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Treatment Question - Options
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Treatment Question - Options

I got my latest test results and apparently my immune system apparently doesn't like HBV as the ALT is now 330.  I found out last fall, so I've had three test for HBVDNA and Liver Panels since then.  
ALT 218 AST 70 September 15, 2012
ALT 98 AST 35, HBVDNA 68K UI, October, 2012
ALT53 AST 33, HBVDNA 7.8K UI, November, 2012
Biopsy Results - No Fibrosis (Ishak=0) - Scattered Foci of Lobular Inflammation (Not sure is this is mild or something) - December 2012
ALT 330, AST 155, HBVDNA 365K UI, May 2013.  

Since I'm HbeAg negative and in the USA, so HbsAg Quantitative is not available, I want to give Peg a try as I'm in great shape and think I can handle the sides if there are any.  My questions for the knowledgeable members here are:

Is there anyway to monitor whether you responded to Peg without HbsAg?  Since the immune system is obviously active, would adding Peg now be like pouring gasoline in the fire?  How long can you sustain ALT in >10 ULN without any significant damage?  I saw a study by some Canadian researchers that they got 30% HbsAg clearance on HbeAg Neg patients when starting treatment during a flare, but I want to make sure that I don't come out worse than I went in.  Any other data that I should look at before deciding?  
9 Comments Post a Comment
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Avatar_m_tn
it doesn tmake sense to try pegintf without hbsag quant, if it is not 1500-3000iu/ml you are wasting your time, why dont you ship blood sample to synlab or check online labs in US making hbsag quant, studyforhope just posted two labs in US

having high alt doens t mean you are active:
if the high alt makes lower hbsag and lower hbvdna it is your immune system controlling hbv

if the high alt is followed by increasing hbsag and hbvdna it is hbv taking control of your liver and immune system and the high alt just makes useless liver damage

be like pouring gasoline in the fire?  
no

hbcab igm can also help understand immune activation, if higher than 0.2sco there is immune activation

hbsag quantitaive otherwise it is impossible to understand what you are doing and where you are going
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Avatar_m_tn
Thanks Stef.  Unfortunately, I looked at the labs that studyforhope listed and I believe they just offer the standard test and no HbsAg quatitative.  Unless I'm missing something on that.  To be honest, I haven't looked much into shipping samples abroad, as we decided to wait and monitor since liver was healthy.  I'll be calling FedEx to see what shipping samples abroad would involve.   At this point, trying to gather as much information as possible to make the best decision.  Do you know if synlab can correspond in English?    

I don't have enough data to determine whether hbvdna will be lower after this flare or not.  I only based my decision because in September my Alts were higher and they lowered when Hbvdna went to 8K.  But now is back up so I'm thinking virus induced flare.  In any case, I may be asking a few more questions in here after a few more labs.  At this point, based on liver health from biopsy, I'm willing to wait a few more months for some more data points.  
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Avatar_m_tn
Do you know if synlab can correspond in English?    

yes it is a network of labs in europe that tests also for human trials, if they say they dont accept samples tell them that you contacted the manager of italian branch and it was accepted, in case pm me and i ll give you the email of the secretary that confirmed they accepted

as regards fedex papaer work can be difficult so it is best you check in this CFS forum, these patients send samples to europe for advanced testing of their diseases because available in europe only and they already know all paper work, here is the link of their forum, look for the post about fedex

http://forums.phoenixrising.me/index.php?forums/gcmaf.10/
http://forums.phoenixrising.me/index.php
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Avatar_m_tn
Well, it appears that the recommendation of specialist is Peg for me.  Will keep community updated. Stef2011 and I have been talking to the synlab about sending samples abroad for HbsAg quantitative.  Still working on that to see if that is doable.  I did have a question for Studyforhope.  Being that I am/was experiencing a flare, any tests that you would recommend I run in advance of starting Peg that are necessary to keep track of side effects?  All other blood perimeters and liver functions are within good ranges.  VitD test is scheduled for next week.   Any comments/input would be appreciated.  
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Avatar_m_tn
You should perform a thyroid panel, tsh and thyroxine to have a baseline. Ifn treatment frequently causes thyroid problems due to autoimmune activation.
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Avatar_f_tn
I didn't do these tests before I started treatment although the intf is still ongoing.
His case is close to mine due to high ALT and e_negative but I appeared to have been responding to intf.  What are the implications? My Doctor never advice for these tests.
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Avatar_m_tn
The implications are that due to partial destruction of the thyroid there is a chance, to become hypothyroid. If that happens you need to know it, since hormone substitution will possibly be needed, depending on the degree of the dysfunction.
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Avatar_m_tn
It's been a while since I posted here, so I thought I'd post an update for the community.  I finally started Peg treatment last month and had the 4-week tests done.  ALT 38 and HBVDNA 20UI.  No side effects to speak of after five shots, although WBC and ANC decreased significantly from week 2 to week 4.  
Not sure if the drop in HBVDNA is due to PegInt or immune system as I never had a chance to get baseline before starting the shots.  Last DNA reading is from end of May @ 355K.  No HbsAg quantitative out here, so I don't have that data to report.  
Regardless, so far the only inconvenience is lab work to be done.  They required testing every two weeks for 2 months and every four weeks after that.  I'm getting to know the lab people by first name now.  
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Avatar_m_tn
Good luck with the treatment buddy.

I agree with you re: lab work. Currently I am doing the weekly lab work because of low numbers.
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