What is Immune Tollerant

[JoieTan]

I am male 31, has hbv since birth, from my mom
recently i did a hbv dna test on June 2011 and it is 2,9 billion
USG seems fine with mild fatty liver.
I am on entecavir Baraclude 0.5mg since June 2011

Question regarding some term,

What does it mean by immune tolerant ?
does it mean that the immune system doesnot kill the hbv and therefore the hbv will keep destroying the liver cell ?

thank you,
regards

[stef2011]

i still think you better stop entecavir if still immune tollerant (normal alt, and about same hbvdna may confirm this)

or add interferon to entecavir, this way you will make both doctors happy

you can search on google or pubmed interferon+lamividine for immune tollerant hbv, you have to keep in mind that lam is extremely weak so the combo of interferon+etecavir+alinia can make much more than lam

[stef2011]

HBV DNA - is representing what ? - my supposition is that this number is representing, or is in correlation, with the number of the liver infected cells.
is this correct ?

no it gives an idea of circulating virions in serum all the rest in the post is somewhat correct, especially cccdna.infact cccdna quantification can tell us something about the infected cells and not hbvdna.it would be the best hbv marker but for now we have only hbsag quant available.
so you got to understand how antivirals are useless for infection, infact they are not hbv cures but liver cures, they just stop liver damage when there is one

studyforhope explained perfectly in entry inhibitors post how the virus acts

[4est]

maybe you are correct, I don't know virusology but I intend to look into this more closer.
My concern was if that HBV DNA is correlated with the infected cells then even if in immune tolerant phase is no damage in immune clearance phase will be more (immune system will challenge all infected cells) - this is only a supposition so maybe I'm wrong

[JoieTan]

Please correct me if I am wrong
HBV DNA is the viral dna that is already in the completed virus.

When a hepatitis virus infect a liver cell, it injects the HBV DNA. This HBV DNA then undergo a repair to make a virus cccDNA.
the cccDNA stays inside the liver cell, and produces several programs to generate virus component HBV DNA, HBsAg and HBcAg/HBeAg.
These 3 components are then assembled into a complete virus inside the liver cell and then excreted out, and free to infect another liver cell.
The cccDNA stays inside the liver cell.

Antiviral are used to disrupt the writing of the programs to generate the HBV DNA, therefore the expected result from antiviral treatment is low HBV DNA.
However it does nothing to the programmer (the cccDNA)

So the number of infected cells should be determined by the number of cccDNA. Some reputable researcher suggest that the numbers correlates well with the quantitative count of HBsAg.

From this forum I understand that the HB Virus does not destroy the liver cell,
Our own immune system destroys that infected cell (if we are in immune clearance phase)
So if we are still in immune tolerant phase, the immune system is not recognizing the virus DNA as the enemy. Thus no damage to liver cell.

[JoieTan]

A doctor friend warn me about the use of interferon, if it fails to bring down the cccDNA, it might make with hepatitis B situation worse.

Is it true ?

Other doctor said interferon treatment can be stopped anytime.

its getting confusing...

[4est]

HBV DNA - is representing what ? - my supposition is that this number is representing, or is in correlation, with the number of the liver infected cells.
is this correct ?

[stef2011]

If my HBV DNA is high in billion and HBsAg is high >100,000 and ALT is within normal <30 and Ultrasound / fibroscan shows no fibrosis. then can assume i am at immune tolerant phase?
absolutely correct and you have no risks/damge

The question is..when are we considered entering the immune clearance phase ?
alt rise with hbsag and hbvdna decline.with time also inflammation of the liver appears

the time of transition is good to try and clear hbv by immune modulators, a detactable hbcab igm have better results on interferon too

[stef2011]

My own novice questions please. Which result gives indication of immune tollerant phase. hbvdna, viralload, alt, sgp or what?

no sings of immune activity so first of all a biopsy or fibroscan with no fibrosis

hbsag very very high, 50000-100000iu/ml or more
hbvdna in the billions
normal alt

fatty liver can make this complicated because it damages the liver too, a biopsy may tell

[JoieTan]

Here's what I think, please help to correct me stef

If my HBV DNA is high in billion and HBsAg is high >100,000 and ALT is within normal <30 and Ultrasound / fibroscan shows no fibrosis. then can assume i am at immune tolerant phase?
I interpret the above as lots lots of virus infection in my liver cell but no damage yet (because the immune system is not destroying the liver cell)

The question is..when are we considered entering the immune clearance phase ?

[miracle852]

My own novice questions please. Which result gives indication of immune tollerant phase. hbvdna, viralload, alt, sgp or what?

[stef2011]

Can I stay immune tolerant for the rest of my life without any medication ?

if you are lucky you can keep this condition until 35-40yo, most get active immune system during teen

[JoieTan]

Can I stay immune tolerant for the rest of my life without any medication ?

