When can I stop Baraclude treatment?

I am female, 28 y.o. I have known being the carrier for about 10 years (probably since birth).
I first started treatment since Jan 08, due to very high load of DNA (almost 600m copies) and high AST, ALT (200, 600 respectively). Echographie abdominale shows Liver were functioning well (all following tests showed same result).
As prescribed by doctor, I have been using Baraclude since. After 6 months treatment (Jul 08), ALT, AST were back in normal range. Virus count dropped to less than 30K copies . Anti-Hbe tested Pos. I was told that the treatment objectives were achieved but advised to continue with the medicine to bring back DNA to lower level.
6 months later (1 year after treatment), my DNA test was done again and showed the undetectable level of the virus (<500copies/ml). I expected then the treatment might be able to stop. However I was advised to continue to taking the medicine being afraid that the resistance to the medicine might develop if I stop using. I have since continued the treatment and all follow-up check-up shows very good result.
Most recently, test in Dec 2009 shows AST 16.2, AKT 11.2. HbeAg Neg. Non-detectable virus count (<500copies/ml).
It looks like it is advisable for me to use Baraclude for life, which is although not too much a problem on the finance aspect, but is extremely inconvinient for other aspects of life. This is because I would like to use contraceptive pills for birth control but it is advisable that anyone taking treatment for Hep B shouldn't use pills.
My questions are therefore, in my case, when can I stop Baraclude? My second question followed, if I have to continue w the medicine, what are the options I can use for birth control (beside usage of condom everytime, which is not a prefered choice)?
Thank you very much for helping with my case.

[stef2011]

you should have monitored hbsag quantity and its decline, so an expert liver specialist can understand if you have achieved immune control or if hbsag is the same as before therapy or even higher

check also our alinia post and developments

when you make hbeab antibody you should have some immune control but at the moment it is not possible to know if it is enough or if you will relapse.you might use hbsag and see if it increases and start immediately if so (hbsag increases before hbvdna and all other tests) but you cannot be 100% sure you don't develop resistance

[qor]

Thank you very much for your prompt reply.
Regarding HbsAg, as of Dec 2007 (before treatment), it was Pos S/co: 3793.
2 years later in Dec 2009, HbsAg It is Pos S/co: 4251.

More on HBeAg, before treatment Dec 2007, it was Pos S/co=371.2. 6months into treatment (July 08), HbeAg Neg S/co=0.748. Latest Dec 2009, HbeAg eg S/co=0.092.

Can you tell more of my case in this? Also, do you have experience/advices regarding birth control issue for female carrier.

[shaikme_83]

Now you are seroconverted .. HbeAg+ to -ve and your HBV DNA is undetectable .which is the expected treatment ouctcome for Hbeag+ patients... .  take your doctor advice on continuing the treatment..... generally if seroconverted with HBV DNA is undetectable, ALT/AST normal .. you can stop treatment after 6 months(observation is needed off the tratment period)... but you still need to monitor you ALT/AST and HBV DNA tests...

One more Question:
when your ALT/AST are high(before your treatment) did u feel any symptoms(abdormimal discomfort/yellow urine)? Now you ALT/AST is very low and ywhich means you are asymptomatic (mostly)

[qor]

Thanks for your opinion. However it seems like my doctor's concern was that if I stopped the treatment and if relapse happens, my respond to Baraclude my lose its effectiveness in 2nd round of treatment. I am not sure if anyone has been in similar case? How long will it normally take to the next relapse? If so, how is the reaction to the same medicine (Baraclude)?
As in my case, based on the definition of seroconversion you guided, I have reached that stage for over a year by now. I don't like this situation of continueing taking the medicine without any end. But at same time I don't want to face the risk that the medicine will not respond effectively should a relapse happens. Please advise.

Regarding symptoms during the time that my ALT/AST were high, basically I didnt feel any abdormimal discomfort. Cant recall any changes in urine color then. But I do remember my body temperature was hotter than average person. I had nose-bleeding once. There were also acnes behind the back then (now they are gone). Also, it seems like it was easier for me to get cough/cold (which was on-going for like a-month). Taking medicine for my cough then may actually accelerate the ALT/AST in the liver too. After my ALT/AST back to normal range, all those bad symptoms are gone. Thanks goodness.

[stef2011]

stay on baraclude, hbe ag is still present and overall virus has increased because hbs ag has increased, relapse is almost certain since there is no immune control (in that case you would have had hbsag decline), entecavir is perfectly safe with almost no sides, resistance is 1% at 6 years (i am on entecavir too)

if you like you can combo with alinia and see if hbsag declines, check also your vitamin D level, i had many cold/flu problems due to severe deficency which is present in almost all hepatitis patients.

since good news from replicor as a final cure to seroconvert to hbsab stay on entecavir until replicor drug is available, it takes 12weeks to make hbsab antibodies and other 12 weeks to gain immune control and stop therpy with high hbvdna, i guess hbvdna und can even gain immune control in shorter time

[qor]

Thanks for your info.
I will stay on Baraclude for now and will follow the hbsag more closely from now.
It is a bit more complicated though as I am female and Baraclude is not advisable to use during pregnancy or breastfeeding the baby. Though it is not an immediate issue for me now but I would like to know in advance. Please share any experiences/advices regarding this matter.
Thanks.

[qor]

Hi Stefano and everyone,
Further question on my situation. Regarding the HbsAg amount, I think the test that I had on were qualitative and therefore not reflective on the quantity.
Tested Dec 07  Pos S/co=3793, July 2009  Pos S/co-4400 and Dec 2009 Pos S/co-4251.
Stefano, do you know what is the quantitative test that I can specifically request? I doubt if it is even available in where I live, which is a developing country in Asia.
Putting HbsAg amount aside, I had achieved seroconversion for almost 2 years by now (since July 2008), should I ask my doctor to allow me to stop medicine for a few months and closely monitor my HBV DNA count on monthly basis to assess whether relapse is likely?
to provide further background, 8 months into treatment due to my travelling, my medicine intake stopped for some 3 weeks and my doctor were very unpleased about it. However the result of AST and ALT after the break were still in normal range. Unfortunately immediate measure of HBV DNA were  not done. 3 months later another test showed DNA undetectable (this was Dec 2008).
My problem is that I am not convinced that "life-time" treatment is the recommended choice given my effective respond to the medicine (serocoversion after 6 months of treatment, and undectable level of virus after 1 year), and also there is no indication of virus replication if the antiviral treatment stops. Do I make sense?
Thanks for reading.

