AST = 524
     HB e antigen = negative
           s antigen = postive
      hb core antiboby = postive
           core surface antiboby = negative
      ultrasound = normal




ON AUG 20 MY VIAL LOAD WAS 1MILLON
MY ALT = 75
      AST = 45

on Sep 1 test result

MY ALT = 40
      AST = 35
waiting for viral load

not on medication
Blank
Avatar_m_tn
It appears that you came in contact with this virus recently and your body is clearing the virus. A process which may go for 6 months.

However, stef2011 and vijik can give you the exact explanation.
Blank
Avatar_m_tn
Dear stef, vijik

Many Thanks for all the support
Blank
Avatar_m_tn
The treatment protocol is combo of Inerferon, alinia and tenofovir. I do not know the exact amount of these medicines.

In some cases they have taking these medicines (or at least one of these) for last 2 years with good results.

I will visit ILBS again on 16th of this month and try to find more details.

Blank
Avatar_m_tn

wow, data about this combo since two years would be very helpful to our community

in US and europe drug makers are trying to make interferon combo data not available since combo of telbivudine and interferon had a decrease of hbsag in all patients by 12-24weeks only, so any data about this protocol would be very helpful especially alinia+interferon
Blank
Avatar_n_tn
Hi everyone. i recently found out that i have a chronic hep b and i have appointment on october 19 to see a heptologist. I am stressing a lot and thinking about it almost every second. I read many different information online, in some they say yes even if you have choronic hep b you can get rid of it and in some site they say you will never get rid of it. This is my first time to post a question about it online and i hope i will get a first hand and accurate info from one of you in here. So my question is, will i ever get rid of it or not???? Thanks in advance.
Blank
Avatar_m_tn

it depends, most doctors are ignorant and not treating or mking tests properly, many are just pushing drug makers business by selling antivirals which dont clear the virus at all.US is also missing all the main tests to monitor disease and see if hbv is clearing so that's the worst country to have hbv...

make sure you get the following:
hbsag quant with diluition by architect in iu/ml
hbvdna pcr
fibroscan
alt/ast

with these tests it is possible to say which and if a drug is necessary, also keep in mind that hbv makes no damage at all to us, it is our immune system to make all the damage killing infected cells, not the virus, this killing without virus clearance makes the damage.

so those having very weak immune response have usually no damage, it is also important to keep oxidation stress normal (redlabs.com or europeanlaboratory.nl have these tests), with normal oxidative stress liver has no damage and viruses and liver can coexist with no damage, see hepatitistechnologies antioxidative therapy and its results even n cirrhosis regression

here is a thread about hbv cure that pharma industry doesn t want to fund, we are trying ways to donate to the small company that has no funds tomake drug approval, any idea on "how to" is welcome (hbsag negative as early as 7days in best cases....so all  costly and useless hbv antivirals to the trash)

http://www.medhelp.org/posts/Hepatitis-B/Entry-inhibitors-show-promise-as-drugs/show/1570784

http://www.medhelp.org/health_pages/Hepatitis/HepB-Introduction--Welcome-Page/show/34?cid=153
Blank
Avatar_m_tn
I found very interesting what you say about the combo and i will like to found more details on that.

On 16'th when you go to the ILBS  could you please see if more details are available and also please ask for the doctors names  (the ones that are in charge with this combo) and email address, if is possible.  
Blank
Avatar_m_tn
some news from the visit form 16'th September ?
Blank
Avatar_m_tn
Hi Stef, Vijik & Everyone

I just returned today from ILBS,
I had a liver biopsy on 16th and had some complications after that, but now it is over.
My latest reports are as follows:

LiverBiposy : Fibrosis-0-1 (Liver Biopsy shows maintained acinar architechtectue. Portal areas show mild chronic inflamation (inflammation), minimal interface activity and mild fibrosis. Few hepatocytes show ground glass appearance of cytoplasm. Few foci of lobular inflammation also seen.

HBsAg Quatification: 16426 IU/ml
HBeAg:   Negative
Anti HBe: Positive
SGPT (ALT): 33
Fibroscan Stiffness: 4.0 KPa

Doctors have yet not advised any medicine for Hep B, rather they have suggested only some vitamin tablets and advised to watch it further.

Meanwhile I found that I have chronic collitis as well for which I am taking medicine from my local doctor. (Probably my stomach pain was due to collitis). Now my stomach pain is almost gone.

Dear Stef, Vijik,  What do you suggest, Is it going in right direction? Can I try some Hep-Tech Products to improve the mild fibrosis which I have.

The best doctor at ILBS is Dr. S.K Sarin (Head of ILBS). He is probably the best doctor available in India for Hepatitis treatment. I do not have his mail address but phone numbers of reception are available on net.
Blank
Avatar_m_tn
Does anyone know good doctor and fibroscan in Mumbai, India
Blank
Avatar_m_tn

your liver is perfectly fine, as to colitis just check that its medication has no effect on immune system or liver

for colitis you may also try probiotics like lactobacillus acidophilus or heptoshield PPC is known to protect stomach, infact as soon as i started that i didn t need probiotics to avoid mild diarrea (diarrhea) due to alinia
also kefir is very good, colitis maybe due to bacteria/viral infections or just unblance of healthy bacteria that protect our stomach

the use of probiotics is also suggested because our immune system works thanks to healthy bacteria in the stomach.i just read a research that we are 90-99% made of bacteria and only 1-9% human in genetic material so we must take very good care helping with probiotics

do you know wht the source of your colitis, i am not expert on this but colitis should be just a general word for stomach inflmmation then you have to look for the source of this

i guess also diet is very important
Blank
Avatar_m_tn

as to treatment it is not necessary now and hbsag is too high to try to clear, i suggest try to lower it by very cheap drugs that we know almost free of sides like:
making vitamin d3>50ng/ml by supplements
nitazoxanide
simvastatin 40mg

try this 6 months and see if hbsag goes down, while on this check alt/ast, creatinine and serum calcium
Blank
Avatar_m_tn
Thanks,

I will try these medicines and also check my check alt/ast, creatinine and serum calcium periodically.

Source of my collitis is probably  water. Moreover it does not go easily and it reoccurs in every 6-9 months if it is not treated properly. I had been taking medicine in past for this. Usually, doctors prescribe a course of Norfloxacin and Flagil for 5-7 days. But these medicine are so horrible that after 3-4 days it becomes almost impossible to continue these medicines.
Recently, my local doctor told me that collitis bacterias do effect the lever severely and a course of 14 days is must to clear this bacterial infection entirely.  She has prescribed me a better medicine Zenflox-OZ (1 tab twice daily for 14 days). I have already taken this for 7 days and continuing it. I feel better and it has helped in reducing my ALT from 47 to 33.

However, as suggested by you,  I will check that this medication has no effect on immune system or liver and also take the medicines as suggested by you to reduce the HBsAg level.

Many Thanks.
Blank
Avatar_m_tn

if those are antibiotics they lower imune system ,when i was younger with inactive hbv sometimes i got it active after antibiotics, same my sister and mother

nitazoxanide (nizonide500) is also active on many bacteria with no resistance and active on hbv too so it would be a good choice.also use kefir and probiotics everyday they boost immune system and avoid stomch infectioncs, as to water it needs to be boiled if not free of bacteria

and last thing bacteria in the stomach does affect liver because the stomach is directly connected to the liver infact probiotics are beneficial to liver too
Blank
Avatar_m_tn
Dear Stef,

My HBsAg Quatification is 16426 IU/ml and HBeAg is  Negative, Anti HBe is Positive
What does it mean?
Does it need treatment.

One more thing my liver biopsy shows 10% damage of the liver. Can it be reversed or atleast can I prevent its further damage. I do not know what caused the damage.

Thanks
Blank
Avatar_m_tn
HBsAg Quatification is 16426 IU/ml

too high t o have chances to clear hbsag by interferon, this needs to get lower.alinia, simvastatin and vitamin d 3 can be tried to see if it lowers and when it reaches low values like 1500-2000iu/ml interferon can be added
vit d 25oh in serum 70-100ng/ml, not more.while on supplements monitor every 2-3months with serum calcium

Does it need treatment.
no

Can it be reversed or atleast can I prevent its further damage
yes by antioxidants like in heptech, healthy life and diet, exsercices and low bmi 22-24, all this things can help improve your liver
Blank
Avatar_m_tn
Dear Stef

Many thanks

I do not know how many people you have helped.
But you have certainly saved me.

May almighty God bless you.

Thanks.
Blank
Avatar_m_tn

i just wish more and more people start to study themselves hbv, trials and results on istitutional websites, most of the doctors are not reliable at all and we need to save ourselves from them and drug makers just pushing sales
Blank
Avatar_m_tn
Hi Stef,

I am fully agree with you the idea of the Final cure of this heb b, and i think we should take part of this not to waite for ever and push particularly REP 9AC.

YOU ARE THE ONE OF THE BEST AND CAN BE A LEADER OF THIS ISSUUE AND WE ALL FOLOOW YOU. i THINK YOU SHOULD START AND ORGANISE TO US

THANKS
Blank
Avatar_m_tn
Dear Stef,
I checked my Vit D3 level, the report has just come, it is only 15.50 nmol/L (normal 75-250). This is big surprise to me. Probably my weakness is due to this only.

I have learned from you, I should try to improve Vit D3 >50 nmol/L by taking 5000 to 10000 iu daily.

