Treatment advice

[questions63]

Was on pegasys for 24 weeks:  viral load started at 15 million, went down to 5 million, but recently jumped back up to 8 million.  Doctor removed me from pegasys, which was obviously frustrating.  During the last 4 weeks of pegasys treatment I really "felt" something in my liver - which I assumed was a good thing, in light of viral load going up am now concerned about "feeling" liver / could also be "worry".  Alt/Ast have gone down to about 70 each after peaking at 120 in December.  Took milk thistle 3 x times a day, which I credit with bringing down Alt/Ast.

Just started viread 3 days ago and have almost a constant nausea feeling.  Apparently this is a commons side effect (googled it).  Questions:  Any experience with viread nausea?  Will nausea eventually go away?  When is the best time to take viread?  Is it advisable to take milk thistle with viread?  

Thanks in advance for any comments or advice.

[stef2011]

tdf and etv combo is for compelte hbvdna suppression, i had some residual hbvdna on etv mono.this is also to prevent any posssible resistance

of course hbvdna suppression is better on combo of these potent antivirals reaching more suppression inside the liver

[questions63]

wow in only 4 months/4 weeks, great results.  let's hope for the best.  

[grmr]

no i'm on viread mono since 4 months and i''ve started ifn 4wks ago.. DNA is dramatically going down under 2000iu/ml.. my docs (who are not followign the very latest protocols)  wanted to start a little before DNA gets und..

[questions63]

am curious about viread and baraclude combination.  did you start with viread alone and have to add baraclude later?  if so for what reason?  thanks

[questions63]

hi, so how long did it take to get dna down on viread?  i am now on viread alone, do you know when you need viread with baraclude - like steff2011? what is you status now + have you re-done pegasys?

[grmr]

hi.. yes 4 ys ago i quit ifn therapy as i still had dna >100000000 so doctors said I still was immuno tolerant and it didn't make sense... no noticeable sides though.. thanks God..

I believe there's no issue on milk thistle you ca intake it at any time.. it's natural and do not hurt

[stef2011]

biopsy can t be repeted, there is also a remarkable death risk and liver damage, it is also obsolete.i d never do a biopsy with fibrosis stage 3.
i had 2 in my life but this is one about 10years ago and one 25-30y ago, it is not used anymore

fibrosis is monitored by firboscan only together with US every 6 months

[questions63]

one last question: had one liver biopsy about 7 months ago, there was damage so they started treatment.  how often do your / recommendations for biopsy?  invasive i know but what are the guidelines here?

[questions63]

let's keep our fingers crossed for good results in may

[stef2011]

yes for now thats the plan with highest hbv clearance, the goal is hbsag<1500iu/ml because add on peginterferon at that low level allows fast hbv clearance in almost 48weeks but also hbsag around 8000iu/ml got to extremely low just adding peginterferon

in may i will start myslef peginterferon add-on (i am 2.5years on etv and 6months tdf)

[questions63]

thanks.  sounds like a plan.

viread 1-3 years @ dinner/lunch + probiotics + d3 + milk thistle.  add pegasys hbsag below 20.000iu/ml after 1-3 years.
monitor creatinine monthly for 6 months; calcium + d25oh quarterly.
have researched d3 + grmr.

thanks for the boost.

[stef2011]

i am on both viread and baraclude so i cant choose.i take viread at breakfast and baraclude before bed

viread is best absorbed by fat meal so depending on the type of meal lunch or dinner may be better

also remember to monitor cratinine before starting viread and then every month first 6 months of vread use

you also need to take vitamin d3 supplements to make sure vitd25oh stays higher than 50ng/ml (optimum levels 80-90ng/ml).this is a must for all hbver because we are all deficent (less than 40ng/ml).this will make viread sides less, will improve immune system resposne and prevent/regress fibrosis/ cirrhosis

check all posts in the forum about vit d3 and all its benefits, taking vit d3 needs also monitoring every 3 months of vit25oh and calcium

[questions63]

Thanks, will do.

[questions63]

Cheers!

[stef2011]

you may try probiotics for the stomach, they are all beneficial to liver and immune system not only stomach

bifidus yogurt is very good for this

[questions63]

What in your experience is the best time to take viread? I currently take it in the morning with breakfast, but read where some people take it before going to bed.

[stef2011]

the doctor is ignorant switch to another one, high hbvdna is obviously interferon failure for sure

grmr had the same wrong treatment but it was many years ago and so it was not known that hbvdna makes pegintf failure and now he has been retreated with viread first and then peginterferon add on

viread alone is useless to clear hbv especially if you have no liver dmage, the chances to clear hbv are only 16% at 4 years.i do suggest to do the same as grmr find a good doctor, keep viread for 1-3 years and then add on  interferon, making viread monotherapy has too few chances to clear

[questions63]

ummm what is IFN - interferon?  Have been diagnosed as chronic for 8 months now so I am still learning.

So I guess then had you on tdf, then moved to interferon + viread?  Is this the usual treatment?

[questions63]

I am hoping viread will lower my HBVDNA - assume tenofovir and viread work the same.  
About "hanging on" what would be a next step if viread has no impact - viread combined with something else?  

Also how long did you have to hang on until you had results?  

The waiting is the worse.  I have another HBVDNA test mid-May so I guess I get to hang on until then.

The "nausea" or stomach unease - see previous post.  I think it is nervousness at hearing pegasys did not work.  

[questions63]

Hello.  HBVDNA is 7.2 million - in other words high.
EAG status = +
Liver damage:  AST = 68; ALT = 72

Doctor's reason for removing me from Pegasys:  sides were very low white blood cell count (hovered between 2.2 and 2.8) and he said with the HBVDNA levels going back up there was "no response" - as the HBVDNA rose again.  Had no noticeable sides while taking pegasys though.

Viread side is more like stomach pain + burping - but I think this is largely nervousness.  When focusing on something else the don't fell stomach as much.  When I think back the unsettled stomach feeling started when they told me I was not responding to pegasys.

Thanks for the milk thistle tip - I had read NOT to combine milk thistle with antivirals like viread.  If you have had good experience with milk thistle I will continue to take it.  If anything it makes me feel like I am doing something.

[stef2011]

i am on viread too but i think nausea is due to the interferon hbv and liver status
viread is the only thing that can work now, hold on

[stef2011]

interferon doesn t work on hbsag>20.000iu/ml and hbvdna millions, in these cases you have to start tenofovir first to make hbvdna undetacatble and then you can use peginterferon and have response.

this is actually the way to get 90% response for any patient on interferon because with hbvdna detactable interferon response gets down to less than 7-8%

[grmr]

i believe you need to post youra data (DNA, eag statuts, liver damage etc) i do not understand you gave up pega sa guidelines reccomend it for 48wks.. was this due to sides?

I'm on combo VIREAD + IFN but even when i was on TDf mono i didn't feel any nausea.. i alwayis take milk thistle and vitd3 supplements