[stef2011]

at last conference in vienna end of april they finally declared that there is no stop point for treatment on nucs, only hbsag decline and cccdna decline might say if you can safely stop.

entecavir and tenofovir seroconversion to hbeab has almost no meaning and most reverse to hbe positive active hbv when they stop treatment, only interferon seroconversion can have a meaning because it actually lowers hbsag/cccdna

to stop treatment you can start interferon for about 6months this will mount an immine response so when you stop etv you will have no mutation or active disease for sometime.
unfortunately many have hbv reactivation after interferon too but it requires some years and has no resistance

another try is to start nitazoxanide, generic nizonide500 or nitarid and after 6 months stop entecavir and keep only nitazoxanide.this drug is free of sides, cheap, and leads to hbsag seroconversion in the highest percenatege compared to other drugs.it has no reistance

hbsag quantity is made by abbott architet with diluition for hbsag higher than 250iu/ml.many wrote me from china and other parts of asia with this assay result, i guess you just need a big hospital specilized on hbv, assay is nothing special.

in vienna they gave a level less than 500iu/ml for 100% inactive carriers and of course they have an immune response to reach this level so i'd suggest stop etv only if you find this level of hbsag or switch slowly to nitazoxanide

s/co unit has nothing to do with quantity, only s/n with 1:1000 diluition or iu/ml can quantitate hbsag

[qor]

Your information is indeed very valuable.
I actually come across this article just now. You might have read it before.
http://www.touchgastroenterology.com/articles/hepatitis-b-treatment-how-avoid-long-term-drug-cocktails?page=0,3
Quoted: "In contrast to their HBeAg-positive counterparts, the treatment endpoint for patients with HBeAg-negative disease is unknown. Although the loss of HBsAG is a very rare occurrence, seroconversion to anti-HBs has been purported as an acceptable end-point in these patients. Because of this ambiguity with respect to treatment end-point, and the fact that HBeAg-negative patients are more susceptible to relapse with one year of therapy cessation, it is recommended that patients undergo long-term therapy of which the optimal duration is unknown. Importantly, relapses are a common occurrence, even in patients who exhibit persistently undetectable serum HBV DNA by PCR assays." I think this means the same with what you have been saying?
Question, in case you've known of this:
- In case if I am already in "inactive" stage, what is the pros & cons of continueing the treatment w baraclude? I assume that the antivirus is not of any help at all at "inactive" period.
- It is obvious that I will have to stop the treatment before getting pregnant, during pregnancy and during breast-feasting, in total at least 2 years. What is the risk of my relapse during this two year-break? Since the body is more vulnerable during pregnancy, I am worried that the risk for a flare during this period would be quite high? What are my options should the relapse happen? What can I do to prepare to prevent it from happening? I know you might haven't looked at it since you are not female. Just in case you can help.
I will check in nearby facility to see where I can get that quantitative test on my HbsAg.
Thank you.

[stef2011]

the problem is hbvdna is not a good test to understand evelution of hbv infection and gain of immune control, only cccdna is a good tool but in the past it was possible to measure it by biopsy only.

now there are two ways to measure cccdna:
1 research only, blood test of cccdna though lymphocytes
2 available in every uptodate lab, hbsg quantity in iu/ml

you gain immune control after hbsag is <500iu/ml in 100% cases, in some cases (i don't remember percentage even hbsag<1000iu/ml), at the same time hbvdna<2000iu/ml or und and normal alt/ast.

this is data without antiviral but such low hbsag means you have some immune control because there is another research on hbsag quantity that says: hbsag is used by virus to suppress immune response against the virus, the level of hbsag reflects the degree of immune suppression

so to stop antiviral you might check these levels and start again if you see hbsag increasing since it is the first to increase before hbvdna and alt/ast.although keep in mind there is no data after you stop antivirals, all this data is about levels achieved naturally to predict seroconversion chances or best therapy, not to see who is safe to stop antivirals, we are just assuming that

anyway i do suggest to keep antiviral because cccdna will keep lowering slowly by the time, hbsag seroconversion should happen between 10-15 years if you have a continous slow decrease
antother way which i do strongly suggest is try nitazoxanide (alinia) combo like our gruop and me is doing and see if hbsag decrease or gets negative by 1-2 years or once you see it decreases you can stop etv and switch to nitazoxanide monotherpay.

alinia is safe enough on pregnancy although no drug is the best or switch to tenofovir which has more data than etv on pregnancy.

another way is 6 months interferon which lowers hbsag and makes you gain some immune control, there is research that confirms you can stop antiviral after interferon combo or slow staggering until interferon mono, once you stop interferon relapse is very slow usually

- In case if I am already in "inactive" stage, what is the pros & cons of continueing the treatment w baraclude?
it will continue to decrease cccdna and hbsag, although you should have a check at baseline and then check during therapy, some have steady hbsag and no decrease

I assume that the antivirus is not of any help at all at "inactive" period.
it depends on hbsag if steady you don't improve but you don't get worse too, you prevent any liver damage although virus cannot be eradicated because cccdna is stable inside the cells

- It is obvious that I will have to stop the treatment before getting pregnant, during pregnancy and during breast-feasting, in total at least 2 years. What is the risk of my relapse during this two year-break?
i'd check if alinia is safe during breastfeeding and try that or try interferon and then stop for 2 years any therapy

Since the body is more vulnerable during pregnancy, I am worried that the risk for a flare during this period would be quite high?
sorry i don't know about this, what was your condition before therapy?after you stop by interferon you should have a stronger immune responce than before starting etv

What are my options should the relapse happen? What can I do to prepare to prevent it from happening?
alinia or tdf continuos therapy during pregnancy is the only chance to be 100% sure virus stays hbvdna und or keep etv

I know you might haven't looked at it since you are not female. Just in case you can help.
did you check with a very uptodate liver specialist, what is his opinion?

[qor]

Thank you very much. That is quite a lot of new info for me to do further research on.
Haven't checked with my specialist yet. Will consult him more in next visit and let you know. Normally he is so busy and ppl are in a huge queue to get to see him and each visit average 5 -10 mins. That is the practice in where I live. No phone consultation either... So I have to do all research independently... You have told me much more info that he did.
Really appreciate it...

[April63]

Hello everyone. Getting into the spirit of Christmas yet?:) I have a one question regarding HBeAg-. Maybe it has been answered before,maybe I had missed it. Could you please explain to me how does one know if his/her HBeAg- is an effect of seroconversion or wirus mutation. I don't get this HBeAg issue. Thank you for your patience.
P.s. Stefano,you are doing wonderful job on this forum. Thank you for sharing your knowledge.:)

[stef2011]

virus mutants are present both for hbeag positive and hbeag negative, both for active carriers or inactive so the only test to know about mutants are:

bcp/precore tests, there are many types commercial or research settings

polimerase mutations tests, these ones have nothing to do with hbeag and are different mutants but i'll make both tests

if you like i will check the names of my tests method but since it is a research center i don t know if they used the commercial ones on me

[April63]

O no Stefano,don't trouble yourself. I'm unable to access those tests here in Canada,anyways.But thank you kindly. So you're saying that the only way to check if HBeAg- is the result of seroconversion or not is by doing bcp/precore tests? Thank you again.

