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What now?
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What now?

Hi Everyone,
First off I would like to thank everybody here for contributing to the forum. You guys have provided an enormous amount of information and support for everybody. Ever since I found out I had chronic hepatitis B, I was in shock. My life totally changed for the worst. I use to have a wonderful social life and everything, but now it's the total opposite. I'm hoping in the future my social life can slowly return to some degree of resemblance. I know I have to take care of my liver from now on and try to stay away from alcohol. Ever since the doctor told me to avoid alcohol, I touched it very little - a little sprinkle of whisky with a glass of soda, or mixing 1/3 glass of beer with water.
I just got the results from my last blood test. The doctor congratulated me and told me that HBV DNA was undetectable and that my liver was no longer inflamed, AST was 28, and ALT was 38.
Just back on 30 June 2010 my blood test showed the following:
Hbsag pos
Anti hbs neg
Anti hbc igm neg
Hbeag pos
HBV DNA > 110,000,000 IU/ml
Liver biopsy: marked piecemeal necrosis, mild intralobular degeneration, moderate portal inflammation, fiberous portal expansion. Knodell score: 9.
Diffuse alteration of the periportal plate in all portal tracts, absent of bridging and confluent necrosis, at least one necroinflammitory focus per lobule, mononuclear aggregates in all portal tracts and stellate enlargement of portal tracts without septae formation. Metavir score: 7

Here are test results for 2005 and the past few months:
29 Sept 2005
AST 20
ALT 23

3 Aug 2010
AST 115
ALT 308
Does this mean that I contracted Hep B sometime between 2005 and 2010?

17 Aug
AST 112
ALT 230

14 Sept
AST 202
ALT 355
I think my enzyme levels increased during this period because I smoked pot for 3 nights straight thinking that it wouldn't affect my liver. Was I wrong!

26 Oct
AST 28
ALT 38
HBV DNV undectable

How meaningful are the above results? Or is it too early to tell?
I began my first injection of Pegasys back on 3 August and have already taken 13 injections. My question is what now? The doctor tells me that I have to take Pegasys until the very last injection (injection 48). Is this true or does he just want my money?
Is there any chance that I may have immunity now? Or is it too early to tell and I just need to continue taking the Pegasys injections?
What are the chances that I will seroconvert and test HbSag (Negative) and HbEag (Negative) in the future? When should I go get tested again?
Does this mean that my liver can begin repairing itself now? Will my liver be able to return to its original state before I contracted the virus?
In my current state, do I still need to stay away from alcohol? Can I drink once in a while? Should I wait until my very last injection before taking a drink?

Thanks everyone.
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32 Comments Post a Comment
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Avatar_m_tn
Is this true or does he just want my money?
absolutely, hbv cannot be eradicated but only controlled, do make 48weeks of interferon and if your hbsag decreases (it means you are eradicating hbv) you might go on for 2 years until hbsag negative, but only 11% have hbsag decreasing

i do suggest to add alinia off label, see all posts in the forum about alinia (nitazoxanide), it might increase chances to get rid of hbsag for ever

when you finish interferon start entecavir or tenofovir if hbsag is still positive because if you take no drug the virus will build up again like you did no treatment.tenofovir, entecavir and alinia combo will slowly deacrease hbsag during the years until it gets negative

Is there any chance that I may have immunity now?
absolutely zero chances, you might have chances in 10years of therapy like i said above.only 11% clear by interferon only by 1-2 years of interferon then hbsag keeps decreasing in about 5 years off therapy but only for 11% of patients, which is equal to almost nobody
alinia is off label and used since 2004 for other illnesses but seems to increase hbsag negative to about 25% in one year as monotherapy, used a sa combo it will probably increase chances

What are the chances that I will seroconvert and test HbSag (Negative) and HbEag (Negative) in the future?
without any drug 1% per year, with drugs you will have no liver damage and probability very high in 10-15 years.we cannot say because nobody got more than 6 years on drugs like entecavir and tenofovir which are the most potent.

