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What Is my Condition?
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What Is my Condition?

I am hepatitis B patient.
At 2007 -> ALT-N, HBeAG- Negative, DNA Negative, USG& EGD- Normal
At 2010 -> HBV DNA-107 IU, S. ALT-48, HBeAg- Negative,,eAB Positive, TP with AGR-Normal
At 2011 -> HBV DNA - 1251 IU, ALT -37
At 2013 -> HBV DNA - 86764 copies/ml, ALT 63, FIBRO SCAN- FSS-4.3/ NO VX/NEG
Above my health condition, My doctor told me my liver is fine but hbv dna increasing now he give a tablet CAVIR(.5)
at night time. Please anyone tell me what is my condition.. Why my hbv dna increase day by day
6 Comments Post a Comment
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Avatar_m_tn
To understand better what goes on you need also to monitir hbsAg quant in iU/ml.
Also you need to test every 3-6 month hbv dna fluctuates and testing once a two years means little.

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Avatar_m_tn
CAVIR is Entecavir. Your doctor believes you have HBeAg negative chronic hepatitis. That is you are in the immune escape (re-active ) phase due to mutations of the virus.
As your hbvdna is above 2,000 iu/ml (10,000 copies/ml) and your ALT is elevated (above 2 times the ULN of 30 iu/l) , you certainly fit the  criteria for treatment according to most guidelines. However, your Fibroscan score of  4.3 kpa (we think that is what your report indicated), your liver has minimal fibrosis.
So, was it right to treat or can you wait? This is a grey area. If your hbvdna is persistently above 2,000 iu/ml and ALT > 2 x ULN, then treatment would be appropriate. But given your age of 31, and liver has only very mild fibrosis, you may have been able to wait to see if hbvdna and ALT return to a lower level. This is a very difficult question to answer.

At least Entecavir is an excellent choice of medication. It should be taken at least two hours before and after meal, so nighttime is appropriate. I think you have some good liver specialists in your country, I hope your doctor is one of them.

I am not a doctor, these are just my opinions.
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Avatar_m_tn
Do not start treatment until you get baseline hbsag in iU/ml. All said above it is just a copy from doctors guidelines written by insurance companies.
Your liver looks healthy and there is no rush with the treatment. Hbv is a slow killer and 3-6 months means nothing for the treatment.
Modern protocol that cures hbv iin 70% of the cases is tenofovir for 3-5 years and then interferon add on. And to follow this protocol you need to test hbsag iu/ml all the time.
As for entecavir it is not the best choice, tenofovir is much better drug with almost no resistance and it is cheaper.
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Avatar_m_tn
Rome will you pls provide us the link  of modern protocol for cure of hbv upto 70% by tenofovire in 3-5 years
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Avatar_m_tn
Do not have it in hand. Read old posts there ware links on research articles.
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Avatar_m_tn
it is not 70% it is 50% hbsag clearance and hbsab seroconversion by 48weeks and 90% response (the 40% not clearing hbsag by 48weeks)  reaching extremely low hbsag (50-300iu/ml) already after 48weeks.the links to the trials or easl, apasl or else conferences are in so many posts of sequential treatments we have since 2010 on this community, just use search box or google

to note hbsag like 100-300iu/ml can even stop all therapies since cccdna is extremely low/und and there is no reactivation, but i d not suggest this as mutations in hbsag can occur

50% is conservative since low potency antivirals were used in these trials, 5years of tenofovir or entecavir might have more than 90% response and more than 50% clearance by 48weeks, although not so important because once there is such hbsag decline it will be cleared anyway overtime by keeping pegintf add on 120weeks instead of 96weeks

a small trial used 12 patients on nucs for a short time but only 2 patients cleared hbv, so the time of hbvdna und by nucs is essential and at least 3 years.of these 2 patients clearing:
one hbvdna und on etv+tdf and prior pegintf monotherapy non response, after 10months und by tdf+etv pegintf add on worked and hbsag was cleared.

the other patient was on etv for about 27months

the reason why pegintf add works as we already posted link to this research is:
nucs rescue cd8 response to hbv by long term therapy
pegintf add on rescue nk cell response to hbv
so when the two are combined after longterm nucs we have these cells response specific on hbv and researchers said this is probably the reson of such high hbsag clearance
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