[stef2011]

maybe you have a wrong thought from hbv specialists from 2000-2005 period, you are looking for the hbeag seroconversion to put your immune response into inactive carrier?

if so that type of seroconversion has nothing to do with the mutants and it is achived very rarely on antivirals, only immune modulators like interferon can have that result.

since that type of seroconversion is not correlated to hbv virus but only to yor immune system there is only one test that can reflect that status and it is hbsag quantity.it reflects the number of infected cells and since only immune system can lower it it also reflects a sustaned immune response
so you might know for sure if hbsag gets down to 500iu/ml and hbvdna stays below 2000iu/ml without drugs

the chances this happen by Nucs like entecavir or tenofovir is very very low and only after a decade of use, this point can be achived by interferon+entecavir or tenofovir and/or nitazoxanide

another very good test would be cccdna quantity by biopsy but this is only in research centers which in italy are normal hospitals in US and canada i don t think that research centers are hospitals which apply these tests and drugs to patients

in italy we have this very good thing about research and cure to patients which are at the same level, they can be directly applied, this is very very good for cancer because there is no point in waiting 5-10years t get the cures, they must reach patients immediately when needed

[April63]

Stefano,you are very lucky to live in such a medically advanced country. I won't even mention how beautiful.:)
My question was related to my lack of knowledge. And only for my interest. I'm trying to understand if my husband's negative HBeAg is the results of a seroconversion sometimes in the past (on it's own) or the presents of a mutant. We won't be able to check as we don't have easily accessible research centers but I would like to understand more about his illness. Thank you again for your patience.

[stef2011]

anyway ask for hbsag quantification it is now 3 years it is presented in conferences and has become routine so they have to buy the new machines to do it, another member in canada found fibroscan and is checking for hbsag quantification, i will let you know in the board if he finds it

unless he makes 1 or 2 years of interferon alone or combined hbe seroconversion is useless and as soon as he stops antivirals hbe returns slowly positive.

etv and tnf do not cure hbv but only stops liver damage, during this antiviral therapy liver usually gets more infected so while liver repairs damage it is actually worst in terms of hbv infection and hbsag stays the same or rises

[stef2011]

when hbsag goes down the cells are clearing from virus, all other tests are useless to see how infection is going

hbvdna is only for checking the effect of antivirals but it is totally useless to see if infrction is clearing or getting worst

[April63]

"etv and tnf do not cure hbv but only stops liver damage, during this antiviral therapy liver usually gets more infected so while liver repairs damage it is actually worst in terms of hbv infection and hbsag stays the same or rises"

This make me very sad. He's on tnf. It's been over a year now. His HBV DNA is undetectable. Which I know means not much. His hbsag has not been checked. Ever. He will not go on interferon therapy. I finished my therapy a year ago (HCV). He saw what I went through and swore never to go. Even thou mine wasn't too too bad. Maybe that's just an excuse,I don't now. But I do know that he will not go. He has a medium damage to his liver (S3). He is male ,over 40. It worries me. I hope you're right. I hope they purchase new medical equipment soon. Maybe then with the new tests and results-he will change his mind. Take care Stefano. Thank you again.

[stef2011]

don t worry in terms of health he is perfectly ok like me reversing all the liver damage, the presence of hbv in the liver cells makes no damage itself, it is only dangerous if one stops therapy with all these liver cells infected with the cccdna because they will restart producing hbv and immune system kill them making a mess of the poor liver.
so a slong as he keeps taking tnf he will be alright, plus we do know that also hbsag and ccdna go down after about 10 years of hbvdna und in many patients

it is just wrong to think we are clearing the infected liver cells, but i do believe that we will have good results from ntz and from the new interferon lambda which has only mild sides.by the way could you clear hcv complitely or are you still in the window period checking hcv rna und?

[April63]

I've won the war.:) I'm virus C free.:) I have what's called SVR,which means und after 6 mos after finishing 48 weeks of treatment.
Thank you Stefano,you are a treasure. :)
I will keep reading and learning everything that you and other post. Like most of the people on this forum I learn about HBV from you and others. My doctor doesn't have time and patience (?) to explain everything. Unfortunately he seems slightly annoyed when we ask him questions. All the best-April.

[May2183]

I am 27 years old and I got HepB therapy for a year by taking Baraclude, Previous 3 months test show ALT=33 and AST=32 and the virus load is 68257 copies/ml.

Im still taking Baraclude after that until I found out today that Im pregnant for 6 weeks now, I don't know should I continue taking Baraclude or stop eat for a year after having the baby. But Im afraid I might resistance with Baraclude and the virus will tun to very high and it could affect my liver.

Please give suggestion as soon as you can because I am very stress at the moment, whether it affect the baby if I still keep continue Baraclude.

All the best!

[stef2011]

the virus load is 68257 copies/ml.

if this is the result after one year baraclude is not working, make baraclude+tenofovir for about 2 months and then slowly discontinue etv

should I continue taking Baraclude or stop eat for a year after having the baby
tenofovir is better for pregnancy and you cannot stop drugs otherwise there is a risk to infect the baby dispite vaccine

the antivirals cannot be stopped due to the fact that they just stop replication while the liver cells keep being infected and sometimes get more infected too so that when you stop immune system will kill them by very high alt dangerous flares
if hbvdna is so high after one year you are already resistant to etv or it doesn t work, tenofofvir will, just remember to check creatinine during tenofovir and after pregnancy add ntz

[samarium]

THank you all for this quite convenient and serious blog about HB.
I`m spanish. 35y/o patient chronic HBV positive. I ve been with pegiltaed beta interpheron for one year and that therapy failed completely. Nowadays I am under treatment with entecavir.
Before therapy these were my analyses:
ALT 126
HBAg >125000
HBV-DNA 8.8log10
HBe 1787

After 4 months with entecavir therapy I have this new results:

ALT 146
HBAg 10877
HBV-DNA 4.01log10
HBe 357

My doctor told me that the tratment is being effective and it is sure it will work in all aspects. My doctos ir normaly quite depressive in the sense that he never smiles and I feel like always I am having really bad news. However in this ocassion he looked quite happy for me. What do you think about these results? could I consider a future free of HBV?
Many thanks

[stef2011]

ALT 146
HBAg 10877
HBV-DNA 4.01log10
HBe 357

your hbvdna is still to high, if at 6 months (24 weeks) it is still detactable i'd combo with tenofovir.an hbvdna detactable with numbers higher than 100-200iu/ml have considerable risks of resistance

i dont understnd why you chose entecavir with such high hbvdna since entecavir has resistance issues and tenofovir has zero resistance and more potent than etv?????