When should I go get tested again?
yearly and by abbott architet quantitative otherwise you'll never know if you are decreasing and if therapy is working.in US/canada they don t have this simple, cheap test, probably they don t have a cure as a endpoint in those countries but neverending pills....

Does this mean that my liver can begin repairing itself now? Will my liver be able to return to its original state before I contracted the virus?
yes if hbvdna un and alt<19, you should check fibrosis by fibroscan to see if it decreases and therapy working

do I still need to stay away from alcohol? Can I drink once in a while?
no it destroys both immune system and liver, it is toxic for anybody.i bet when fibroscans will be available evrywhere they will find many cirrhotic livers around, in germany there is a touring bus with free fibroscan to see liver health of population since alchool and fat diet can make cirrhosis as much as hbv

Should I wait until my very last injection before taking a drink?
if you care about your life you should wait until your liver gets back to zero fibrosis and hbv eradicated, it is normal to live without alchool too
do also avoid gas drink, they are just chemicals that make damage, normal plain water has much less toxic chemicals





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Avatar_m_tn
if you don t have a healthy life style, diet and so on, drugs can do very little because what you reapir by drug is redamaged by unhealthy life styles

unhealthy life styles can also make damaged liver, it was not known in the past because there were no tools to see liver damage, now with fibroscan they are checking all livers damage not only for hbv and hcv and they are finding a lot of fibrosis in fatty liver disease, alchool consumers and so on
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Avatar_f_tn
Thanks for the detailed write up.
What does it actually mean that hbv DNA is undetectable? Since my count went from more than 110000000 to undetectable does that mean that they all died or are they all laying dormant? Is the Hbsag positive coming from the remaining hbv dna that the test can't detect? Does this mean that before there were billions of hep b viruses swimming in my body, but now there are only a couple of hundred of thousand? I notice a large drop from 110000000 to undetectable all of a sudden, so why can't this stupid virus ever just disappear forever? Sorry for the stupid question. It's just so frustrating. Good is just never good enough with this virus.
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Avatar_m_tn
What does it actually mean that hbv DNA is undetectable?

not detactable in the blood by commercial assays in the blood but of coruse what you see in the blood is not what happens in the liver, in any case there is a correlation between virus in the blood and virus in the liver as regards suppression

as regards interferon there are 3 tests to see if interferon is working:
hbsag quantification by abbott architet, this will tell if you are clearing infected cells by virus, very very important with interferon, if you have no decrease by 12weeks interferon can be stopped because not working
hbvdna, if no decrease by 12 weeks interferon can be stopped because not working, by 12weeks at least 2 log decrease are necessary

by monitoring hbsag decrease you will see if you have chances of eradicating hbv

or are they all laying dormant?
no virus is always active even when you clear hbsag, it just means that replication (not number of virions or infected cells) is decreasing.hbvdna has no meaning to say if you are eradicating hbv, it is just used to see if drug is working

actully the best way to understand what is happening is a biopsy and a measure of the antigens, hbvdna, cccdna directly from the liver cells, but this is not necessary and usually done in best research centers.it is not very important to do biopsy for this, only in case you want to know if tenofovir or entecavir are eradicating virus this might be useful or to see virus mutations with maximum sensibility

why can't this stupid virus ever just disappear forever?
this virus like others, have many ways to suppress immune system, only lowering or making hbsag the immune system can start to work again and clear hbv
in any case you started with the best drug in terms of virus clerance, see alinia posts and if you like you can order it on line and combo with that to have more chances, it has no sides and for now only used on hcv combo therapies with interferon

in any case do not be fooled by hbvdna, it means nothing in terms of virions and infected cells, only hbsag quantity cn tell you that.hbsag quantity has very poor correlation with hbvdna, alt/ast and has good correlation with infected cells and cccdna (the virus template inside cells)
all the virus is made by cccdna inside cells, interferon and alinia are the only drugs to have a strong effect on this template and on number of infected cells

