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What can i Do
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What can i Do

Hello every one!
I'm from Albania! This is my history: In  sepember 2010 I have the result: Alt 420 IU, Ast300 IU, Hbeag Negative, hbv-dna 2.6x10^5 IU/ml. Immediatily I was put on interferon (roferon A 3 times weekly) for one year till october 2011. After 6 month off treatment (march 2012) my Alt 42 IU, Ast 35 IU,  hbv-dna 1.4x10^4 IU/ml, Hbsag 1080 IU/ml. On March 2012 Hbsag 960 IU/ml, Alt 40 IU Ast 30 IU. Today after 2 years and half after the end of treatment (march 2014) Alt 41 IU, Ast 30 IU Hbasg 747 IU/ml, Hbv-dna 4.0x10^4 IU/ml, Fibroscan (7.5 kpa) F2 (for the first time) . During this time I,m taking 5000 IU vit. D every day. Doctor told me to treat with tenofovir, because your fibroscan is F2. I ask him to treat me with  interferon, because I thougth that my hbsag is declining and is <1500 IU/ml., and doctor said ok , but we have to wait 1 month for interferon, because it will be delivered to hospital.\
My question is : Is my decision good to go for second time for interferon or to treat this time with tenofovir? The  first time of interferon was terrible, but  I want to be cured, not to be on tenofovir for all life.
Any suggestion Steff Ti prego!
46 Comments Post a Comment
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Avatar_m_tn
I,m 33 years old and I want to correct  hbsag 960 IU/ml was on march 2013 not n march 2012. For 2 years and half I,m not on any treatment , only vit.D3 5000 IU/ml and fish oil every day,
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Avatar_m_tn
Please guys any suggestion about my retreatment? Which drug would You choose tenofovir or Pegasus in this case?
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Avatar_m_tn
Definitely your decision. Go for the chance of a cure. TDF might do the job as well.

When you said terrible while on IFN the first time, what do you mean? Inconvenience, tiredness?

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Avatar_m_tn
Hello mustthinkposite! Thanku You for your response.
When you said terrible while on IFN the first time, what do you mean? Inconvenience, tiredness?
Every part of my body hurt, my hair fall and did not grow back . I was very nervous with every body. I lost 15 kg and I gain only 5 kg after interferon. My live changed, I thing now I am an other person. I am very depressed, not happy guy anymore. About tiredness I was not, even never got flu for 2 years. Only my legs even now hurt, they burn. I was changed like a victim, people did not even regnozise me. I work in the office, but was very hard to do something, I was not concentrated. About interferon I am happy only about one thing: my hbsag is declining. I never did this test  before treatment, only after and was 1080 IU/ml, and now after 2 years and half is 747 IU/ml.
Do think I have a chance to go again for Pegasus, or better to go for tenofovir? I,m afraid that maybe again my sacrifice will not be worth.
Any suggestion.
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Avatar_f_tn
Hello there .i hope u doing well..please can u tell me were did u do the hbsag test..did u do it in Albania or u when out of country..I m from that part so I wanted to go for that test..thanks and I hope u cure ...
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Avatar_m_tn
Hello Seka! The hbsag test (called Hbsag Quantity, cost around 33 euro) I did in Albania, in Tirana. The name of laboratory is Intermedica, is well known in Tirana. They used ellyses, not Architect Abort, but I think is the same thing.
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Avatar_m_tn
6/10 patients have loss of HBsag when they use long term NUCs and add peginterferon on. Read this website from Denis Ouzan. http://www.aphc.info/pdf/2014/Luncheons_13012014/S-242A/Denis_OUZAN.pdf
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Avatar_m_tn
Thank You Mert!
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Avatar_m_tn
Elis don't think that you have to take your antiviral for all your life. The cure is on way,for few years will be out. Cure for hep c is already out, now the interest will focus on hep b, and already there are discoveries. For now the best cure 60% is tenofovir for 2-3 years and later on peginteferon. You need to low your viral load, while your hbsag is a good number to get a chance to clear it.By the way,here in USA we don't have the possibility to know about the quantity of Hbsag, I am planning to come this summer in Balkan. Where in tirana is located Intermedica?
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Avatar_m_tn
Hello mer971!  Intermedica is in front of the train station of Tirana. It is almost in the center of Tirana. The phone number of this laboratory is 0035542274662.
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Avatar_m_tn
you have now the highest chances to clear hbsag and make hbsab, even if you will not clear by 48weeks hbsag will be so low to continue the clearance by your immune system