did you check polimerase resistance before starting entecavir?this is very important because these resistance mutations are present in considderable number of patients.as an example i had and probably still have the mutation rtq215s which is reduced response to:
lamivudine, adefovir and possibly tenofovir too

if you didnt have that test ask for it, even if the percentages of resistance are low somebody will have to fall within those percent

[samarium]

Dear Stef,
many thanks for your quick reply.
I know my hbv.dna is still high but is getting dows more or less 2log10 each 2 months. At the second month of therapy I was on 6.3log10 after 4 months 4log10... it seem that after 6-8 moths should it be und?
At the same time my doctor tolod that he is happy due to my  Hbe and HBAg is being lowered. He did a resistance test a while ago and no mutations on my virus were observed. The reason about choosing entecavir instead tenofovir, I do not really know. He said that entecavir is giving more or less the same results than tenofovir and we could choose one of them in more or less 50% probability to work. I will get my new analyses on september the 17th and I ll see whats happening. I hope it works... To be honest I think my doctor has a lot experience on HBV since he is the number one of his section. I have been told that is the best doctor in my region treating HBV. I hope that is true.
Nowadays I have no symptons at all and I feeling quite healthy (not in the past or at the beginning of my entecavir therapy)...


your hbvdna is still to high, if at 6 months (24 weeks) it is still detactable i'd combo with tenofovir.an hbvdna detactable with numbers higher than 100-200iu/ml have considerable risks of resistance

i dont understnd why you chose entecavir with such high hbvdna since entecavir has resistance issues and tenofovir has zero resistance and more potent than etv?????

did you check polimerase resistance before starting entecavir?this is very important because these resistance mutations are present in considderable number of patients.as an example i had and probably still have the mutation rtq215s which is reduced response to:
lamivudine, adefovir and possibly tenofovir too

if you didnt have that test ask for it, even if the percentages of resistance are low somebody will have to fall within those percent

[stef2011]

my consideration about resistance is this and doctors are crazy to take it so light, it looks like they are pushed by drug makers because every trial is not concentrated on best performance/hbsag clearance

if you do develop a resistance it is a no way out situation, entecavir has more than 3 mutations to make resistance and tenofovir is not able to fully suppress hbvdna in all cases, there are only clinical case reports....not even studies.if it happens what will you do since you might easily end up with no wroking drugs?

in my case when i saw a low decline of hbvdna at the 4th month i started vitamin d supplements since it was low and alinia so i could get hbvdna below 50iu/ml at 6months but full undetectability at the 7th or 8th month.what if i choose to follow guidelines...russian  roulette with my cirrhosis....
when i stopped vitamin d and lowered alinia at 10months therapy hbvdna rebounded to 21iu/ml...so entecavir monotherapy was indeed failing

my point is it is extremely stupid to run these risks of resistance and it is much better to exagerate on the opposite side because you have nothing to lose using combo or more potent drugs.
resistance is not only a problem of ending with no therapy, the mutants increase liver cancer risk even if you can get hbvdna by tenofovir, they stay recorded in the cccdna so you will never get rid of them once happened and in case you need a liver transplant for liver cancer (that we all may face) will tenofovir work?if it damages kidneys what are you going to do since no other drug works?

my suggestion is start from now with increasing vitamin d to more than 50ng/ml, possibly to the max high normal range 100ng/ml
lower cholesterol wtih simvastatin or red yeast rice to total cholesterol <150mg/dl, ldl50mg/dl
increase hdl by pantethine and possible liposomal glutathione

your doctor may be good but he just follows guideline from what i see here, no personalizations or suggestions according to latest liver conferences.acceptable but definitely not the best

[samarium]

Hi stef,
many thanks agaig for your valuable comments. I will start to have D-vitamine and I ll see what happend form septmeber onwords. I will let you kow. Finger crossed. Thanks

[samarium]

Hi Stef,

here are my new analyses

4th month ETV treatment:
ALT 146
HBAg 10877
HBV-DNA 4.01log10
HBe 357

6th month ETV treatment:
ALT 48
HBAg 1596
HBV-DNA 2.1log10
HBe 5375

HBsAg, ALT, HBV-DNA have been clearly lowered however HBe has been increased... My Doctor told me that my virus is under control but still too soon to talk about seroconversion. I will check my levels again in three months. I m happy for my results things seem to be OK but still wondering what is going to happen... wich is your highly valuable opinion?

Many thanks.

[samarium]

Dear Steff,
I ve just found paper published in may2011 (I am attaching abstract), perhaps is useful for someone...
Thanks.


Background: Hepatitis B surface antigen (HBsAg) loss is the ultimate goal of antiviral therapy and its prediction may be important for treatment individualization. Quantitative HBsAg (qHBsAg) has been shown to predict response to interferon-α, but few studies have analysed qHBsAg during treatment with nucleoside/nucleotide analogues (NAs). Serum interferon-inducible protein-10 (IP-10) has been associated with treatment response in hepatitis C, but data in chronic hepatitis B are lacking. Here, we aimed to investigate potential factors predictive for HBsAg loss.

Methods: HBsAg was quantified at multiple time points in 126 patients with chronic HBV infection; 95 received NA treatment for 6–107 months. At an early time point (first 6 months of therapy) and late time point after virological response (VR; HBV DNA0.5 log10), moderate decrease (10% to 0.5 log10) and no decrease (0.5 log10 cleared HBsAg. By contrast, early HBsAg decrease after 6 months of NA therapy was not associated with HBsAg loss. Baseline serum IP-10 levels were associated with late but not early HBsAg kinetics and were highest in patients with HBsAg loss.

Conclusions: Monitoring qHBsAg after successful HBV DNA suppression might be useful to identify patients who clear HBsAg, implicating finite NA treatment. The role of IP-10 as predictive marker for HBsAg loss should be further evaluated.

[stef2011]

6th month ETV treatment:
ALT 48
HBAg 1596
HBV-DNA 2.1log10
HBe 5375

please post the number of hbvdna, at 6 months it must be low or und
hbeag rise is not a good sign, entecavir is failing...making hbvdna undetactable has no effect on infection the choise of entecavir was bad.why did your doctor choose entecavir instead of more potent tenofovir or interferon combo?

entecavir is weak for hbeag seroconversion

tenofovir has more chances to clear hbsag about 16% at 3 years, entecavir is about 9% and is weak on hbeag seroconversion too

[samarium]

At 6th month dnavhb is 23IU or 135 cop/mL

if ETV is not working...why dnavhb was from 8.8log cop/mL to the current value of 2.1log cop/mL or HBsAg was lowered from >125000 IU/mL  to the current value of 1586IU/mL.?

