Very Low qHbsAg, No Medications, What Next

[hitman76]

Starting a new thread as continuation of http://www.medhelp.org/posts/Hepatitis-B/Recently-diagnosed-with-CHB-Fatty-Liver-Fibroscan-62-HBe-negative-Low-DNA/show/2535015, as this is getting longer and takes more time to read...

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Recently got my quantitative HbsAg done and got 3.44 IU/mL.

No HBV related medications so far, just wondering what should be my next course of action.
Experts, please advice....

Here are my other baseline tests done 5 months back when I was diagnosed with HepB...

-Recently Diagnosed CHB Patient, age 38 years, living in US.
-Must have aquired in childhood since Mother doesn't have it and I got vaccinated twice for HepB in last 15 years.
-Also diagnosed with hypothyroidism 2 years back, started the medication 2 months back-started Livothyroxine 0.1 mg daily. Now 0.025 mg daily.

Baseline Tests :
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HBsAg : Reactive
HBsAb : Non Reactive
HBe Antigen : Non Reactive
HBe Antibody : Reactive
HepB Core Antibody, IgM : Non Reactive
HepB Core Antibody Total : Reactive
HepB DNA 70 IU/ml(1.85 Log IU/ml)

ALT 27
AST 18

Abdominal Ultrasound(02/27/2015) : Fatty Liver
"The liver appears hyperechoic diffusely suggesting fatty infilteration or hepatocellular disease."
I am 5'7" and weigh 145lb, so not fat per say.

Fibroscan(03/31/2015) : 6.2 (Average of 3 values 6.0,6.5 and 6.2)
Abdominal Ultrasound accompanying Fibroscan says "Minimal homogenous hepatic echogenicity. Findings may reflect infilterative process, including hepatosteatosis"

Cholesterol Related :
LDL 101 mg/dL
HDL 33mg/dL
Chol 157 mg/dL
Trig 115mg/dL

Vitamin D Related(April 25, 2015) :
Vitamin D, 25-OH, Total :12ng/mL (Taking D3 supplement 5000IU/mL daily)
Vitamin D, 25-OH, D2   < 4ng/mL
Vitamin D, 25-OH  D3   12ng/mL

Intact PTH : 33 pg/mL
Calcium 9.4 mg/dL

[hitman76]

Yeah, i will monitor my HBsAb as well and try to correlate if "< 3.1" is just the  maximum presion of the machine running the test or the true number.

[twinboys1girl4me]

I do believe that HbeAg sticks around, but do not know if it sticks around forever?  I would highly assume with your moms testing and you and your brother both having it that she was chronic, passed it on to you both, and then cleared at some point after.  If she was acute she would have cleared in a much shorter window, in which you and your brother both couldn't have fallen in the time frame.  I presume if she were acute and passed to one of you, that the chronic child could have passed it to the other one later but much more likely you both got it from your mom when she was active/chronic.  Do you have any other family members that can be tested, say your maternal grandma, grandpa, aunts, uncles, etc?  This may tell even more.

That is interesting you have some circulating hbsab's.  I do too and do not understand why this is.  I'm going to ask my next visit but feel they may not have a good answer.  In 2010: hbsab <2.80, 2014 hbsab <3.10, 2015 hbsab <4.23.  Do you think this is just a reference range in the U.S. (I've read others having this and believe they are in the U.S. too) or do you think this is a true quantitative?  For you, if you can keep tracking hbsag quant and hbsab this may tell you if you are gaining the upper hand in clearance.  For me, since I can't track quant hbsag I feel the hbsab is a mystery.

[hitman76]

Thanks, If she was chronically infected at some time, I would assume she would have HBe antibodies as well ..Isn't it ?

I had my HBsAb saying "< 3.1" which meant non reactive, so I think for me still body has to fight off remaining HBsAg.

[twinboys1girl4me]

With her hbcag being reactive this means that she did have HBV in the past.  I do not believe any further testing will reveal acute or chronic at this point (I'm sure others can say for sure), but since you and your brother have it and your mom does have core antibodies I think it's more likely she was at some point chronic.

I sincerely hope since your mom cleared HBV you can too, especially with your low hbsag.  Have you had hbsab quant done?  If it is increasing it may be useful since hbsag is so low (especially since now you are back in the US without hbsag quant).  Good luck!

[hitman76]

Since we both brothers have chronic Hepatitis B, we got some extra tests for our mother related to Hepatitis B to maybe trace how we may have got it.

Her results :

HBsAg : Non reactive
HBcAb - Total : 1.77 U/ml( > 1.15 is positive so this is positive)
HbeAb 0.84 ( <0.9 Negative so this is Negative)
Anti Hbs : 187.2 mIU/mL ( She got Hep B vaccinated recently)

Can we conclude, if she had Hep B in the past and might have cleared it ? Acute or Chronic ?

Any other clues from her tests ?

thanks a lot to the helpful community as always.

[Royal36]

Ohhhh i have been reading all day long the thread of abrerdeen577 but lately he doesn't show up after dec 2014. Hope he cleared the virus and back to his normal life and was so impressing to follow all the discussions out there guided by our legend stif2011.

[stef2011]

yes

[Royal36]

Stef2011 was aberdeen577 an Hbeag negative patient? Coz it hard to get rid off Hbsag if your are not Hbeag positive. Thanks!

[hitman76]

I am visiting India...so got it done here.

[luckyman316]

Where did you get the quantitive test done in the US?