What are the tablets available for this, and how long I should continue this.

Presently I am taking Probiotics and Vatamin B complex.

Regards,
Blank
Avatar_m_tn

hbv interfere with vitamin d and we dont respond as other people, i just got my results too and found 26ng/ml!

there can be only 2 ways for this:
test mistake (it can be, i will retest next week)
vitamin d3 from puritans are mixed with fake pills (very possible)
gcmaf changed vit d transport (very unlikely, gcmaf normalize vit d)

this is just to say you have to choose a reliable brand and 10000iu daily, not less than check every 2 months for both vit d25oh and calcium
Blank
Avatar_m_tn
" you have to choose a reliable brand " - what brand ?

- puritans pride ?
- now ?
- swanson ?

opinion about the above listed brands ?

some other brands ?
Blank
Avatar_m_tn

now i am taking an italian brand, dibase 10000iu daily

attention to unit reported, i always talk about ng/ml, the unit used in your test is even lower nmol/L, you are extremely deficent, you are at rikets risk, your vit d 25oh is 6.2ng/ml
i do suggest to see the doctor and start with injections of very high amount instead pills, it is so severe on you that rikets is possible

normal levels in ng/ml: 50-100ng/ml (it looks like only 10000iu daily can reach more than 50)

normal levels in nmol/l: 125-249.6nmol/l

how to convert:
http://www.soc-bdr.org/rds/authors/unit_tables_conversions_and_genetic_dictionaries/e5196/index_en.html
Blank
Avatar_m_tn
http://www.mayoclinic.com/health/vitamin-d/NS_patient-vitamind/DSECTION=dosing

any brand is ok as long as it has vit d3 and high amount, monthly injections of 600000iu should be ok
i dont know your country but i just go the the pharmacy and buy vit d3 oral liquid at 100000iu bottle
Blank
Avatar_m_tn
Thanks Stef,

I will see my doctor and start Vit d3 medication.
Blank
Avatar_m_tn
I have started Vit D3, i.e Calciral Sachet (60,000IU) - 1/week x 6 weeks.
Is it O.K.
Yesterday, I took the the first weekly dose,but after taking this I am feeling weaker, I do not know why?

Do I need to take Calcium Tablets along with Vitamin D3?

Regards,
Blank
Avatar_m_tn
Do I need to take Calcium Tablets along with Vitamin D3?

no you dont

Yesterday, I took the the first weekly dose,but after taking this I am feeling weaker, I do not know why?

it is a big dose you probably need to balance that or maybe not related.i saw a study yesterday and something like 500000iu dose got vit d3 level up about 10-15 points with no effect on calcium.these big doses are only for severely deficent on 20-30ng/ml range

at 6 weeks check both calcium and vit d 25oh and then you should find a maintenance dose, usually 5000-8000iu daily on us cronic (chronic) but this can vary patient to patient
Blank
Avatar_m_tn
Thanks.

I am feeling better today. May be it was due to a sudden change.

I will continue this for 6 weeks and then check 25oh and calcium serum.

I want to give it some time before starting nitazoxanide (nizonide500). Will it be O.K. if I start nizonide-500 after 5-6 weeks.

What about your latest d3 level? Hopefully the earlier report war wrong.

My doctor told me that if the weekly dose of Vit d3 does not work for me then after 6 weeks, he will start an injection which is to be taken once a year.

Regards
Blank
Avatar_m_tn

I want to give it some time before starting nitazoxanide (nizonide500). Will it be O.K. if I start nizonide-500 after 5-6 weeks.

yes of course it is better to have full vit d levels because ntz uses interferon pathways and interferon+vit d levels has increased svr on hcv

if you have a chance to use simvastatin i'd start that too before ntz, also sim is able to increase interferon response because interferon acts same way as sim by lowering intracellular cholesterol levels, sim is less potent on intracellular cholesterol but better than nothing

What about your latest d3 level? Hopefully the earlier report war wrong.

i will check next week, i am using a cheaper lab and they slow on results but even pisa hospital had a strange result in 2010 going from 35ng/ml to 11ng/ml in 4 weeks, so i think it is vitamin d assays to be less precise.in any case i started solarium lamps too, this time i will try to reach 80-90ng/ml levels at least i ll have some extra stored vit d just in case
Blank
Avatar_m_tn

I want to give it some time before starting nitazoxanide (nizonide500). Will it be O.K. if I start nizonide-500 after 5-6 weeks.

yes of course it is better to have full vit d levels because ntz uses interferon pathways and interferon+vit d levels has increased svr on hcv

if you have a chance to use simvastatin i'd start that too before ntz, also sim is able to increase interferon response because interferon acts same way as sim by lowering intracellular cholesterol levels, sim is less potent on intracellular cholesterol but better than nothing

What about your latest d3 level? Hopefully the earlier report war wrong.

i will check next week, i am using a cheaper lab and they slow on results but even pisa hospital had a strange result in 2010 going from 35ng/ml to 11ng/ml in 4 weeks, so i think it is vitamin d assays to be less precise.in any case i started solarium lamps too, this time i will try to reach 80-90ng/ml levels at least i ll have some extra stored vit d just in case
Blank
Avatar_m_tn

I want to give it some time before starting nitazoxanide (nizonide500). Will it be O.K. if I start nizonide-500 after 5-6 weeks.

yes of course it is better to have full vit d levels because ntz uses interferon pathways and interferon+vit d levels has increased svr on hcv

if you have a chance to use simvastatin i'd start that too before ntz, also sim is able to increase interferon response because interferon acts same way as sim by lowering intracellular cholesterol levels, sim is less potent on intracellular cholesterol but better than nothing

What about your latest d3 level? Hopefully the earlier report war wrong.

i will check next week, i am using a cheaper lab and they slow on results but even pisa hospital had a strange result in 2010 going from 35ng/ml to 11ng/ml in 4 weeks, so i think it is vitamin d assays to be less precise.in any case i started solarium lamps too, this time i will try to reach 80-90ng/ml levels at least i ll have some extra stored vit d just in case
Blank
Avatar_m_tn
Thanks

I checked my d3 level in other lab just to make sure that there is no error and it gave me the similar result (13.32 ng/ml).

I am continuing with the medication, it seems it is improving.
I will get it checked after one & half months.

One more clarification, if LDL and HDL levels are OK, is simvastatin still needed. Or it is needed only when Cholestrol levels are abnormal.
Blank
Avatar_m_tn

no it has nothing to do with cholesterol level, the antiviral effect cannot be measued by cholesterol lowering only although a study found those with tot chol <150, ldl less than 70 to have weaker virus (it gets less infective)

we dont know yet if it works in vivo as montherapy until now we have the study with interferon on hcv and the study in vitro but anyone can try and see if it works or not for 6 months since the drug s extremely cheap
Blank
Avatar_m_tn
Hi,

I was just wondering that  which form of Vitamin D3 is good. Is it Cholecaciferol or Calcitrol. Cholecalciferol is the form most commonly used whereas it Calcitrol which is the active form of Vitamin D3.
Blank
Avatar_m_tn
Cholecalciferol is the natural form of vitamin d and is also called vitamin d3, this can t be patented because it is produced naturally in our body and it is also the one that works...of course.so vitamin d3 or Cholecalciferol is the one to be used

drug industry made a different forms of vitamin d to makemore money, these synthetic types of vitamin d dont work, actually work very little, with sides effect too.....calcitriol.also d2 must not be used

http://www.vitamindcouncil.org/about-vitamin-d/what-is-vitamin-d/
Blank
Avatar_m_tn

so it is important to double check when buying vitamin d3 that it is specified vitamin d3 natural Cholecalciferol

i am sure that the one member who had sides from taking vitamin d3 was taking a synthetic type not natural because our body produces 25000iu of d3 just with an hour of summer sun
Blank
Avatar_m_tn
I am taking WHAT THEY CALL Doctors BEST vIT D3 (10,000 iu per day) is that is not Natural?l, I thought it is cholecalciferol stef
Blank
Avatar_m_tn

check here
http://www.vitamindcouncil.org/about-vitamin-d/what-is-vitamin-d/

i guess cholecalciferol is the natural type only
Blank
Avatar_m_tn
Many Thanks

It seems calcitriol (the active Vit d3) is only available in synthetic form and it does not benefit much.

However, as I understand, Cholecalciferol must be converted into Calcidiol in Liver and then to Calcitriol in Kdney, before it starts working.

So, if liver is not able to covert the Cholecalciferol into Calcidiol, chances of getting benefited by  Cholecalciferol may also get reduced. This is just a thought. May be wrong.
Blank
Avatar_m_tn

your thinking is wrong if i got it correct, you just need to supply natural substances to your body in order for them to work, while synthetic doesn t work.this is for almost all substances

all substances are changed inside the body and as long as natural they are made correctly in the body

te problems are:
synthetic substances can be patented
natural substances cannot be patented
synthetic substances cant be made pure and as good as natural ones
Blank
Avatar_m_tn
I checked my vit d3 level after 2 months of medication. It has improved to a level of (40.30 ng/ml).

I have followed following medication. Calcirol - 60,000 IU (1/week) for six weeks + 1 Shelcal HD daily.

Now I am continuing with the  schedule: Calcirol - 60,000 IU (1/month) for six months + 1 Shelcal HD daily.