Since 3 years i ve just got my lower levels of ALT (48 from 990 when I started with my symptons...)

thanks

[stef2011]

At 6th month dnavhb is 23IU or 135 cop/mL

ok, hbvdna suppressed, if there was no use of lamivudine in the past and polimerase mutation tests before starting entecavir had no mutations your risk of resistance is 1,2%, which is almost zero.

hbvdna is not correlated to infection, hbv keeps replicating in the liver by hbvdna and cccdna.hbvdna in the blood has no meaning except for risk of resistamce and liver damage

HBsAg was lowered from >125000 IU/mL  to the current value of 1586IU/mL.?

this is a helpful test, if hbsag is about 1500iu/ml you are closer to immune control and also hbeag will lower and become negative.i do suggest to add alinia (nitazoxanide) to fasten this process or keep monitoring hbsag

check also your vitamin d25oh level, it must be higher than 50ng/ml for imune system to work properly

[samarium]

Dear Stef,
many thanks for your reply. I am quite happy with my las resluts, however I m trying to be quite prudent... just in case. I am looking forward for my new analyses in 3 months in time. I hope to keep lowering HBsAg... and who knows... perhaps hbeag gets negative soon... fingers crossed

about nitazoxanide...do you know if it is necessary a doctor prenscription? which is its commercial name? Is htere any secondary effect in its utilisation? I would no have any problem adding new drugs on my tratment.

Many thanks.

ps.- I ve got the full paper about qHBsAg just in case you are interested.

[phihungmd]

You mentioned the drug nitazoxanide for the treatment of hepatitis B in pregnant women. So I asked if any guidelines or are not FDA approved. Can you give me a few sources of nitazoxanide hepatitis b treatment?

[phihungmd]

You mentioned the drug nitazoxanide for the treatment of hepatitis B in pregnant women. So I asked if any guidelines or are not FDA approved. Can you give me a few sources of nitazoxanide hepatitis b treatment?

[stef2011]

alinia has many generics, nizonide500 by lupin is a good quality/price

it has almost no sides and better not use during pregnancy.from our experience it boosts interferon response but very little effect on monotherapy or alinia+nucs unless hbsag is already very very low

prescription is required and it is off label use since the drug company is very small and poor to get aaproval for hcv or hbv, it is actually an orphan drug in US and europe while very common as a generic in south america, mexico, india

[samarium]

Dear Stef,
many thanks again for your reply.
Today I ve just got my lasta results. My doctor seems quite happy with them. I will start control each 6 months rather than the current 3 months.
Here are my last analytical:
ALT 24
HBAg 1234
HBV-DNA negative
HBe 2.18

My doctor told me that there is a probability for a negativizacion of both HBsAg and HBeAg (he is sure about HBeAg negativization) and he told me that it is important to see the lowering of the HBAg levels since it keeps lowering [from >125000 one yer ago, to 10877 (8 months ago), then 1586 (5 months ago and nowadays (analysis carried out 1 month ago) 1234]. I am taking D- vitamin as you suggested.
Do you think that the lowering of both HBsAg and HBeAg  is it too slow? or that rithm is ok?
Do you strongly recommend alinia in my case?

Many thanks again for your help.

[stef2011]

since the lastest news of interferon add-on i d strongly suggest to add interferon and alinia so you will be clearing hbv in 48weeks with hbsag as low as 1234iu/ml and even if it is not cleared by 48weeks it will get to very very low that it gets cleared even stopping all drugs
but if both hbsag and hbeag are going down fast and hbeag is cleared by 24 weeks you may keep etv mono at least one year before interferon add-on

be sure the number hbsag 1234 is followed by a unit which must be iu/ml or that it is tested by abbott architect otherwise that number is not hbsag quantity

[samarium]

Many thanks Stef for your prompt reply.
The number 1234 is of course followed by IU/ML. I have my concerns about my doctor wants to prescprit me again interferon. I have been one year using interferon (previously to my therapy with ETV) and it failed...
I will try to find out where i can purschase alinia in spain, it seem is not sold in spain yet...
is 1234iu/mL a high or a low number?
Thanks again for your help. This is a very good and serious post about VHB and it is because of your information. THX.

[stef2011]

interferon (previously to my therapy with ETV) and it failed...

the news is that previous interferon non-responders after hbvdna undetactable by etv or tdf do respond to inteferon and clear hbsag.
keep using etv until you see hbsag lowering gets slower, check every 3 months, and then add interferon.the best time to add interferon is hbsag 300-500iu/ml

is 1234iu/mL a high or a low number?

it is a low number, it means you are getting immune control of hbv if your genotype is D

[samarium]

Stef,
so many things to take into account on VHB... it is a nightmare!
My genotype is A... Does it any change about inmune control of HBV...?
Thanks, today I am quite happy im looking forward to see my new analyses on february 2012!!!
Thanks a million.

[stef2011]

geno A and D are about the same, A is also much weaker to both interferon and antivirals infact most hbsg clearance on nucs is on geno a and d

the complite immune control is at 500iu/ml geno A-D, for geno B and C i dont remember exactly but it was something like 200-300iu/ml

[samarium]

these are good news... lets wait to see what happens...
I wll  post my analyses on february (looking forward for them)... fingers crossed.
A last question...is it normal the slower decrease in my last analysis for HBe and HBs?
Thanks Stef.

[stef2011]

A last question...is it normal the slower decrease in my last analysis for HBe and HBs?

well as soon as you see a slower decrease of hbsag add on of interferon is indicated because it means that killing of infected cells by immune system has been alted or new infected cells are balancing those killed

please post hbsag decrease by start of etv to now.if you have it during interferon post it too

[samarium]

Dear Stef,
thnaks for your reply. Here is my story...
during my interferon treatment no response at all, I ve been more or less with

ALT aproximattely ranging between 150-450
HBAg >125000
HBV-DNA 8.8log10
HBe aproximately 2000


At the beguinning of my ETV treatment:
ALT 126
HBAg >125000
HBV-DNA 8.8log10
HBe 1787

After 4 months
ALT 146
HBAg 10877
HBV-DNA 4.01log10
HBe 357

After 6 months
ALT 48
HBAg 1596
HBV-DNA 2.1log10
HBe 5.37

After 9 months
ALT 24
HBAg 1234
HBV-DNA negative
HBe 2.18

Next visit to doctor I will ask about to start with interferon therapy. I will have my next visit with my doctor in february and analysis by the end of january...

[stef2011]

you started with no immune response and the lowering of hbvdna has rescued your immune response.you may clear with etv only too but this will be very slow, interferon now works and will boost clearance but better wait and see if hbsag will reach less than 1000iu/ml at that point add on of interferon 48-96weeks will clear for sure

[samarium]

Thank you very much Stef.