I read that chronic hepatitis B may stay immune tolerant for the first 20-30 year.
So if that is the case sooner or later, the immune system would start destroying my liver cell if my HBV DNA still high.

thank you, regards,
joie

[stef2011]

if you see entecavir makes hbvdna und by 6 months you are safe on it.check that you are usign 1mg dose, 0,5mg is too little

[stef2011]

if you have a family history of hcc it is important to treat but not starting with antivirals, you should try interferon+entecavir at this point or interferon+tenofovir

other drugs with no sides that can boost response on interferon are:
alinia, vitamin d and simvastatin

i don think indonesia has tools to monitor hbv treatment like hbsag quantification by abbott architect, fibroscan.....the best places in your area are: china, india, probably singapore.vietnman has generic cheaper interferon and if i am not wrong we had a poster about a center in vietnam with all tools

[JoieTan]

alt was 67, ast was 32

[JoieTan]

Wow, thank you steff2011 for the info, there are lots of info to digest.

I have yet to do another HBV DNA test and liver biopsies.
Some doctor in Indonesia say that liver biopsies may promote scarring/chirrosis altough i doubt that opinion.

So the question is : now, if i stop entecavir / baraclude and if my HBV DNA still high
1. How can I know if i am immune tolerant ?
2. Do I need to be treated ?
3. If I need treatment, which medicine should I be researching.
4. How can I know when I need treatment?

I read that hepatitis B is silent killer and If I dont understand this virus properly, I am afraid to end up like my uncle with HCC at 54. I understand that although i feel great now, it is not reflecting the current damage to my liver

I did read the book of ignorance last night..
I consulted the doctor at hongkong while accompanying my uncle to undergo Radiofrequency ablation for his HCC.

I had hepatitis B because my mom did not understand the risk upon birth. She has hepatitis B from her mother as well.

So I did the HBV DNA test, the Hongkong doctor was surprised to see the numbers are in billions with HBeAg (which mean very active).
So he recommend to take baraclude/entecavir. I have no never taken any treatment before

I was assuming that the goal was to bring the HBV DNA to undetectable level to prevent further damage.

So i take the entecavir because I had a cousin who manage to bring HBV DNA to non-detectable level. I am not sure whether it is called success of not.

Just to share the story.
My cousin has Chronic Hepatitis B from birth, never had any hepatitis B treatment before. About 3 years ago he felt terrible, nausea and hospitalized. So he did a HBV DNA test and his copies were in billions. His doctor at Indonesia started interferon treatment for a year with no result (according to my cousin) so the doctor gave him Baraclude 1mg. Now after 1 year of Baraclude he said he is better - HBV DNA is undetectable. HBeAg trend is continuing to go down. His complaint now was low energy level and fatigue.

So apparently having seen a seemingly success story, I follow the doctor's recommendation to take baraclude 0.5mg with goal to bring down my HBV DNA.

Having read this forum and various useful resources such as the full paper from the core group.
http://www.sciencedirect.com/science/article/pii/S0168827811004971

I have realized there is a huge misconception of how hepatitis B. Probably because doctors dont teach, they prescribe.

I now understand that cccDNA may still present eventhough that the Hbv DNA is undetectable thus the infection is still present.

This forum is a great help
thank you for maintaining it.
my apologies if I asked repeated questions.

Thank you,
regards,
joie

[stef2011]

http://www.medhelp.org/posts/Hepatitis-B/update-on-my-fatty-liver/show/1500346

here you can find how i eliminated fatty liver in a couple of months by diet, excercise, supplements and losing weight

[stef2011]

http://www.medhelp.org/health_pages/Hepatitis/HepB-Introduction--Welcome-Page/show/34?cid=153

HepB Introduction & Welcome Pag...
this is for you to understand hbv virus and tests and especially to help you understand if you have found a real doctor or an ignorant butcher like it happened now

[stef2011]

http://www.medhelp.org/health_pages/Hepatitis/the-general-book-of-ignorance-about-hepatitis-B/show/1152?cid=153

this was written for your doctor, you can take to him anyway even if in your country you cant sue him
robert g.gish, MD, has posted a presentation at a conference about hbv in 2009
"the general book of ignorance about hepatitis B"
every doctor should have it since probably much more than half of all doctors need it

this is very good for all us patients, despite conference was in 2009 all the studies are still very updated

[stef2011]

another way that has used to change immune system from tollerant to active is entecavir+interferon, but it was mostly a failure because immune system just started to kill liver cells without clearing the virus so condition just worsened, very few clear hbv on this combo

adding interferon to entecavir you may block hbv mutants and slowly stop both entecavir and then interferon.
but if you have hbv int he billions and normal alt you can safely stop entecavir anytime and the sooner the better before immune system turn to active or mutants develop

[stef2011]

my god who gave you entecavir?stop it immediately because you can develop untreatable hbv mutants.immune tollerant hbv cannot be treated and doesn t need to be treated because you are perfectly healthy and can only worsen your condition

entecavir is totally useless on hbv virus, it is used only to block liver damage when there is one.if you can sue your doctor for damage and mal practice if your country allows that and look for a real liver specialist as soon as possible

as to ways to stop entecavir:
check how your hbvdna is now, to avoid mutants it must get down to undetactable by 6-12 months but the higher the replication the more mutants are produced

what is alt/ast

what is biopsy result?also be aware that fatty liver is worst than hbv in your case because hbv makes no damage at all when immune tollerant, fatty liver can make a lot of damage til cirrhosis/liver cancer