tenofovir cannot help in this, so i would not use it

be sure to have good levels of vitd like 60-80ng/ml before starting peg, i believe it can help a little in lowering inflammation, it also boost peg repsonse because it activates genes involved with intf pathways (a research a read recently).sides should be much less, many report less sides on peg with low hbsag, usual sides at start but less when hbsag start the decline towards very low levels like 100iu/ml
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Avatar_m_tn
the problem of using tdf when hbsag is so low:

you have immune activity since you have low hbsag and declining, but also some hbvdna which suppresses your own intf pathways but at the same time these virions boost your immune activity.if you go for tdf now you may lose some of this immune activity and need to stay on tdf for a few years to be sure peg add on will work

it can also happen that hbsag increase at first with the decline of immune activity, i think it is best to retry peg
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Avatar_m_tn
Thank You Steff2011. My doctor is well know here in Albania. During the the first treatment my doctor follow only HBV-DNA, which was negative during the treatment. One month after the end of treatment my HBV-DNA was 240 IU/ml. My doctor order me to test HBV-DNA, and HBSAG after 6 month off the treatment. 6 months later my HBV-DNA was 1.4x10^4 IU/ml and Hbsag 1080IU/ml. My doctor was happy about Hbsag and order me to test only Hbsag (not HBV-DNA, it is not necessary he told me) 1.5 years after the end of treatment. 1.5 years after the end of treatment my Hbsag was 960 IU/ml. My doctor was happy and told me that Hbasg is decling. I ask him about HBV-DNA, he told me that Hbsag is decling so and HBV-DNA is declining and order me to test Hbsag. HBV-DNA and fibroscan (he don't want biopsy) after 2.5 years after the end of treatment.  2.5 years after the end of treatment my result are:
Alt 41 IU, Ast 30 IU Hbasg 747 IU/ml, Hbv-dna 4.0x10^4 IU/ml, Fibroscan (7.5 kpa) F2.
I was reading all the time your post Steff so I made a decision to go again for interferon.(in Albania we can not use tenofovir +interferon, beacuase is poor country, so I choose interferon)
Thank You Steff, god bless You.
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Avatar_m_tn
I am Elis! Thank You Steff! Thanks to you I proposed my doctor retreatment with interferon. I know that Italian doctors are the best. I have been in Roma and the doctor told me that even you will not clear your hbv at least you will wash up your body with interferon. Gracie mile!


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Avatar_m_tn
you are welcome, look at otan post last year, in her case peginterferon plus simvastatin was used and hbsag was cleared before 24weeks

i think she started with hbsag around 400iu/ml and simvastatin may have done the trick of faster clearance (there are in vitro studies on sim but human trials never started, sim is too cheap...)

otan said sim increased sides, she used low dose 10 to 20mg at the start, then stopped but hbsag decline was started already
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Avatar_m_tn
Hello Steff ! My cholesterol is high around 215 IU/ ml. Do you think I have to use Sim like otan did? I have a lot of pain in my right side near the liver, because of gas in colon(doctor told me after fibroscan that saw gas). To ringrazzio!
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Avatar_m_tn
I have reada lot of your postes here helping successful clearing hbv. I wish and believe that you also will clear hbv, thanks to you rs doctors and Italian mediacal system  that are so human with patients. My doctor has been specialize in milano for professor degree. I will post my whole treatment
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Avatar_m_tn
antiviral effect is not exactly connected with cholesterol

anyway yours is a bit high so prescription should not be too much of a problem.sim has also anti liver cancer effect, so it is good to use unless it makes bad sides like too much muscles pains
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Avatar_m_tn
hope fascist europe will be stopped before they make too much damage, we have indeed one the best world healthcare systems for free

they are trying to destroy public health care system as well as welfare in many european countries
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Avatar_m_tn
  I know Italian system is more human than even switrzeland. I have been in Italy a lot of time, even in viterbo there were a lot of pleasant doctors. I am happy that I live so close to italy. We in Albania can get a lot from Italian experience
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Avatar_m_tn
Hello Steff! I would like to ask You that during treatment with interferon is the fibrosis of the liver reversible, i mean that F2 can go down for example F1,or even F0? Thank You
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Avatar_m_tn
yes it does especially if hbvdna goes und and alt less than 30.but for this result pegintf needs to lower hbsag to very very low

you also need a healthy diet, not overweight and no fatty liver.anyway f2 is little fibrosis, most population is f1-f2 due to chemicals in processed foods and being fat...
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Avatar_m_tn
PEG is once weekly, roferon is 3 times a week. A big difference in lifestyle.

The only bad thing about IFN treatment is the inconvenience of keeping the med in fridge and constant monitoring on blood count such as WBC and Neutrophils. I am sure you been through Roferon and know what's it's like.

Hopefully you don't get too depress because PEG IFN is not for people with already depressive mood as it can cause more problems. Good luck.