[samarium]

Hi Stef,
here are my new analyses:

After 12 months of entecavir therapy:
ALT 29
HBAg 1178
HBe 1.80
HBV-DNA negative


I told to the doctor about to start combo with INF and my doctor said that these results about negativization in this stage with INF combo are quite preliminary. I wll have my new analysis in 6 motnhs (rather than 3 months till date) and he is still very positive in my response with ETV... he said that is very probable my negativization but no way to know when... I will be still with ETV and D vitamin (as you suggested).

Thanks.

[stef2011]

HBAg 1178

is this hbsag in iu/ml?

if hbeag turns to negative soon you ll have high chances to clear hbsag too but it is a very slow process on etv mono, adding intf we do know already it will clear much faster

if doc doesn t want to combo intf you may combo simvastatin or alinia, they both boost etv response but less than interferon

[samarium]

yeah de units are iu/mL

simvastatin? which one? 10mg, 20mg or 40mg? is it is new thing that simvastatin helps to boost etv reponse? I read here about alinia. The point is that alinia is not available in spain however simvastatin is...
Whcih is the dosis of simvastatina?
Thanks.

[stef2011]

that is very important for interferon response if you want to combo in the future, with hbsag less than 1500iu/ml you are certain to clear fast on intf+etv

simvastatin? which one? 10mg, 20mg or 40mg?

the dose to increase etv response in vitro is 40mg, this is from a 2008 or 2009 study, as for all the cheap generic, unpatented drugs, nobody cares or spend a penny so the only news we have is about liver cancer prevention and universal recommendation to use it on hbvers with abnormal chol levels

i suggest to start with 20mg dose for about 3 weeks and increase to 40mg if you experience no sides on 20mg.

simvastatin is reported to boost both nucs responce and interferon response, there is  post thses days about otan making a sim+interferon combo and clearing hbsag in about 16 weeks

[OrientS]

does simvastatin lower hbvdna? or hbsag?
if i use simvastatin with vit d3 .. no interferon .. no antiviral .. can i get any benefits?

[stef2011]

there are no trials so we just know simvastatin boosts response to nucs and interferon, there is no data to know benefits of simvastatin used monotherapy

we know simvastatin monotherapy prevents liver cancer from big human trials but no data about direct effect on hbv

[DavidEurope]

Hi, Stefano,
sorry for my English, I am not English. I am 48 years old man. One and halp year I found out I have Hep. B., wild virus, positive. The doctor prescribed me INF alfa, but after 38 shots he stopped the treatment, failled. Now I am taking Baraclude 3 months. I do the blood tests every months. So, after first month I had something like 190000 viruses, after second month it was about 42000, then after third month 39300. That seems like not too big decrease between second and two months. Can I be becoming resistent for Baraclude? After three months of Baraclude my AST and ALT are almost normal. Biopsy in December 2011 showned fibrose level 2. Doctor told me that I can eat everything, but I cant drink alcohol. I dont drink alcohol from the moment I found out I have hep. B. I even dont know, how I was inffected, I never had any sex affairs and my wife has no hep B even she was never vaccinated. It is very strange for both of us. I can tell you that psychologicaly it ruins me a lot, interferon theraphy was a hell. Now it is ok, I feel no sympthoms, just little tired and getting some fat. Doctor also told me that I can work out. Unfortunately during last tree months my good cholesterol decreased so I dont know it it has something in common with Baraclude. My doctor is also very fast-going, so I dont know too much about hep. B, a bout my future, how long time I can still live, etc. Maybe you can give me any information. I am living in France, then acctualy, there is not so many information about hep b on europeen internet. Only about hep C. So, does it mean that hep B is not that dengerous? Thank you for event. reponds. David

[DavidEurope]

Hi, Stefano,
sorry for my English, I am not English. I am 48 years old man. One and halp year I found out I have Hep. B., wild virus, positive. The doctor prescribed me INF alfa, but after 38 shots he stopped the treatment, failled. Now I am taking Baraclude 3 months. I do the blood tests every months. So, after first month I had something like 190000 viruses, after second month it was about 42000, then after third month 39300. That seems like not too big decrease between second and two months. Can I be becoming resistent for Baraclude? After three months of Baraclude my AST and ALT are almost normal. Biopsy in December 2011 showned fibrose level 2. Doctor told me that I can eat everything, but I cant drink alcohol. I dont drink alcohol from the moment I found out I have hep. B. I even dont know, how I was inffected, I never had any sex affairs and my wife has no hep B even she was never vaccinated. It is very strange for both of us. I can tell you that psychologicaly it ruins me a lot, interferon theraphy was a hell. Now it is ok, I feel no sympthoms, just little tired and getting some fat. Doctor also told me that I can work out. Unfortunately during last tree months my good cholesterol decreased so I dont know it it has something in common with Baraclude. My doctor is also very fast-going, so I dont know too much about hep. B, a bout my future, how long time I can still live, etc. Maybe you can give me any information. I am living in France, then acctualy, there is not so many information about hep b on europeen internet. Only about hep C. So, does it mean that hep B is not that dengerous? Thank you for event. reponds. David

[stef2011]

recheck hbvdna at 6months on entecavir, it still higher than 100iu/ml combo with tenofovir and after 6 months on the combo stop entecavir

i also did not like entecavir myself, too weak on me too, i kept the combo of both etv+tdf but tdf is the most potent on hbv and has nor resistance so you may use tdf alone but keep combo for about 6 months before switching to tdf alone

[4est]

"The doctor prescribed me INF alfa, but after 38 shots he stopped the treatment, failled" - what was the results before INF start and at the meoment that doctor stoped ?

"Can I be becoming resistent for Baraclude?" - if you start the Baraclude without having any-other antivirals before is very unlickly to develop resistance at Baraclude

"Biopsy in December 2011 showned fibrose level 2" - are you monitorised also using fibroscan ?

"I even dont know, how I was inffected, I never had any sex affairs and my wife has no hep B even she was never vaccinated" - is possible to have it from childhood and also is possible that your wife to have the virus and  clear it (din she check anti HBsAg ?) or is possible that she never contacted the virus (she have to do the vaccination).

"Unfortunately during last tree months my good cholesterol decreased so I dont know it it has something in common with Baraclude." - I don't know but I know that some research correlate HDL with HBV activity

"My doctor is also very fast-going, so I dont know too much about hep. B, a bout my future, how long time I can still live, etc. Maybe you can give me any information. I am living in France, then acctualy, there is not so many information about hep b on europeen internet." - have a look for another doctor, actually France is one of the best country for treating HBV  and has  good researchers in HBV area. HBV is a serious issue, but with proper management it can be manage and ususaly people die with HBV and not from HBV. Have a look also on this forum  regarding some doctors recomandation from France

[DavidEurope]

On the start of Pegasys I had something like more then 110000000 IU/ml, AST 144, ALT 250, ALP 91, Cr. 1.04, ultrasound upper obdomen: Mild fatty change

After 38 shots I was still 4600 IU/ml so the new doctor said the treatment failled.