This is the shcedule my doctor has prescribed. I do not know why he is giving Shelcal - HD (it has Calcuim -500mg and vit d3 - 500 IU).

Good part it my Liver Function test has come to normal -
AST - 28.0
ALT - 31.0
S. Bilirubin Total : 0.61
Other tests  are also normal
S. Creatine - 1.0
S. Calcium - 9.1

Though, My overall health has improved, but I still feel some giddiness. Doctor says it will take some time to improve since I was suffering from chronic deficiency of Vit d3. (any views Stef ?)

After 15 days i will check my HBSag level and let you know for your further guidance.
Blank
Avatar_m_tn

i dont see why take calcium if you have no osteoporosis, vit d alone will solve calcium issues since it increases calcium absorption
i d rather go to high dose vit d with no calcium and just check blood calcium to tsay normal.

my ister got to 80ng/ml and she is getting normal range alt too despite hbvdna 190.000iu/ml, we are all startng to think vit d works on making normal alt even with detactable hbvdna

very happy to know ast/alt getting to normal, t copy your post to the vit d thread so that anybody knows and follow there too

calcium and creatinine ok but it is better if you have creatinine before taking vit d, again i d not take calcium because you cannot go to very high range vit d 80-100ng/ml taking calcium
Blank
Avatar_m_tn
http://www.medhelp.org/posts/Hepatitis-B/vit-d3-82ng-ml-and-lowering-alt--not-on-therapy/show/1654187

here is the other tread

again since our puporse (probably ur doctor is not aware of this) is antiviral effect of vit d and improvment of liver fiibrosis/function and not improvment of calcium absorption for bones, i do strongly suggest as follows (you may tell your doctor too about this):

make vit d3 10000iu daily or 70.000iu weekly, dont go as suggested by your doctor.but to do this stop calcium because you may absorb too much with this vit d dose, stay one week with no calcium and then go for this vit d level to get to 80-90ng/ml

drink at least 2-3 liters of water daily

check calcium, complete urine test and vit d monthly

the goal is see what happens to ast/alt, hbvdna and hbsag at serum vit d 80-90ng/ml

you have improved already ast/alt but maybe because your hbvdna is lower than my sister's.i suppose 80-90ng/ml may have a stronger antiviral effect, immmune system boosting effect, better antifibrotic effect.people on cancer (autism and other viral diseases) is suggested to go on the high normal range vit d 90ng/ml
Blank
Avatar_m_tn
I will do the same (i.e. stop Calcium and take high dose of vit d3) and check for d3 level after 15-20 days and let you konw.

I forgot to mention that  I have also been taking Probiotics on and off. Can I continue Probiotics.

Blank
Avatar_m_tn

yes and try to find lactobacillus bifidus to make home yogurt, do not take pills because they are useless the probiotics need the milk to make immune boosting ubstances
Blank
Avatar_m_tn
if you dont find starters to make home yogurt you can buy bifidus starter here, yo dont need yogurt machine you can just make milk about 40-45° and put starter and milk in a termos flask, the website sells everything to make it

http://kefir.it/acquisti.asp?cat=3

bifidus starter is the second product
Blank
Avatar_m_tn
I have stopped taking calcium (Shelcal) and Probiotic from last 10 days. Instead I am taking only Vit d3 and home made yogurt. Now, I feel much better, almost normal and full of energy.

Will write you back about my latest HBSag count, which I will be testing in next week.
Blank
Avatar_m_tn
Dear Stef,

My latest reports have come:

Vit D3        - 56.8 ng/ml     ( 2 months back - 40.30 ng/m)
HBV DNA  - 6450 IU/mL    ( 6 months back - 10170 IU/mL)
HBsAg      - 22378  IU/mL ( 6 months back - 16426 IU/mL)
AST          - 27.0              (2 months back - 28.0)
ALT          - 38.0               (2 months back - 31
S. Bilirubin Total - 1.0        ( 2 months back - 0.61)

I think my reports are improving except for HBsAg.
HBVDNA has come down but HBsAg has increased, what does this implies. Am I improving or deteriorating. Any view/ suggestion?

Now I am taking Vit D3 10000 IU/day and trying to take it to 80-90 level and then i will see what happens to HBsAg count.

Once I reach 80-90 level of Vit D3, what should be the daily maint. dose.
Blank
Avatar_m_tn
HBVDNA has come down but HBsAg has increased, what does this implies. Am I improving or deteriorating. Any view/ suggestion?

difficult to say but i know on antivirals same thing happens, i mean when hbvdna gets to undetactable the virus uses cccdna life cycle inside the cells trying to increase cccdna and intrahepatic hbvdna, this can reflect an increase of hbsag which will decrease again soon

my pattern was at start of etv in 2010 (bi/monthly tests):
hbsag 4500iu/ml  hbvdna 130iu/ml
hbsag 5400iu/ml  hbvdna 50iu/ml
hbsag 7200iu/ml  hbvdna undetactable

then up and down between 4500-6500iu/ml until i started gcmaf, after gcmaf it got stable and slowly decreasing
Blank
Avatar_m_tn
Once I reach 80-90 level of Vit D3, what should be the daily maint. dose.

i think we are similar in hbv, me and my sister get 70ng/ml by 7000-8000iu/ml daily as maintenance

my father has no hbv and got to 85ng/ml by 3 months on 10000iu daily he can keep it stable over 60ng/ml by 5000iu daily

i guess we are all a little difference so we have to find out our doses, i d try 8000iu and then slowly to 5000iu, anyway i think 5000iu gives little less than 50ng/ml, 7000iu little less than 70ng/ml and so on
Blank
Avatar_m_tn

hbsag is a very slow process, i think that we can monitor hbvdna at first and once it gets to very low you may add nitazoxanide to vit d3 and see if hbsag goes down
when we have hbsag down to about 1500iu/ml we are certain to have highest response on interferon add on
Blank
Avatar_m_tn

remember to drink at least 2 liters of water a day, this is good for anybody but for us on vit d supplements is even better
Blank
Avatar_m_tn
Thanks for all the clarification, suggestions and encouragement.

I will follow the same.

Since your advice, I have doubled my water intake.

I forgot to mention that my Fibroscan report has also improved 3.6 (earlier - 4.0).

I think, nowadays I feel a lot better. More energetic and no more weakness, no more tiredness. However, sleep is a problem. I often spend sleepless nights.

I wish, I should have followed your advice much earlier, then my situation may have been much different.

Thanks.
Blank
Avatar_m_tn

I forgot to mention that my Fibroscan report has also improved 3.6 (earlier - 4.0).

wow, this is a great improvment, average fibroscan for males is around 5kpa, getting to lower than 4kpa and being hbv carrier is really a great result.i think we can open a new thread called vitd4 hbvdna and fibroscan improvment

as to sleeping i alo had that problem in the past and it is common to cronic (chronic) diseases which of course have immune system damage/non response, i solve that using melatonin which is a potent antioxidant, absolutely non toxic at any dose (they could not find any toxic level), anticancer, increase white blood cells.you have to take it 2hrs before sleep or when it gets dark, try different hours and dose until you reach sleep effect you just need to avoid taking it when there is day light
i get best results taking it at 21pm, dose 10mg
Blank
Avatar_m_tn
Thanks Stef,

I will try melatonin (antioxidant).
Blank
Avatar_m_tn
hi
i got my Hbs Ag + and Hbe Ag _. my hbv viral load is 1300iu/ml.what type of treatment i should start.
thanks for ur reply.
Blank
Avatar_m_tn
As per my understanding you do not need any medication at this at this viral level. To be sure just check your HBsAg (Quantitative level) and your Liver Function Test, ALT and AST.

Avoid any form of alcohol, take healthy diet and keep away from tension.

However, I would suggest, take opinion of Stef2011.

Blank
Avatar_m_tn

yes that s exactly the best suggestion and in case hbsag very very low consider immune modulators like pegintf to clear hbsag
Blank
Avatar_m_tn
Well I had similar results, but my doctor did biopsy and found that I have fibrosis stage 2-3. so I need medication. I would suggest that you should go for biopsy.
Blank
Avatar_m_tn

why biopsy?fibroscan is much better with no liver damage done or risks
Blank
Avatar_m_tn
hello stef2011 , i am suffering with hbsag+ from past 3 years , i used lamvir for 2 years and stopped for 6 months, again my DR suggested to use lamvir tabs because my viral load is increse if i stop taking medicine, before it was HBV QUANTITATIVE (VIRUAL LOAD)- REAL TIME PCR : 976 IU/ml  (1 UL/ml: 7 copies/ml), now it was 1,234 IU/ml (1 IU/ml: 7 copies/ml), so dr asked to continue with lamvir HBV tabs.HBeAg Test : Negative, HBsAg:(Chemiluminescence) POSITIVE, ALT(SGPT)-SERUM:43, AST(SGOT)-SERUM: 18 iu/l. my liver scan shows texture and fatty liver. dr said no problem with liver. when i read ur posting , u r suggesting to use inferon combinations. but my dr says no need to use interforn combinations it was very cost and risk process, how this virus can eradicate from my body, help me if u have any suggestions..