[hitman76]

thanks steff

[stef2011]

his nickname
aberdeen577

[stef2011]

Can I take 2 pills of 5000 IU tablet to make it 10000 ?

of course

Also, the other member who cleared, did he start tdf/gcmaf after he was at 16 iu/ml ?

we dont know his hbsag baseline after many years of tdf he checked hbsag and it was low for few years, after about 6 months of goleic gcmaf plus vit d3 plus tdf he cleared.we cannot say 100% it is due to vit d3 or gcmaf but nothing to lose by trying both are free of sides

How much time did it take for him ?

there is a thread, his nickname is aberdeen or similar, maybe other members remember about his post

[hitman76]

Can I take 2 pills of 5000 IU tablet to make it 10000 ?

Also, the other member who cleared, did he start tdf/gcmaf after he was at 16 iu/ml ? How much time did it take for him ? Would be great if you could give any clue about the relevant thread.

[stef2011]

vitd is extremely deficient, 5000iu is too low, you need at least 10.000iu daily

another member cleared by using sublingual goleic gcmaf, vit d3 and tdf, he was about 16iu/ml

[hitman76]

Hi Royal36,

Not sure if I follow you...I am not on any medications, so stopping it(as you mentioned) doesnt make much sense, unless you wanted to say something else....

:(

[Royal36]

& your HBSAg at the baseline is a good predictor to the reduction or a final and the good thing yours is a low way below.

[Royal36]

At least the medication is safe for 3.5 years after discontinuation and if you are lucky may be you can be from the 2(5%). Thanks!

[Royal36]

Stopping Tenofovir is better for the Hepatitis B Patients in Long Term
FEATURED
      1 Vote

Most hepatitis B patients who stopped taking tenofovir (Viread) after more than 3 years on treatment had good outcomes, according to a presentation at the European Association for the Study of the Liver (EASL) 50th International Liver Congress last month in Vienna. Although all patients who stopped tenofovir saw their HBV viral load rise, most maintained normal ALT levels and only a few needed to restart therapy.

Antiviral therapy using nucleoside/nucleotide analogs such as lamivudine, entecavir, or tenofovir is the mainstay of chronic hepatitis B treatment. While antiviral drugs can effectively suppress HBV replication long-term during therapy, they usually do not lead to a cure, as indicated by hepatitis B surface antigen (HBsAg) loss. The optimal duration of nucleoside/nucleotide treatment is still not defined.

Thomas Berg from University Medical Center Leipzig and colleagues looked at outcomes after controlled discontinuation of prolonged tenofovir treatment.

Prior research indicates that long-term effective antiviral therapy may lead to partial restoration of HBV-specific T-cell function, the researchers noted as background. Stopping therapy usually results in disease reactivation with HBV DNA viral load rebound and sometimes hepatic flares, or sudden ALT (alanine aminotransferase) increases due to inflammation as the immune system attacks the resurgent virus. In some cases, however, this may be followed by HBsAg clearance.

The “Finite CHB” study included 45 chronic hepatitis B patients at 13 sites in Germany who had been on effective tenofovir treatment for at least 4 years, with HBV DNA <400 copies/mL for at least 3.5 years. A majority were men, most were white, and the median age was 45 years. At baseline all were HBsAg-positive, hepatitis B “e” antigen (HBeAg)-negative, had normal ALT (median 22 IU/mL; 40 IU/mL is considered the upper limit of normal), did not have cirrhosis, and had no history of decompensated liver disease.

Participants in this open-label study were randomly assigned to either stop tenofovir or continue therapy for 144 weeks. Tenofovir could be restarted if clinically significant hepatitis B flares occurred.

The primary endpoint was HBsAg loss at week 144, considered the closest approximation to a cure. Berg presented interim 48-week findings; 21 participants in the stop-tenofovir group and 21 in the continuous-tenofovir group completed 48 weeks and were included in this analysis.

Results

At 48 weeks, patients who remained on tenofovir maintained viral suppression, had stable ALT levels, and none experienced HBsAg loss.
3 people (14%) who stopped tenofovir restarted therapy by week 48 — 2 due to early hepatitis B flares and 1 due to persistent high-level viremia; all returned to undetectable HBV DNA and normal ALT.
All patients who stopped tenofovir experienced HBV rebound, mostly within the first 12 weeks after discontinuation.
By 48 weeks, among the 18 patients who stopped and stayed off tenofovir, 16 (89%) had a viral load below 20,000 IU/mL, including 14 (78%) with HBV DNA <2000 IU/mL.
Most people who stopped tenofovir also experienced ALT elevations, with 12 (57%) reaching levels more than twice the upper limit of normal.
But by 48 weeks, among the 18 who stayed off tenofovir, all had ALT less than twice the upper limit of normal, including 15 (83%) with normal ALT.
Several patients who stopped tenofovir experienced substantial reductions in HBsAg; the median reduction was -0.28 log, compared with just -0.09 log in the continuous-tenofovir group.
2 patients who stopped tenofovir experienced HBsAg loss, 1 at week 20 and 1 after week 40.
Participants who experienced the largest HBsAg reductions — including the 2 with HBsAg loss — started out with lower baseline HBsAg levels (<25,000 IU/mL) than those with smaller or no HBsAg reductions.
The proportion of people with both low HBV DNA and near-normal ALT increased with longer time off tenofovir.
“Stopping [tenofovir] in HBeAg-negative patients with undetectable HBV DNA for at least 3.5 years appears to be safe,” the researchers concluded, and tenofovir can be restarted if necessary.

“Stopping [tenofovir] was associated with a more profound decline in HBsAg levels compared to with continuous [tenofovir],” they continued. “These data support the concept of stopping antiviral therapy in long-term HBV DNA-suppressed subjects without cirrhosis.”