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Avatar_m_tn
get vitd25oh to around 90-100ng/ml this can help a lot on depression and peg response...but i guess the best cure for everything is reading the report hbsag undetectable....and you ll easily get there
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Avatar_m_tn
I never got vitd25oh test. It cost 400 euro here. I got used with interferon. Even I didn't clear I felt that my body got restart and I havemore energy now. I am not a doctor but ifeel that interferon is better than other antiviral.
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Avatar_m_tn
are you sure it is 16euro here and there are even online tests very cheap.you ship them a drop of blood and they test it, dont remember the websites

check vitamindwiki.com i saw these cheap online tests there
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Avatar_m_tn
Ask once and told me 400 euro. I will ship Steff. About vit d and fish oil my doctor said that in mediteranio area is not neccesary because we have a lot of sun and good food. What do you think. I bought vit d3 and fish oil from USA on internet. Do I have to continue taking them?
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Avatar_m_tn
In summer I will be in Rome, exactly Rignano Flamigno 20 km from Rome, I have my family there. I will test vitd25oh if I will not do it before. Thanks Steff
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Avatar_m_tn
doctor is a little ignorant, vit d is suppressed by chronic viruses, especially hbv, hcv and cancer but also all auto immune diseases, even if you stay under the sun all day and vit d doses need to be very high, there is inverse correlation of vit d and hbvdna
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Avatar_f_tn
Hello erjona...when I found out I have chv my vit d level were low in 20..thanks to steeff coments I start taking 10000 daily and after one year in half my vit d level is 90..I still take 5000 daily...hope u doing well..
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Avatar_f_tn
Hello erjona...when I found out I have chv my vit d level were low in 20..thanks to steeff coments I start taking 10000 daily and after one year in half my vit d level is 90..I still take 5000 daily...hope u doing well..
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Avatar_m_tn
Hello mustthinkpositive! It 's true than depress is almost sure while we are on interferon, but the hope that we will  regain the life back is much stronger that depress. I hope You will beat the devil. I would like to thank my wife that supported me during the tough time.
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Avatar_m_tn
Hello steff! I don't understand how is possible that after end of treatment with interferon my hbsag is declining, but hbv DNA is rising and fibrosis is more in the liver?  
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Avatar_m_tn
I am reading about relapse, but what I understand is that both hbv DNA and hbsag must be rising. Am I wrong?
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Avatar_m_tn
yes

there is no correlation with hbsag and hbvdna except when hbsag gets very low and of course with very low hbsag hbvdna gets almost und or very very low

hbsag will drive pegintf results, but if hbvdna is on the rise on high numbers that might reflect on hbsag too.if hbvdna is on the rise start peg as soon as possible and start vit d too with 5000iu daily you ll never overdose
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Avatar_m_tn
I am on vit d 5000 IU almost a year. My hbv DNA is 40000 IU/ ml. Is it high to precast not successful treatment with interferon?
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Avatar_m_tn
hbvdna has no meaning, you cannot predict anything from it.all hbv disease is based on hbsag quantity, if it is 1000iu/ml you can clear the infection with highest chances
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Avatar_m_tn
Hello Steff! My platelet for the last 3 month are 313 000 /mm3, before they were always 260 000 /mm3. Is something wrong with platelet that are rising? I am not on treatment, after one month I think I will be on interferon.
Thank You
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Avatar_m_tn
it is a good sign for liver health and it is good because pegintf will lower plts so the higher the better
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Avatar_m_tn
Thank You very much Steff! It's so difficult to get the answer from the doctor. They don't like so much questions.
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Avatar_m_tn
Hello Steff! I would like to ask You a question, because I don't understand.
Does it mean that I have to get F0 fibrosis during treatment to clear HBV, or (if I can clear) can I clear HBV without getting F0 fibrosis during treatment?
I mean my liver must be ok to clear HBV??
Thank You Steff!!!
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Avatar_m_tn
no no correlation between fibrosis and clearance

if you have decompensated fibrosis you can t use peg (this is last stage before dying of liver failure, only nucs in these cases but here we dont care about hbv anymore but staying alive is the goal)
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Avatar_m_tn
decompensated fibrosis -It's mean F4?
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Avatar_m_tn
I would like to ask You Steff that during fibroscan the doctor said that I have  angioma in my liver. He said that nothing to worry about, because that are something like benign cancer. Is that true?
I have HBV and I'm going to retreat again with interferon.
Thank You!
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Avatar_m_tn

yes angiomas and cysts are something not to worry about.

i have a cyst that was regressing when i was on stabilized vit d and an angioma at last US, both have nothing to do with cancer and are absolutely nothing to worry about
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Avatar_m_tn
Thank You very much Stteff!
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