Blank
Avatar_m_tn

lamivir is not an hbv drug anymore, it makes mutations and hbv infection worsening and makes all other drugs useless.
the only drug you can use now is tenofovir or interferon

change doctor and sue the previous if possible because there is no reason to use lam today, if you need antivirals start tenofovir which is the only one safe and without resistance mutations
Blank
Avatar_m_tn
Thanks for the reply, as my first DR started Lamvir HBv for 2 years, later my new DR is using same medicine. he said as that previous DR started lamvir HBV tabs , he want to proceed with same medicine. is tenofovir or interferon is tabs or injection. my virual load is 1236 iu/ml 7 copies. is low rate virual load. or very heavy. i have hope it will cure , but what is right medicine to to cure this hbsag +, because of this problem my wife want to give divorce as that i am unable to work in abroad with her.no peace in my family life? prepare to suicide i feel its last option. i never made any mistakes in my life, i dont know how i got this dirty diseases..........
Blank
Avatar_m_tn
lam is out of guidelines, they are crazy, go to a serious hbv hospital and let them check the mutnts you developped.
lam mutants can make hbv damage your liver and make liver cancer even if hbvdna und and even if ast/alt normal, the virus turn from non cytopatic to cytopatic.it can really be a matter of life and death if you develop these type of mutants and of course they are not curable because drugs now just make hbvdna und

tenofovir (pills), entecavir (pills) and interferon are the only drugs on hbv guilines, now that you used lam entecavir is out
these drugs dont cure hbv but cure damaged livers or people at risk for hcc so be followed by real doctors
Blank
Avatar_m_tn

also check all forum posts and heathpages, hbvdna is not hbv life cycle, even if you make hbvdna undetactable in serum the virus keeps replicating in the liver so these drugs are not hbv cures but jut lower replication to repair or stop liver damage.liver with no damage may not need any drug
Blank
Avatar_f_tn
Just curious , what does if one 's test result hbsag +,hbsab-, hbcoreab+a,hbcoreigm- and hbeag negative.? What is the initial step to cure the desease . Thanks
Blank
Avatar_m_tn

almost all carriers are like that, therapy is not needed if no liver damage and no hcc risk, if there is liver damage tdf or etv and then years after pegintf add on to see if hbv can be cleared
Blank
Avatar_m_tn
My scan report shows no damage to liver. Can you suggest
any test to identify damage in liver? I alredy mention my
Virual load. But in one post you mention when virual load
Is less than 1500 ui/ml you said to use tenofovir or intterferon
my 2 drs wasted 3 years by giving lamvir tabs. Any way i am
Just looking for new dr who can prescribe the medicines you
Said to me. Need more help and information.
Blank
Avatar_m_tn

scans can see liver damage, you can have cirrhosis and perfect scan....

fibroscan result?this is a measure of fibrosis/liver damage in kpa

Blank
Avatar_m_tn
Hi Stef/Brij/Vijik & others,
My name is Mangesh & i m from Mumbai. I am HBV carrier for the last 2 years. Recently done Liver Biopsy. I am taking advice from a Hemotologist from Hinduja Hospital.The results are as follows. dated 30-05-12
Liver biopsy core reveals normal architecture with grade I inflammation in portal tracts with minimal interface hep. The portal infiltrates comprise small lymphocytes chiefly with an occasional eosinophil. Mild portal fibrosis with occasional septum formation is noted on reticulin and msson stains.
Diagnosis - Metavir Grade A1,Stage F2.
What does this mean- is my liver damaged if yes by what %?
Dated - 18/05/12
Viral Laod - 171934 iu/ml
HBsag - 48253 iu/ml
SGPT - 33
SGOT - 29.4
bILRUBIN- .8
My doc is suggesting Interforin or tenofovir. The decision will be mine. But he is insisting on interforin & claims that it has high % of clearing HBV within 1 year time frame.
Pls advice i have to start the medication asap
Blank
Avatar_m_tn

i d check fibroscan too because biopsy has a margin of error of more than 1 grade fibrosis, f2 is mild and requires no treatment, healthy supplements, lifestyle and diet may regress f2 to f1

HBsag - 48253 iu/ml
this is a lvel on hbeag postive, if you are still hbeag pos you better start tdf and then intf add on to clear hbv, not just control it.while if hbeag neg chances are so low that it is better to monitor

intf alone doesn t work, only 7% clearance at 1 yr.tdf alone only 16% hbsag clearance at 3 years.intf+tdf together 24% at 1 year

sequential tdf 1-3years and then intf add on highest response
Blank
Avatar_m_tn
Hi Stef,
Thanks for your reply, we do not have fibroscan machine here in Mumbai as of now. So will have to rely on the lievr biopsy results i guess.
So going by your advice i should start with Tenofovir & not Interferon ?
& after 1 or 2 years add interferon. Also the supplement your talking about kindly advice which one's to take. If assuming i start with Tenofovir will i have to take it for life long? & also there is no 100% formula to clear HBV?
I must of your responses you have mentioned the imp of taking vit D3 along with the regular medications. But my Dr. has never adviced or suggested it as of now?
Thank u in advance for your suggestions & advice.
Blank
Avatar_m_tn
If assuming i start with Tenofovir will i have to take it for life long?
no after taking intf for 24-48weeks you can stop it, or you can stop it after 4-5years even without intf since 39% are reported to clear hbv by stopping adv which is similar but weaker than tdf

& also there is no 100% formula to clear HBV?
tdf+intf add on has the highest chances to clear

But my Dr. has never adviced or suggested it as of now?
most doctors are not updated and just care to prescribe/cell drugs, they are not updated enough and dont care about patients enough
Blank
Avatar_m_tn
Hi stef,
          I recently found that i have a chronic hepatitis b(carrier).i am stressing a lot and thinking about it almost every time.This is my first time to post a question that can i get rid of it (hepatitis b carrier)??????????.

My previous report was as follows,
1.On 30-10-11
Sgot-79u/l
Sgpt--134u/l

2.On 06-01 2011
Anti body to hepatitis b core antigen( total) - positive
Hbeag-negative
Anti hcv-negative
Bilirubin total-2.56 mg/dl
SGPT-48U/L
Serology/immunology(Anti hbc igm)-  0.11 index value  (Index value<0.9,Negative)
Ultrasound(Liver elastogram)- normal
U.G.E- final empression is distal esophagitis, antral gastritis.
C.T. Scan of whole abdomen conclusion- normal examination,barium follow through.

3.On 12-03-2011
hbsag-positive
Anti hcv-negative
Bilirubin total- 2.74 mg/dl

Recentally i visited ilbs delhi and my current results are as follows,

1.Hbv Dna Quantitalive real time pcr- 8155 iu/ml
2.Fibroscan-E(kpa) -5.3 kpa, Success rate-100%
3.LDH-143
4.LFT-
Biirubin total- 1.6 mg/dl
Sgot-19 iu/ml
Sgpt-26 iu/ml
Alkaline phosphte-74 mg/dl
Total protine-7.7 gm/dl
Gobulin 3.7 gm/dl
A/G ratio-1.0

5. Total colestrol-145 mg%

Test results yet to come on 04-08-2011 is,
1.HbsAg Quantification

I have continuous weakness problem, So please suggest and guide me what to do?
I will also post you my hbsag quantification result.
Blank
Avatar_m_tn
How about Telbivudine? Did you have chance to review this medicine?
Blank
Avatar_m_tn
I was receiving Telbivudine for a year, and now I am thinking to switch to other antiviral like TDF. will Switching have consequences?  
Blank
Avatar_m_tn

it is telbivudine to hve consequences, it is not a firstline hbv drug and makes a lot of resistance mutations
tdf is the only one to make no resistance so add on as soon as possible and after 6 months of add on discontinue telbivudine
Blank
Avatar_m_tn
fibroscan is available and please contact with dr.bhanka's clinic in mumbai
Blank
Avatar_f_tn
hi raja..would you be kind enough to inquire for me how much entecavir 500 mcg in india?i'm currently here in bahrain and maybe i could ask somebody to buy for me..thank you very much..
Blank
Avatar_m_tn
Stef is absolutely right. Follow his advice to clear virus by interferon+vit d3+alinia+simvastatin

However, I will make some changes.

Your Problem of continuous weakness and stomach pain are exactly the same which I was having for several years. For 2 years doctors treated me for gastritis with no help.

Your root cause is Vitamin d3 deficiency. So, you need to take a test, go to any pathology and ask for "vit d3 25 oh" test and check the report, it should by >30ng/ml.   Even if you do not want to take the test. Start following medicines immediately to improve your vitd3 level.

1) Calcirol - 1 sachet / week for 6 weeks  and then 1 sachet / month for next 6 months
2) Shalcal HD - 1 tab/day for 3 months.
Besides you can take the medicine for gastritis for 1 month simultaneously.

(These medicines are readily available in most of the medical shops and this the protocol what is followed for improving vitd3 in our country). I am taking this myself for more than 10 months and still continuing. Also I have tried this on more than 10 persons and every one has got excellent results and are happy.

You will mark the difference within 4 weeks. Your weakness and stomach pain will vanish in 3 months.
Then you can start the combo which steff is suggesting to clear the virus.

Watch your SGOT,  SGPT & Bilurbin level. Good that now it has come to normal.
Avoid any other medicine like calpol, paracetamol or any painkiller, any form of alcohol or any thing which puts your lever on stress.

Good Luck.
Blank
Avatar_m_tn
Hi,
I am a 42 year old male based in Mumbai (India).  I have been detected  HBsAg +ve 12 years back, It was confirmed in subsequent years. My other tests in 2001 were
HBvDNA -ve and HbeAg -ve . Since then I have been just getting my LFT done in subsequent years. It was normal till last time. But now my Bilurubin levels are high 1.7 . ( confirmed on repeat tests0. My doctor has just advised vitamin supplements. But I am bit concerned . What tests I need to undergo and what course to follow.