sorrry if i can t be very clear but hbv is quite complicated and survive because replication which causes liver damage, infected cells and number of virions, mutants are not exactly correlated to one another but in concert make virus persistance
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Avatar_f_tn
Hi,
I was wondering if you can give your thoughts on my latest blood work:
-   Hbeag changed from Positive to Negative
-   anti-Hbe is now positive
-   HBV DNA is still undetectable since late October
-   AST 22
-   ALT 24
-   All other blood work normal
I am currently on Pegasys and just had my 25th injection last Tuesday.
Any thoughts would be much appreciated.
Thanks
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Avatar_m_tn
hbsag quantification is needed to know if you have chances to make it negative, there is also a study on hbe negative by 3 or 6 months i dont remember now, that predicted hbsag loss.in anycase you are doing very good on peg and should absolutely check hbsag decline, in case hbsag gets very low it is better to make 2 years of interferon

http://www.natap.org/2009/AASLD/AASLD_01.htm

i do suggest to add nitazoxanide too so that you have very high chances to get rid of hbv
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Avatar_f_tn
Thanks for the reply Stephano.
Can you tell me the difference between testing Hbsag Quantitative vs HBV DNA?
How come doctors have never tested me for Hbsag Quantitative?
Thanks
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Avatar_m_tn
hbvdna is just the virus replication and does not reflect infected cells, immune control or clearance of infection.it also makes sense very easily that if the goal is hbsag eradication the most indicated test is its quantitative

the test is easy and cheap and known from as early as 2008, i guess it s not available widely because of antivirals use, antivirals monotherapy is useless against virus and this test will clearly show it, i dont see other reasons not to use this test

you should check with the most advanced centers in your country for hbv therapy and send us a sample for hbsag quantification

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Avatar_m_tn
the name of the best test is abbott architect hbsag quantification by manual diluition 1:1000

in vietnam they do it
http://www.medhelp.org/posts/Hepatitis-B/HbsAg-quantity-in-Phnom-penh--Cambodia-or-Ho-Chi-Minh-City---Vietname/show/1430388?personal_page_id=1694419#post_6523446

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Avatar_f_tn
Hi,
I tried to explain the test I wanted at the International Clinic Lab and they gave me tests for HBsAg and Anti-HBs
Here are my results:
HBsAg - Non-reactive (titer 0.73 s/n)
Anti-HBs - Non-reactive (titer 0.8 mlU/ml)
Was it the right test? What are your thoughts?
It's funny how complicated this disease is. When I initially received my test results, it did not have the titer numbers and so the nurse said "congratulations you tested negative." All I thought in my head was "I wish."
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Avatar_m_tn
HBsAg - Non-reactive (titer 0.73 s/n)
s/n is not helpful, i also tried it but there are diluitions so we can t say nothing for sure.my is 250s/n corresponding to 4000iu/ml but i don t even know if there is a correlation with s/n and iu/ml
it might be very low but we cant say for sure, do add nitazoxanide as you can see from hcv trials ntz boosts interferon response

Anti-HBs - Non-reactive (titer 0.8 mlU/ml)
well at least it is not 0.00, you should ask them the sensibility of the test, is 0.8miu/ml very low titer of hbsab?if so you are starting to have a response and ntz should absolutely added
if 0.08 is just the test and not the antibody then it doesn thelp to understand if hbsag might be low and response started