In December 2012 I passed past fibroscan also, before biopsy, then fibroscan shown fibrose level one, but the doctor wanna be sure, so he made me the biopsy what shown fibose level 2. So, doctor told me that biopsy is more precise.

My wife did a test immediately when I found out I have it, she has nothing, so she passed a vacciation immediately, my son too, my mom too, simply all my family I am in contact with. Thank God I have so nice wife who didnt suspect me of something wrong. (Acctualy when I looked back, eight year ago I have passed a tatto, then about one year after a doctor told me that I have a bad liver test and I should stop drinking, wat was a joke because I was always an accasional drinker. I even didnt know that something like hepatide exists and he didnt tell me anything more).

I think my doctor is good, they say he is the best hepato in the region, so I trusst him, only I would appreciate if he gives me more info. In the same moment I understand he wants to keep my mind positive. I can tell you during Pegasys treatment I thought several times about a suiside... ugh.. Even now I am not that confortable with this sickness. It makes me asocial, it is not pleasent to explain to the friends that I can´t drink any alcohol, even I loved wine before  and now I miss it from time to time. I was not a big drinker but you know what I mean, there are some occasions, families parties, dinner with friends etc... and I have an appetite to drink while seing the others... It is horrible. You think it is possible to drink a little when the virus is undetectable one day?

You think they will find any real medicament againts it one day, soon? Does any of you have any infomation how the scientic research continues? Is there is any change to get rid of it totally? I have read that they test a marrows transplantation. my son would gime his marrow but the docetor told me that in this moment it is not used as a treathment method.

Did anybody of you hear about MMS? I dont trust it too much but can it work?

I am becoming a paranoiac... ugh. Acctualy, I have changed a doctor. The firstone almost killed me with Pegasys, I had a horrible side effects, huge decrease of weight - 10 kilos, permanent imsomnia and enormous decrease of white blood cells, so the doctor gave me each two weeks a shot to increase white blood cells. I though I am going to die, then I found my temporary doctor who told me that the previos doctor could have killed me with those shots for white blood cells.

I was all my life very sporty guy, now I feel like a ruin even I am feeling much more better then during Pegasys.

Thank you, guys, and thank you Stefano too.

[4est]

I can understand your feelings, all of us face most of them, but be positive HBV even if is not curable is manageable.

INF treatment is a pain in the *** and can have a lot of side efects (I only read about it). To be honest I was expecting to tell me that your doctor look at  the quantitative HBsAg during the interferon treatment.

Regarding the treatament, they are some drugs that show great potentials, but we have to wait until all test are finish (Myracludex or REP 9AC) and also a new combo show better results (Antivrials + INF), and in this new combo even if persons that were not responsive to INF can become responsive after a antiviral therapy.

Regarding the antisocial part of the HBV, is bed effect but manageable, some of us don't say to anyone about this, some of us say - is a  personal choice. And regarding wine - hard question - general advice si 0 alcohol even if you are a inactive carrier, but some of the doctors say that 1 - 2 glasses of view are acceptable for inactive caries. In the end also this is a personal choice but I think that will be good to discuss this with your doctor and see his opinion.

I don't know anything about MMS or about marrows transplantation.

Regarding the sports, you should not give up on sports, moderate sports is a good thing, even can improve natural production of interferon and help you body to control the virus.

[4est]

have a look on this:

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2893.2012.01599.x/abstract?userIsAuthenticated=false&deniedAccessCustomisedMessage=

maybe it give you a beater idea

[DavidEurope]

Thank you for all those info. I need to hear some positive things.. I also needed to hear the other HBV people experiences. Evidentely you know very well this issue. I dont understand too much all those medical terms. All I know is that I would give all my money to someone who take this f...g virus out of my body once forever :-( I got my last blood test last week, there was not too big virus decrease between second and third months of taking Baraclude. So, my doctor told me, that I am a slow responder and I can expect the DNA undetectable in six months. So, I will wait, that´s all I can do, unfortunately.

Yes, my doctor told me, that I can´t drink any alcohol, so I dont drink. I dont want to say to everybody that I have hep. B. so I always say I have something with my stomac that´s why I rather dont drink. Ugh. It *****. Only my closest family knows it. I feel like dirty.

I think that the marrow transplantation could be a way. There was a guy in Berlin who lost his AIDS virus this way. They also do any research with sharks extrack squalamine, that could be a hope too: http://articles.latimes.com/2011/sep/20/news/la-heb-shark-extract-squalamine-fights-viruses-20110920 Maybe you guy, who are americans, could search some more infos about this.

We must believe. Ectually, in this modern and fast time the new medicaments appear very often. So, I keep a hope.

[stef2011]

if you are in europe switch to tenofovir, it is more potent and also get hbsag quant tested, it s available in most euro conutries

[DavidEurope]

Thank you, Stefano. For this moment I will follow what my doctor says, so I will follow Baraclude, then I will see after sixth month. My doctor said that baraclude is something like a Rolls Royce among all the hep. medicaments, so I trust him. He uses to go to many hepatologic international conferences, so I hope he is well informed and following the trends.

I run every day, I work out four times per week, I feel good at the moment. My urine is white again. Only I am getting a little fat on the sides and belly. It is nothing tragic, I believe that running will help. I lost a lot of kilos during Pegasys treatment, so my doctor told me that it is a body reaction after that lost, my body creates a reserve now.. ups. After Pegasys I regained those lost ten kilos even another 6 kilos more in tree months, ugh.. So, I eat only low fat food, no oil, no fried meat, everything only steamed.

[stef2011]

vit d around 80-90ng/ml may help with fat and fasten response to etv

[DavidEurope]

Thank you, will try it.

[grmr]

Hi David, were you 48yo when went through IFN tx?

it seems strange as i went through a 30wks ifn tx and now i'm still on ifn but no sides at all.. it may be correlated to something you already had and ifn made it rising,, i believe...

[stef2011]

i believe optimum vit d levels may lessen or make no intf sides at all, they never did studies on this but it would be interesting to see ourselves it it is so

i also find aldara has no sides at all, just chills but i cannot conisder chills as sides they are not so relevant

[grmr]

do agree with u stef..

[stef2011]

actually there is a study by italian researchers on high end of normal vit d levels being able to control cytokines and acting as pain killer, the same thing maybe true on interferon

[DavidEurope]

Hi. I had no side efects first tree months of Pegasys, so I thought everything goes well, then it appeared from one day to another. My doctor told me that it is strange because people have ussualy the side effects on the begining. I dont know, but those side effects were really horrible, it was the biggest hell of my life. I was like a zombie, like a skeleton... I rather dont wanna think about that period of my life anymore..