VJ
Blank
Avatar_m_tn
Hi VJ1971

Since you are above 40, you need to monitor it very closely,

Get following tests done.
1) HBsAG (Quant)
2) HBVDNA
3) Fibroscan
4) Vit D3 25oh.
5) LFT

These tests you must do to assess your real condition.


Blank
Avatar_m_tn
Hi stef,
You are doing a v noble job, for which we cannot repay you!
My case? I am 38, male, on job, from Pakistan.
In 1998 (i was 24), had symptoms like nausea/less appetite etc, and found that I was HbsAg +ve, my SGPT ALT remained v high for months (even in thousands). I tried some local things, but no medicines. Ended up becoming a carrier. Went to a doc in 1999. He ran many tests. HBVdna qualitative was +ve. He gave me Lamivudine 1/day for 6mths. My HBVdna became -ve after 6 mths. I discontinued trtment then.
I monitor my ALT off and on, its been ok: gen condition remained good. In 2010, checked HBVdna: was -ve.

Last few months (Apr-June) I've had a lot of work related stress, and v disturbed meal timings. Had GERD-like symptoms, acidity etc; and also weight loss 3-4 kg. Checked HBvDNA on 01 Jul,12 by chance, and it was 25,800 COPIES/m. HbsAg +ve. I read alot and got really scared for mutations.
Showed 3 specialists. My results were:
01 Jul: HBvDNA, 25,800 Copies/m. (IUs ??); HBeAg -ve; HBeAb +ve.
16 Jul: SGPT ALT 31 (lab X, up limit: 50)
Liver ultrasound: Totally normal
02 Aug: SGPT ALT 44 (Lab Y, up limit: 40)
08 Aug: SGPT ALT 42 (Lab Y)
          : Alphafeto Protein : 5.58 (should be <8.5ng/ml) ie ok
Hep C & Hep D: -ve
General Condition now: Good, no nausea/ weight loss (God be praised)
All specialists say treatment NOT needed/useful for now coz body is not fighting the disease yet. They say monitor ALT monthly and HBvDNA+ultrasound 3-monthly.
I am really scared about mutations. The docs are just not giving the importance to the relapse/mutations aspect I find on internet.
Your advice plz? Won't the disease give me a sign before starting to cause real harm (fibrosis/cancer)??
wishful01
Blank
Avatar_m_tn

dont concentrate on hbvdna which is meanless to monitor liver damage or infection, the tests to do are fibroscan for liver damage and hbsag quantity to understand the phase of infection.hbvdna is useful only to measure response to drugs

as to mutations 6months of lam withhbvdna undetactable should not allow mutations but you can check resistance by blood tests

after a fibroscan we can know what the liver condition is, as regards drugs use only tenofovir or interferon, all other drugs are not safe at all for you since you used lam
Blank
Avatar_m_tn
Thanks for your very prompt reply. Means a lot, really!

I'll get the HBsAg (quant) done in a few days, God willing, and will post the values. Also I came to know that we have Fibroscan at one place(only) in Pakistan, in Karachi. I'll just try to find the place, and try to have that done, if not too hard.

I forgot to tell that for the last month or so, I heard about vit E being good antioxidant and started taking 2x200mg (ie 400mg) daily. I have a feeling it has had a good effect on the overall well-being, but I am not sure.

A question: if my Fibroscan comes out fine now, how frequently should I monitor ALT, HbsAg(quant), Alphafeto protein, and Fibroscan so that I can timely detect a fibrosis or a cancer developing?
Best regards.
(btw, did you get your latest HbsAg level done? Did you start Tenofovir? Looking fwd to how the gfmac thing you are trying turns out+the Russian drug they say is coming. Wishing you and all of us the best!!)
Blank
Avatar_m_tn
A question: if my Fibroscan comes out fine now, how frequently should I monitor ALT, HbsAg(quant), Alphafeto protein, and Fibroscan so that I can timely detect a fibrosis or a cancer developing?

you should monitor fibroscan every 6 months, we dont neeed all the other surrogate and extremely poor sensibility tests now to know how liver is, so you can monitor them every 6months with fibro and ultrasound

btw, did you get your latest HbsAg level done?

yes but not arrived yet, in this summer holidays they take 4 weeks for results

Did you start Tenofovir?
tenofovir+entecavir

myrcludex is not available yet out of russia
Blank
Avatar_m_tn
Hi

Just read your reply to one of the people (username 'thirdie' date 12 Aug, 2012) on one forum here who was hbe positive; where you told that person not to wait for Hbe to become negative because then virus would have mutated, and then therapies are less likely to work.

This has made me really worried, because i am hbe-ve myself and have no idea since when! How ineffective are antivirals (like Tenofovir) and pegylated interferons for hbe- people? There must be something good about Hbe-ve (i always thought/heard its better to be Hbe-ve than +ve). And, like i told earlier, my doc has told me not to start antivirals just yet based on my results.

Thanks
Blank
Avatar_m_tn
How ineffective are antivirals (like Tenofovir) and pegylated interferons for hbe- people?

only 7% clear hbv ion hbeag neg by intf, 0% clear hbv on antivirals
Blank
Avatar_m_tn
Oh.
So antivirals (even Tenofovir) are NOT for me at all? No matter what the outcomes of my HbsAg (quant) come out to be, I'll just have to watch, and do nothing? I read somewhere that Tenofovir helps Hbe-ve patients also.

Or did you mean that the antivirals would reduce the hbvdna but wont make it zero?

Thanks
Blank
Avatar_m_tn

helps is useless, we consider it clears hbv or it doesn t clear hbv and antivirals dont clear hbv in hbeag neg
Blank
Avatar_m_tn
What about the patients treated with adefovir stefano? in one of your recent posts was stated that 45 % i think lost hbsag and i think they were all hbeag-neg. we dont know their basaline qhbsag but i think an important study about hbsag loss and stopping of NA which is unknown in hbeag-neg people....
Blank
Avatar_m_tn
Oh i realize my mistake. When you said hbv you meant HbsAg, right?
I was thinking about HBVdna. I have learnt from your posts that HBVdna is not important. But antivirals do reduce HBVdna in hbe- ppl, right? which can then be a good starting point to start pegylated intf, for having some hope of getting rid of HBsAg. Am I right?
Blank
Avatar_m_tn

yes you are correct
Blank
Avatar_m_tn

yes you are correct too, both adv and tdf gets hbv clearance if stopping after years of use

here are the charts, abnormal alt is the sign of response and clearance takes very long time 24-66months

https://docs.google.com/file/d/0B8E77QizhkLQV1JsSFd5OUgzeUE/edit
Blank
Avatar_m_tn
To Stef & others,
(reference to my post of 22nd June)Had discussion with my Dr. on starting the medications. he is insisting on Interferon as my elder bro who is also HBV carrier had developed resistance to lamuvidine. He is saying its only for one year & has higher chances of clearing the virus. What is your say on this.
1) Should i go with Interferon or tenofovir ?
2) In tenofovir what are the best available options
3) If i take ineterferon for a year than i will not have to take drugs life long?
   i am Genotype D
Thanks in advance to all
Blank
Avatar_m_tn
1) Should i go with Interferon or tenofovir ?

both sequential, mono work very little

2) In tenofovir what are the best available options

tdf 1-2 years and then intf add on

3) If i take ineterferon for a year than i will not have to take drugs life long?

drugs are never life long if you stop tdf after 5 years you have very high chances to clear hbv
Blank
Avatar_m_tn
Hi Stef,
Thanks for your prompt reply. Now i am clear that i will start with tenofovir
& then add int. in a couple of years. One query regarding my bro. in your earlier post to you have advised wishful01  as regards drugs use only tenofovir or interferon, all other drugs are not safe at all for you since you used lam. My brother was also taking lam earlier but since he developed resistance to it my dr adviced Enticavir. Now he is using baraclude since 2 years is it safe for him.
Pls advice
Blank
Avatar_m_tn
Dear stef2011 and brij and other senior menmbers,

20 days back,when I went to donate blood, then I came to know that I am Hepatitis B Positive,
My report says that
a) HBV DNA is 17409 IU/ml ie  more than 1,00,000 copies
b) HBSAg is 5147 IU/ml
c) AST, ALT and ultra-sound are normal
d) Fibroscan facility is not aavailable here
As per local doctor recommendation, I am taking Tenvir (TENOFOVIR) from past 10 days.


1) As per the above report, Please tell me how critical positon of Hepatitis I am suffering currently   ?

2) is Tenvir (TENOFOVIR) is good start?


3) I want to seek consultation to some good doctor. Please suugest good hospital names, doctor name in India for Hepatitis B Treatment

4) Is ILBS, Delhi is good for hepatitis B? Approax for how many days I have to stay at ILBS for diagonosis and treatment?

5) I am planning to visit ILBS, Delhi after 20 days , and since I started taking Tenvir (TENOFOVIR)  just 10 days back, So should I STOP taking Tenvir (TENOFOVIR) and wait for senior doctor advice at ILBS?