Was it the right test? What are your thoughts?
this is not abbott architect, it is another assya, i also have a hospital in my town with these tests, these are the first i made.in any case s/n cn be helpful to understand if hbsag is decreasing if the number goes down keeping the same dilution

my suggestion is to absolutely add nitazoxanide (alinia) since we do know it boosts interferon response without adding sides
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Avatar_f_tn
Thanks for the quick reply.
Since every chronic hepatitis B patients' wish would be to seroconvert to HBsAg Negative, can you please tell me how in my case I will be able to know?
Is it the Abbott Architect HBsAg quantification the ultimate test to find out? What does the test have to show to know that chronic patient is cured?
Thanks.
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Avatar_f_tn
Hi again,
I'm wondering if the way a doctor diagnoses and treats chronic hepatitis B is based on one's financial background?
For instance, in my case, I was treated at an international hospital in Bangkok where I can tell that prices were much higher than other hospitals (Pegasys costs $490 per injection at the international hospital, whereas it costs $275 at another hospital across town). I'm wondering whether the doctor has prescribed me to take all 48 injections just because I can afford it? Whereas if it was another person at another hospital, and that person had financial difficulty buying Pegasys, the doctor would tell that person that he/she is cured (if he/she had the same blood/viral results as me) and doesn't have to take Pegasys anymore.
I'm asking this because I've heard a lot of people here in Laos stopping Pegasys because they said they were "cured." Did their doctors tell them to stop or was it the patient's decision? But I've done much research to know that everybody needs to finish all 48 injections (or does this have to do with the Pharmaceutical companies marketing strategy).
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Avatar_m_tn
you please tell me how in my case I will be able to know?

also by a normal test qualitative but you will have a result only in the end while abbott shows when it decreases so if you see it is going down itmight have sense to make a longer interferon treatments or add nitazoxanide and see if it goes down faster.on the contrary if hbsag is stable or increasing (only 11% respond decreasing hbsag on interferon mono, 35% on interferon+lam and probably more on interferon+ntz+etv) you just give up after 1 year interferon mono

Is it the Abbott Architect HBsAg quantification the ultimate test to find out?
yes because you will be able to monitor if you respond or not

What does the test have to show to know that chronic patient is cured?
decreasing hbsag with time until it reaches zero and hbsab appears, sensibility of test is 0.05iu/ml

i suggest to check if you can send a blood sample to a specialized lab to make hbsag quantification if not available in thailand.in hong kong i have seen priavte labs doing both hbsag quantification and cccdna quantification
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Avatar_m_tn
stopping Pegasys because they said they were "cured.

i guess ignorant doctors considering hbvdna und and hbeag seroconvertion as a cure, which of course that is not, the most will relapse by a couple of years if hbsag positive and not decreasing

interferon mono has only 11% making hbsag negative by 5 years, response to 48weeks is much much lower.i have also seen higher percentages than 11% at 5-10years but again this happens in those with very low hbsag at the end of 48weeks and with a slow decreasing pattern

my idea is the hbv is considered a business like hiv since the virus integrates inthe cells and complite eradication is difficult, and i do consider very starnge that we are still at mono therapies when we do know there is no hbv eradication with mono.
on the contrary hiv and hcv have gone straight to the combos
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Avatar_f_tn
Thank you so much for your thoughts
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Avatar_m_tn
HBsAg - Non-reactive (titer 0.73 s/n)
Anti-HBs - Non-reactive (titer 0.8 mlU/ml)

i was thinking about this test and you have almost seroconverted, very very close to it.

hbsag test with s/n has sensibility at 1-2s/n which is not zero yet bt very close, so congratulations and let us know when hbsab gets higher than 10miu/ml

also do not stop interferon until hbsab gets high much higher than 10
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Avatar_m_tn

this january 2011 is a very good month you are the 3rd or 4th person close to hbsag seroconversion that posted
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Avatar_m_tn
My doctor said to me the same, whan you are HbsAg -, and anti-HbsAg- its 75% for seroconversion. i got seroconversen 4 weeks after theraphy ( i was 48weeks on theraphy).
i know how u feel.
tell me when will u finish your theraphy?
u must wait little time :)