Blank
Avatar_m_tn

get your brother on tdf as soon as possible, etv cannot be used on lam resistance it doesn t work and just add more mutants in a few years (the mutant can be presnt from day one but tests will show it in 6-12 months)

so get him on tdf+etv for 6 months and then discontinue etv
Blank
Avatar_m_tn
1) As per the above report, Please tell me how critical positon of Hepatitis I am suffering currently   ?

blood tests can tell status of the liver since it is not hbv itslf to make the damage but ur immuen system you need a fibroscan or a biopsy to tell, not tests about hbv

2) is Tenvir (TENOFOVIR) is good start?

yes it is.tdf is the most potent drug we have available for hbv now, on hbeag + it is even more potent than intf in clearing hbv


3) I want to seek consultation to some good doctor. Please suugest good hospital names, doctor name in India for Hepatitis B Treatment

browse community other indian members posted names, there is one very good one probably as good as european ones or even better, they even do combo tdf+intf+alinia there

4) Is ILBS, Delhi is good for hepatitis B? Approax for how many days I have to stay at ILBS for diagonosis and treatment?

check with other indian members

5) I am planning to visit ILBS, Delhi after 20 days , and since I started taking Tenvir (TENOFOVIR)  just 10 days back, So should I STOP taking Tenvir (TENOFOVIR) and wait for senior doctor advice at ILBS?

no stay on tdf and just follow specialists advice on intf add on to tdf, when to do it and how


Blank
Avatar_m_tn
Hi
1. Disappointing as it sounds, I have checked a few of the top labs of Pakistan, and they all do HbsAg by EIA (enzyme immunoAssay) method or by some "enhanced" method. They say it is a quantitative method,and they give values. Is this really quantitative or totally useless? They do not mention the name of the methods you mentioned in one post (Abbot, and maybe Roche). Also, if this is not what we want, can anyone from Pakistan here help me find a lab for HbsAg Quantitative test in the country?
2. A question:  If someone develops some kind of pain due to hepatitis b, what kind of pain is it more likely to be?
(a) Mild and intermittent(3 to 4 times a day, for a minute or two) in 2 or 3 pin-pointable areas (centre and upper right quadrant abdomen)? OR..
(b) A general (spread out) and persistent pain for longer duration in the liver area?
Thanks
Blank
Avatar_m_tn
Sorry, one more thing..
Is this alinia thing good in my condition if and when i start trtm't?
Blank
Avatar_m_tn

everything reported without the unit iu/ml is useless for hbsag quantitative, the tests menthioned to you are not quantitative.
we think people in the labs know what they do!well most of them is totally ignorant about the tests, they just read machine results but have no clues about the tests, so when you ask info they answer totally wrong because they dont want to answer we dont know

alinia is of little help to henance intf response, it has no sides and may increase response
Blank
Avatar_m_tn
First of all thanks to Stef2011 for prompt reply.

Dear members from INDIA,
Do, You suggest any other hosptial or ILBS is best? I am from Patna (Bihar).

I am planning to visit ILBS hospital after 20 days. Please suggest, Approax How many days I need to stay there in Delhi to get the investigation and consulatation done?
Blank
Avatar_m_tn
ILBS is probably the best as it has all the facilities for all tests required.

Since you are from Patna, you better visit in the morning hours, they will conduct all the tests by afternoon and You can return back in the evening or late night. The reports will come after 3-4 days., so you can visit again after 1 week to get the final opinion of the doctor.

You can also post the report on forum to get final advice from stef before starting any medication.
Blank
Avatar_m_tn
Hi Stef,
Thanks a lot for your valuable advise for me & my brother.
Will communicate your advise to my bro regarding tdf.
Also one more question
as Baraclude is the most effective in enticavir which drug is the most effective in  Tenofovir?
Blank
Avatar_m_tn
Thanks a lot Brij for your prompt reply.
I will definitely wait for you people advice to start medication after getting the report.
Blank
Avatar_m_tn

attention baraclude is just a commercial name for entecavir molecule, all brands are the same as long as they have entecavir 0.5mg ingredient

same thing for tenofovir, all brands are the same as long as active ingredient is tenofovir 300mg

i d go for the cheapest brand
Blank
Avatar_m_tn
Hi Stef,
Will follow your advice. Also will update once i start my medications.
Looking at the researches going on all over the world cant we expect a
definite cure for Hep B in the near future.
Blank
Avatar_m_tn
Dear Stef and Brij,
I read your advice to wishful01 on Aug 22, 2012 for HBeAg negative.

My HBeAg report came to NEGATIVE too So, my complete report are
a) HBeAg  - 0.22 (Negative)
b) HBeAb  -  0.02 (Positive) , So, it means that NO antibody is produced
c) HBV DNA is 17409 IU/ml
d) HBSAg is 5147 IU/ml
e) AST - 33 (within normal range 15-37), ALT - 42 (within  normal range 30-65) and ultra-sound are normal
f) Fibroscan facility is not available here

Local Doctor told me to start Tenofovir, So, I am taking it from past 12 days
1) Whether any antiviral  is effective for the treatment  HBeAg negative and HBeAb NOT producing patient ?

2) Is there any treatment required for HBeAg negative?

3) Shall I continue to take Tenofovir before consulting senior doctor (at ILBS) OR stop taking Tenofovir?

Blank
Avatar_m_tn

keep taking tenofovir, you have chronic hbv with hbeag negative and postive hbeag antibody, this is more severe than hbeag pos because the virus has mutated, so keep using tdf

i suggest use tdf for 1-3 years and then add on intf to lower hbsag.tdf will probably have no effect on hbsag but it will improve intf response when it will be added 1-3years later
Blank
Avatar_m_tn
Thanks a lot Stef for your prompt reply.


Reply For mel851 for Aug 13 query
--------------------------------------------------
Price of entecavir 500 mcg - in INDIA
For Cipla - it cost approax Rs. 2100 for 30 tablets (Rs. 70 per tablet)
There are few more companies that provide in same rate.

Baraclude company ntecavir 500 mcg costs much more - Rs. 2200 for 10 tablets (Rs 220 per tablet)

As per the experts like Stef , brij and others, go for cheaper but reputed company
Blank
Avatar_m_tn
Here are my results for HBSAG

HBV Viral load 8,44,648
HBV DNA Qualitative PCR +VE
HBeAG -VE(0.255)
HBeab +VE (0.02)

I have been Prescribed with interferon injections. Can you plesae suggest what should i do?
Blank
Avatar_m_tn
Hi jhr123/Brij & others
Can u also upload the rates of  tenofovir brands available in India.
Would really appreciate that as i would be starting my medications soon enough & would be opting for tenofovir.

Thanks in advance
Blank
Avatar_m_tn

you miss the main and most important test which is hbsag quantitative in iu/ml, your hbvdna is not so important but only hbsag quant
Blank
Avatar_m_tn
Here are the results for quantitative analysis.

Test Description                                                  Observed Value                   Biological Reference Interval
HBV Viral Load by Real Time PCR :
HBV Viral Load                                            8,44,648 Sensitivity                      Limit : 3.80 IU/mL
HBsAg, serum by CMIA                                Positive (>250)                            Negative : < 0.05 IU/mL
Blank
Avatar_m_tn
hbsag is qualitative positive, not quantitative.

the fraud you they reported >250iu/ml which is obvious for all chronic carriers, they did not diluite blood sample and measured quantity, if you paid for quantitative test ask money back
Blank
Avatar_m_tn

chronic carriers have thousands of hbsag, usually 3000 to 20000iu/ml,
Blank
Avatar_m_tn
Thanks Stef2011 i will confirm back to you. Will consult my Doctor again.
Blank
Avatar_m_tn
Lab results i have are in Copies/ml not in IU/ml.
So my viral load is 8,44,648 Copies/ml. Plese let me know if this helps.
Blank
Avatar_m_tn
Hi,

Currently, I am using Tenofovir of CIPLA company with brand name TENVIR.
In India, Its price is Rs. 1500 for 30 Tablets bottle. I am not aware of other brands, but I think this is generic and is cheaper than other foreign brands.
Blank
Avatar_m_tn

Thanks a lot

Regards,
Mangesh

Blank
Avatar_m_tn
I am 50 yr male from Delhi. I have been detected HBsAg positive. further test results are

HBeAg   (0.24) -Non Reactive
HBeAb   (33.8) -Reactive
ALT   58.7
AST   42.8
Bilirubin ( total)   0.68
Ultra Sound  Normal
HBV DNA 652 IU/ML

Pl advise what should I do .
sa1962
Blank
Avatar_m_tn

without hbsag quantity in iu/ml and fibroscan we can t know your status, you made complementary tests but missing the main and most important ones
Blank
Avatar_m_tn
Hi Stef,

Here are my latest reports.

Date           HBSAG(iu/mL)        HBVDNA(iu/ml)     Fibroscan   vitd3(ng/ml)
20.09.12      20,600                     12,900                     3.5kpa       38.2
21.02.12      22,000                       6,450                     3,6kpa       56.8
05.09.11      16,000                     12,800                     4.0kpa         6.2

I am still only on vitd3 and B-Comlex tablets.
My HBVDNA has bounced back. I Do not know, whether it is improving or deteriorating.

Any further suggestion?

Blank
Avatar_m_tn

not much difference in numbers, i think it is stable but reinfection of cells make it up and down from time to time

is hbeag pos or neg?

you can both wait for myrcludex or rep9ac to be available since your liver is perfectly healthy or start tenofovir for at least 3 years to try intf add on and clear hbv
Blank
Avatar_m_tn
Many Thanks

HBeAg  - Negative
Anti HBe  - Positive

I think in my case it will be difficult to clear virus.

However, With vit d3 improved I feel a lot better. I want to continue with vit d3 intake and increase its dose and wait for another 6 months before starting tenofovir. Will it be ok?

Blank
Avatar_m_tn

actually sequential tdf 3 years and then intf add on has much better results on hbeag neg, at least the group was all hbeag neg

but you dont need too and may wait for myrcudex
Blank
Avatar_m_tn
Dear Sirs/Madams,


My fibroscan report is available now
fibroscan is 3 KPA for stiffness and 221 for FATTY LIVER
Other details are
a) HBeAg  - 0.22 (Negative)
b) HBeAb  -  0.02 (Positive) ,
c) HBV DNA is 17409 IU/ml
d) HBSAg is 5147 IU/ml
e) AST - 33 (within normal range 15-37), ALT - 42 (within  normal range 30-65) and ultra-sound are normal

As suggested, I was taking 1 tablet for 300 mg Tenofovir daily for 30 days. But, Based on the above report another DOCTOR TOLD ME LEAVE TENOFOVIR. As per him,  NO NEED OF MEDICATION as of now. Even he was worrying why I had started medication.

1) I am worrying that whether LEAVING Tenofovir just after 30 days will make my problem WORSE after few month or years, to my current level (of HBV DNA = 17409 IU/ml and  HBSAg = 5147 IU/ml)  ??

2) PLEASE suggest whether it will be a problem to leave Tenofovir now ??
Blank
Avatar_m_tn

the only reason to try tenofovir is using it to clear hbv and not for the liver since it has no damage.
two choicees since tdf alone doesn t work to clear hbv:

take tdf for 3 years and when hbsag reaches lower values like 1500iu/ml stop tdf and see if hbsag gets lower

take tdf for 1-3 years then add on intf and see if hbsag goes down and clear

or simply stop tdf now because your liver has no damage and you dont need it, myrcludex or rep9ac will be available in next years and those will be able to clear hbv probably
Blank
Avatar_m_tn
Dear Brij,

Please tell me the name of test (with detail) and cost that you are getting done at ILBS hospital to monitor the hepatitis
Blank
Avatar_m_tn
Hi
Got the tests done. Fibroscan reading is 7.1 KPa, IQR 0.7 IQR/Med 10% Success rate 100%. got the HBsAg quantative done the value is 1556.30 U/ml. Also got FAP, the value is 3.62 ng/ml

please advise.

Blank
Avatar_m_tn
sorry forgot also got ultrasound redone. it shows fatty liver Gr II. I am diabatic too.But under control now.
Blank
Avatar_m_tn

can you control diabetes by diet and bitter melon?is it diabetes type 2?

drugs to control diabetes are not good for the liver in case you can control it by diet and bitter melon that is better

both fatty liver and diabetes are a result of bad quality processed food and bad diet during your life, hopefully you  are on time to change it by diet too.look at my posts on how to reverse fatty liver because diabetes and fatt liver are due to the same bad habits

diabetes increase liver cancer risk to very very and decrease intf response very very much
Blank
Avatar_m_tn

liver is low fibrosis since art of 7kpa can be due to fatty liver too, i d work changing diet  and life habits to improve diabetes and fatty liver first

after results from this i d go for tdf+intf (sequential or directly) since hbsag is low and chances to clear high
Blank
Avatar_m_tn
To update from my previous post : 42 yr old,
recent tests :
HbsAg ( >250 iu/ml, lab falsely called it quantitative,)
Hbv dna ( 1050 iu/ml)
HbeAg ( -ve , 0.2)
LFT normal ALT and AST with bilurubin 1.3
Liver ultasound, : normal , but cystic lesion ( 2.5 x 2.1 cm) involving right lobe with five septations within
Showed the result to one of the reputed gastroentrologist from reputed hospital in Mumbai, advised to follow ultrasound yearly, was dismissiive of any concern or the Hbsag quant tests. He had advised me no medications 10 years back, same now

Should I be worried about the septated cyst ( I do feel stomach fullness and some discomfort)
Hbs dna was negative on  back,  How it is detectable now
Blank
Avatar_m_tn
My diabetes is under control the herbal way using bitter Gourd, Aloevera juice and some more herbal preparations. it is type 2 Diabetes. checked yesterday ,the  Fasting suger was 93 mg/dl.

My doctor has advised me only to follow up the hepa b with repeat tests after three months.In his opinion my viral load and alt levels are not high enough to start treatment.
He says fatty liver might be due to diabetes also. For fatty liver he has given Evion 400 1 OD and Ursocol SR 450 1 OD.
Blank
Avatar_m_tn
my viral load and alt levels are not high enough to start treatment.

this is a very old view, hbvdna must be und to have good chances to clear hbv by intf, not high and as regards intf chances to work and clear hbv only hbsag counts although the higher alt the better...if you like you can correct him and ask him why he doesn t consider these parameters which the most updated liver specialists use
Blank
Avatar_m_tn
You dont think fatty liver has to with hbv?

I have fatty liver. Developed it over 6 years of being sick with hbv. Before that the liver was ok. My cholesterol is really low too. So why I have it?

I did a 3 hour glucose tolerance test. Second hour post sugar intake my values were above  the normal range. Then by third hour it went back to normal.

So the lab just put a note next to the result. And my doctor told me not to worry about it.

So i did cut down on white bread and sweet juices.
Blank
Avatar_m_tn
Maybe because I have a core promoter mutant my disease moves fast? :(

As for vitamin d3 ever since I start taking it i feel better also. My chronic chest pains have stopped. I used to have terrible chest pains if I was tired or did not have a good 8-10 hour sleep. Only aspirin was of help. Now i dont need it since taking 8000iu daily. Which is a big thanks to Stefano here. He is a life saver guys. Also periodic dull liver pains have stopped. So definitely vitamin d 3 i feel is working. And i have more energy too.  
Blank
Avatar_m_tn

there are some good studies online and fatty liver is epidemic in US, UK and some countries were food quality is low and fats high but it may be due to hbv too

also being on good quality food only may not prevent fatty liver but being on exsercise, low weight and natural vit E, vit d3, bitter melon, fish oil do help for sure

check your oxidative stress too, it has also much to do with fatty liver and liver damage, also hdl value is very important and values over 60 were suggested to be protective and even little antiviral effect
Blank
Avatar_m_tn
Yeah here is a huge problem with GMO that they only recently have started to talk about. So peoples endocrine and  immune systems are all out of alignment. So given hep b on top of it causes even more  health problems.

Oxydative stress test I will do on my own to see what is going on.
Blank
Avatar_m_tn
is b k agerwal from patna good dr for hapytaits B?pls suggest me best dr in india.
        thanx
Blank
Avatar_m_tn
Hi Stef;

kindly find below results

HBsAg(CMIA)  250 IU/ml

SGPT(ALT)   25 IU/ml

SGOT(AST)  28 IU/ml

HBV DNA, QUANTITATIVE REAL TIME PCR ( Real Time PCR using
Cobas Ampliprep & TaqMan)   658 IU/ml

AIDS(HIV-I, HIV-II) ANTIBODIES FOR HIV (I&II)/P24 ANTIGEN 0.10

PT/PT-INR
Prothrombin Time
Test 12.5 second(unit)
control 11.0 second(unit)
INR 1.1

Anti HBe Method by chemilumiscence Result Non - Reactive(sample/cut-off ratio(s/co)-1.24)

HBeAg  Method by chemilumiscence Result Non - Reactive(sample/cut-off ratio(s/co)-0.3)

HBsAg Quantification 3626 IU/ml

Fibro Scan
Cap(db/m)                              E(KPa)
Median      370                       Median            6.5
IQR*           25                        IQR*               1.2
IQR*/med    7%                       IQR*/med        18%

plz help and suggets me any treatment to make HBsAG negative
Waiting your usual Advise
Blank
4658135_tn?1357662630
hi stef ... appreciate ur posts and answers
im a dr from Iraq...
we have a patient with hep b ...
if I post his findings,  u will be there for us ....?
we dont have fibroscan in iraq ... and dont have hbv quantification test ...
any advices ?
waiting for ur reply !
thanks ......
Blank
Avatar_m_tn

it is very difficult to know the real status without fibroscan, hbsag quant and hbvdna quant, we do know for sure that natural extracted vitamins and antioxidants help keeping liver healthy and reducing fibrosis if present so that is the first thing to do

as to tests why dont you send fedex to indian labs, they are the most advanced, cheap and available for testing, check older posts for the indian lab network available for this
Blank
Avatar_m_tn
use Himalays Liv52 B caps for hepatitis B, u will have results within 6 months
Blank
Avatar_m_tn
Hi, my result is HbsAg Postive(Qunt-37000 IU/ml), HbeAg- Positive, HBV DNA- undetectable. How much time & cost will come to make HbsAg negative?
Blank
Avatar_m_tn

it is not allowed to post phone numbers because that d be considered spam, before posting like that you have to proof hbsag clearance on patients in 24days only and what treatments (drugs ingredients) used
Blank
Avatar_m_tn
hi i have just done my test on 13/02/13 and i got hbsag +
den doctor asked me to do further tests and they are
hbeag - non reactive
hbv viral load -101 IU/ml
anti hbc Igm - 0.08 negative
anti HBe  - 0.14(postive)

my doc has to say that i am having chronic hepatitis b with inactive virus and no treatment needed ..
but i can not get rid of virus anytime and cant become Hbsag negative ..
please guide me with the same ...is there any chances ???
Blank
Avatar_m_tn
you need hbsag quantity in iu/ml to know if youare clearing or can clear by intf, hbvdna is not helpful for this even if und
Blank
Avatar_m_tn
i have mentioned my hbsag quantity is 101 iu/ml , now wat does it mean pls help me with it ...
thnx.
Blank
Avatar_m_tn
i have mentioned my hbsag quantity is 101 iu/ml , now wat does it mean pls help me with it ...
thnx.
Blank
Avatar_m_tn
no you said hbvdna is 101iu/ml, not hbsag quantity

hbvdna is useless to see if hbv is cleared, it can be 0iu/ml but your liver is full of virus
you need hbsag quantity in iu/ml by abbott architect or roches hbsag quantificaion
Blank
Avatar_m_tn
that was my mistake in typing ..
as you asked ya my hbsag quantity is 101 iu/ml
Blank
Avatar_m_tn
hbsag 101iu/ml peginterferon can clear hbv by 48-96weeks
Blank
Avatar_m_tn
Hi Stef,

Here are my latest reports.