when i was on theraphy i didnt drink alcohol but two times in mounts i have smoked canabis, but dont do that. its not recomended.
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Avatar_f_tn
Hearing you say that I've "almost seroconverted" really gives new found outlook in life. I will continue to take Pegasys until week 48 and hopefully I will be positive for Anti-hbs by week 48. Have you ever heard anyone with chronic hepatitis B gaining immunity? Is it possible?
Just to let you know, ever since I started my Pegasys injections, I've also been taking vitamin b complex, centrum multi vitamin, vitamin e and folic. I haven't missed a single dose of my vitamins yet. Maybe it will work for others.
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Avatar_m_tn
yes its possible, i have immunity, anti-hbs +, titar>1000, titar must be high then 10.
but i was anti-hbs positive 4 weeks after teraphy, my doctor told me that i supose to be positiv after 24weeks but i was after 4. Some people can be positive after 96weeks, some for the time theraphy.
i didnt take nothing except theraphy.

did u have so big alt and ast first 12 weeks(my ast/alt 2000/3000), after 12 weeks 20/30?
my last analysed ast/alt 8/12, when i cured, and last mounts i eat evrerything, fast food, pork, coca-cola, alcohol, red bull. but its normal(ast/alt 8/12) when i am cured.
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Avatar_m_tn
do u know what is your genotip of hbv?
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Avatar_f_tn
@hepdeck
Doctors and both hospitals never tested me for genotype. I don't know why. Maybe almost all CHB carries in SE Asia have a predominant genotype. Btw, how old are you and where are you from?
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Avatar_m_tn
i am 29, from Serbia.
U?
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Avatar_f_tn
I'm 34 from Laos.
It's really amazing how you now have antibodies. How did you first find out that you had chronic hep b?
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Avatar_m_tn
i had chronic hep b and i was 48 weeks on theraphy pegasys + lamividin. U will see your antibodies, wait.
One day i had some reaction like vaccine reaction ( vaccine for flu), everything hurt me.
In two days i was going to test for antibodies and i had >1000. I told to my doctor for that reaction and he told me that he is not sure that si reaction for hbs antibodies but that i am lucky man.
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Avatar_f_tn
Hi,
I was wondering if my body has been able to bring the virus to undetectable levels and almost to seroconversion, would it be logically possible to get Hb vaccination in order to make antibodies? Why not? If there is the possibility of making anti-Hbs on my own anyways, why isn't possible  to speed up the process?
Or maybe it is a conspiracy? LOL
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Avatar_m_tn
really i dont know, ask stefano, maybe he knows.
its logic but i dont know
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Avatar_m_tn
Majority of Asians had genotype B and C (82%).
Majority of Europeans had genotype A and D (84%)
North Americans mainly had a mix of genotype A, B, and C (81%)
South Americans mainly had genotype A and F (78%)

Loss of HBsAg differed according to HBV genotype: 14% for genotype A, 9% for genotype B, 3% for genotype C, and 2% for genotype D.

One year of Peg-interferon alpha-2b for HBeAg-positive patients led to HBsAg loss .Peg-interferon alpha-2b is the best therapy to achieve HBsAg clearance in patients with genotype A.
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Avatar_m_tn
My test resul for HBV are as follows:

HBsAg = 2889
anti HBeAg = 0.01
ALT = 21 U/L
AST = 19 U/L
HBV by PCR (real time) = 4540 copies HBV / ml


Any advice on how to bring HBsAg value below 1.0 its giving me greeat probs for going abroad and getting job
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Avatar_m_tn
My test resul for HBV are as follows:

HBsAg = 2889
anti HBeAg = 0.01
ALT = 21 U/L
AST = 19 U/L
HBV by PCR (real time) = 4540 copies HBV / ml


Any advice on how to bring HBsAg value below 1.0 its giving me greeat probs for going abroad and getting job
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Avatar_m_tn
My test resul for HBV are as follows:

HBsAg = 2889
anti HBeAg = 0.01
ALT = 21 U/L
AST = 19 U/L
HBV by PCR (real time) = 4540 copies HBV / ml


Any advice on how to bring HBsAg value below 1.0 its giving me greeat probs for going abroad and getting job
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