Date           HBSAG(iu/mL)        HBVDNA(iu/ml)     Fibroscan   vitd3(ng/ml)
04.03.13      15,075                     12,500                     -------          66.2
20.09.12      20,600                     12,900                     3.5kpa       38.2
21.02.12      22,000                       6,450                     3,6kpa       56.8
05.09.11      16,000                     12,800                     4.0kpa         6.2

I am still only on vitd3. My SGPT has increased to 53 (iu/L) & SGOT has remained constant at around 35.

Any further suggestion?
Blank
Avatar_m_tn

i dont think vitamin d supplements can hold any effect on hbv clearance, it can just help on general immune function and keep healthy liver or boost a little some immune therapies

now it is best to see if ezetimibe i am trying has really an effect on hbsag lowering, or just a coincidence.
if ezetimibe really works as an entry blocker the best therapy would be: peginterferon+tenofovir+ezetimibe
Blank
Avatar_m_tn
Hi, its me again, after a break of about 6 months but I have been doing a lot of reading and searching. I have some useful info for Hepatitis B patients from Pakistan:
1. Please note that HBsAg (quantitative) by Abbot Architect is only available in Pakistan at Chughtai Lab in Lahore; the rate is Rs 4,500. The good news is that they take samples from all major cities in the country and give results within 3-4 days.
2. Fibroscan, (the most impoartant non-invasive test for checking liver fibrosis/cirrhosis) is available at Dow Medical Hospital in Karachi.
3. Vitamin d3  is available easily (drops) at medical stores for Rs 280 a month which last for more than a month. (D3 is to be used, not D2)
4. Many good brands of NATURAL vitamin E are available (the other one thats not natural is not very effective) the usual cost is around Rs10-15 per capsule of 400 mg, which is recommended dose for HBVers by some ppl. Oil form is also available.
5. We have been told that products from hepatitistechnologies (two of them are most important) are good for HBV patients, but i am sorry I could not find them in Pakistan. Maybe someone can guide/advise in this regard.
Regards.
Blank
Avatar_m_tn
Hi Stef, its me again. Could you kindly refer to my first post here of 18 August, 2012, and then have a look at the following update please:

Since my last post of August, I have been reading a lot, shown myself to a couple of doctors. And got many tests done. Here is a summary:

1. ALT done almost monthly in last 6 months: is fluctuating between 19 (min) to 44 (max). HBeAg continually negative. And HBeAb+.
2. HBsAg (Quant) by Abbot Architect done in Feb,13: was 2674.73 iu/ml.
2. Fibroscan done in October and shows Liver Stiffness 3.3 KPA. (At the end of report, it says this correlates with F0-F1 for HBV)
3. HBVDNA that was 28,500 Copies/ml in July: Checked again in September, was UND. Checked again in Feb, 13, was again UND.
4. AFP was 5.58 in Aug, 12 (upper limit 8.5). Increased to 6.37 in December.
5. Ultrasound was all normal as checked twice. However, the portal vein dia is decreasing from 1.3 cm in Jul to 1.1cm (end Aug) to 0.8cm (Jan 13). (last two U/S were from same lab)
6. I used to have a lot of meat especially mutton, but have left that almost completely for last 6 m, and also cooking oil in food much reduced. Maybe that explains the weight loss. Now, I am maintaining same weight +/- 2 kg for last 6 months. Watching my diet.
7. SYMPTOMS: Sometimes I feel a bit of pain in the liver area. Often it is pointable ie i can pin-point it, its not a diffused one. But its almost always bearable. Its sometimes much high in chest(upper part of liver?), sometimes behind right rib, sometimes below it, sometimes in the back. Sometimes lasts for seconds, sometimes minutes. Sometimes its a dull diffused one too that doesnt hurt much. THIS PAIN IS MY NO 1 CONCERN. The second symptom is sometimes I feel some some bloating, nausea, slight acidity (mostly bearable again). Like nowadays.

QUESTIONS
1. Should I make efforts to find out whether I am Lam resistant so that if in future I have to decide abt antivirals, I make the right decision? (I used Lam for 6 months about 12-13 years ago when first discovered and left it when i got HBVDNA negative). I dunno how to do that but I am sure it is possible in Pakistan.
2. Should I make efforts to find my genotype (possible with hbvdna neg?) (Maybe not very easy to find lab but would try). Would it make a difference to find genotype?
3. Should I think of antivirals (advantage, as i understand is that it would attack the HBVDNA without harming the hepatocytes; unlike my own immunity system which maybe is attacking my liver cells to keep HBVDNA down, hence the variations in ALT. They may safely take me till the time HBsAg defeating drugs are out (next 2-3 years). OR.. Should I NOT think of antivirals because Side-effects plus NO endpoint for hbe negative?
4. Why the variation in portal dia? I heard some simple factors can affect it, also labs were not the same. Your opinion?
4. I am presently just taking 4000-5000 of Vit D3 and 400 natural Vit E. Just avoiding beef/mutton, artificial foods and oily stuff. Any important addition?
5. The occasional pain and the increase in AFP makes me eager to go for biopsy, but i am scared, and also think U/S and F'scan do not suggest it. Hope I am not making a mistake.
6. Does my HBsAg suggest anything? Any advice?

Thank you so much for your patience and help.
Blank
Avatar_m_tn
Sorry, forgot to add that after taking vit d3 for two weeks, checked vit d level for first time in my life and found it to be 37, it said i am deficient. I am still taking it.
Blank
Avatar_m_tn
better wait and see how it goes with ezetimibe before thinking about a treatment


you dont need any treatment now and lam-r is no an issue since we use tenofovir now
Blank
Avatar_m_tn
Thanks a lot.
Thanks.

One question:  I noticed a significant Creat rise after 2 weeks of starting vit d. The cause could've been vitD or HBV itself i dont know. Anyways, it went down quickly also. Is Creat management important/tricky in Hep B?

Hep B elevates Creatinine. Vitmain D is good for HBvers but may elevate ceatinine.

I think this kind of problem once caused you to discontinue vit D too. Did you restart? How did you manage it? I am thinking on a slight reduction of intake, maybe take 2500 iu/day. But not sure.
Thanks again.
Blank
Avatar_m_tn
Thanks Stef,

Can you suggest some brand name for "ezetimibe" in India.

Is it something new.
Blank
Avatar_m_tn
no old drug, any ezetimibe brand is ok
Blank
Avatar_m_tn

hbv can also make some damage to kidneys but not vit d directly, on the contrary vit d is essential for kidneys to work

vit d helps also calcium absorption, very few people can have a rare disease where they cannot balance calcium in blood properly (dont remember the name of this disease), in these people vit d needs monitoring together with calcium because it is calcium to make kidneys damage if too high

so i do suggest all taking vit d to have both vit d and calcium monitored, members in the community exerienced a lowering in calcium by the increase of vit d at high end of normal and not an increase, so this is probably true only with people having problems with calcium balance
Blank
Avatar_n_tn
Blank
Avatar_m_tn
Can you kindly tell me whether it is possible to get following tests done while HBVDNA negative?

1. Precore/core-promotor mutation tests?
2. Virus Genotype test?

Many thanks.
Blank
Viewing 1-200 comments:
Blank
Weight Tracker
Weight Tracker
Start Tracking Now
Hepatitis B Community Resources
RSS Expert Activity
242532_tn?1269553979
Blank
The 3 Essentials to Ending Emotiona...
Sep 18 by Roger Gould, M.D.Blank
242532_tn?1269553979
Blank
Control Emotional Eating with this ...
Sep 04 by Roger Gould, M.D.Blank
242532_tn?1269553979
Blank
Emotional Eating Control: How to St...
Aug 28 by Roger Gould, M.D.Blank
Top Hepatitis Answerers
Avatar_m_tn
Blank
stef2011
Italy
Avatar_m_tn
Blank
StephenCastlecrag
Australia
Avatar_m_tn
Blank
veteranB
CA
Avatar_m_tn
Blank
jrai2014
Delhi, India
Avatar_m_tn
Blank
mer971
Avatar_m_tn
Blank
waschool
Ghana