[DavidEurope]

As I am 48, my imunity system is probably quite old and not strong enough. That´s probably why I am even not fast so much with Baraclude now. It is only my own theory. That´s why I had those side efects probably too. Simply a younger organism is surely more resistent.

[DavidEurope]

strange, today I have a liver pain.. ups.. I found on internet that the liver can´t pain, so I dont know what it is... maybe only my paranoia.. It takes already two hours. I had a cereal breafest and then one box of sweet pop-corn and coca light in the cinema. (btw, dont go to see Wreth of the Titans - it is so bad that probably that´s why I got a liver pain)..

[stef2011]

on hbv it is the opposite the olders have lower hbsag, higher clearance rates without any therapy, so no correlation with strength of immuen system

sides effect of interferon are heavier on older patients and usually no sides at all means no immune system modulation.

that liver pain has no relevance, we all had it sooner or later and it is from liver surrounding organs.as regards entecavir i dont like it at all because it also failed on me and took 7-8months to make hbvdna und, i strongly prefer tenofovir

[DavidEurope]

Hi, Stefano.
So, I bought today a multivitamin pils. It is a full spectrum vitimin, included vit. D also. So, I will see if it will help with accelerating the Baraclude affect and getting fat. My question is: Is aby other vitamin dengerous for the liver? Is it ok to take multivitamin what includes all of them? Thank you.

[stef2011]

no dont use multivitamins unless all natural extracted from food, most vitamins are synthetic chemicals made in labs and they are not the same as the natural ones

take only vit d3, the natural type, 10.000iu per day, check also dose most vit d3 are very very low quantity prer pill

puritans has 5000iu pills d3 at very low price

[DavidEurope]

so, you mean that multivitamin is not good for the liver?

[stef2011]

no if it is not if vitamins are synthetic

puritans.com, pho.it, hepatitistechnologies, solgar, these brands sell natural extracted vitamins and of course these are much more expensive.heptech are the best for the liver

but if you have no liver damage you should take vit d3, liposomal vit c and liposomal gluthatione

[grmr]

I also knew the hardest period while on IFN were the first months..

[DavidEurope]

I have a liver dimage already, I have a fibrose of 2nd.level..Doctor told me that using the Baraclude should also recover my liver. Does it mean that the fibrose will disapper?

[stef2011]

yes it means fibrosis will regress but it will take years of therapy and healthy diet/lifestyle
low bmi/wheight, many antioxidants in the diet and natural vitamins, especially d3, will help fasten the process

[DavidEurope]

My 4th month of entecavir. Yesterday I have passed the blood test. Test of the serum takes about one week, so I still dont know the result, but I already know the other results and they are not that enthusiastic..:-(
My glucose increases - there is a ref 77 - 99 and mime is 94, last month it was 84. Does it mean I am getting a diabetes?
My creatine decreases - ref is 0.50 - 1.50, I have 0.82, last month I had 1.01
My good cholesterol decreases too, it should be bigger then 40, and it is 37, last month it was 39.
AST still 37, last month 37,
ALT 50, last month 50.
Phosphorus is 3.4, last month 3.7, month before 39.
Is there something wrong with me?

[stef2011]

diebetes (diabetes) is mainly due to bad microbiota, eat bifidus home made yogurts and bitter melon and then recheck glucose

also serum vitd25oh must be kept higher than 50ng/ml, my father had high glucose for years, early diabetes2, he got vitd25oh to 85ng/ml, fish oil epa and dha 2g daily, fibroguard and glucose went down to normal in 3 months

[Engr_JDelacruz]

I'm very sadden by your story. Interferon is the most advanced medication for hepa b but there are many types and the cheap ones usually have the worst side effects. I'm glad you have good results now. You have normal alt/asl just after 4 months of entecavir. There are also supplements here in the Philippines which can heal fibrosis. Maybe you should consider visiting our country for treatment and relaxation. Stress is the number factor which can worsenHBV. Hope you heal soon my friend.

[DavidEurope]

So, finaly I got my DNA HBV result today:
1. month - 187980 IU/ml
2. month - 40000 IU/ml
3. month - 37900 IU/ml
4. month -  9000 IU/ml

After 3rd month my doctor told me that I am slow reponder to baraclude, but now he told me that there is a big improvement after 4th month. It is true that 4th month I started again to sport much more intensively then before, it maybe helps, I dont know.

[stef2011]

i d not go over 6 months with detactable hbvdna higher than 50iu/ml, too dangerous for resistance risk, did you check if you have lamivudine resistance?

if i were you i d go to tenofovir directly, combo and when hbvdna und for at least 4months tdf monotherapy

[DavidEurope]

Stefano,
sorry, but why do you prove everybody to switch to tenofovir... Sorry, but I have a felling like you were an employee of tenofovir producer....Arent you?

[stef2011]

because etv has resistance problems and in case of lam resistance it jumps to more than 50% resistance.if resistance is not checked before starting etv it is not possible to exclude a resistance percentage so high snce around 10% patients has lam resistance even if lam was never used

etv failed on me too

[stef2011]

if you also consider how useless is the result of antivirals when they work, hbvdna und clears no virus, that a fast non response is even more useless.also keep in mind that after use of these cheins terminators like etv and tdf for more than 10years dmage to our won dna and mitocondria will be very dangerous so they have to give fast results

cure will be hopefully available in 10years because use of these antivirals for life is not possible

[Engr_JDelacruz]

hi i'm not very familiar with tenofovir is this another antiviral much better and more advanced than entecavir? Here in the Philippines we were always given entecavir for hbeag positive cases. The other antiviral which are considered obsolete and are no longer prescribed here if patients have the money to buy are Lamivudine and Hepsera which have many side effects. Can you please tell me about tenofovir so I can ask my doctor about it.

[stef2011]

tenofovir is the most potent hbv antiviral with zero resistance, it is also cheaper and used since 2000 off label and approved in 2008

entecavir has also a big cancer problem because it made lung cancer on mices they were about to cancel development but since it made no cancers on monkeys they kept it but with close cancer monitoring, i use it too but since it failed to make hbvdna totally und by 2 years i am combo with tenofovir until may then interferon will be added and entecavir removed because the trials are for interferon+tenofovir

all hbv antivirals canbe considered obsolete appart tenofovir because they all make resistance, since tenofovir is the oldest and will be off patent in few years it will also be the cheapest

[stef2011]

also last results on kidneys damage for hbv found entecavir as heavy as tenofoir on kidneys so in the end there should be no reason to use entecavir appart give drug makers more money since entecavir is also more expensive

[DavidEurope]

Stefano, sorry, I cant believe what you say here. Where did you find the information that entecavir creates a cancer? If it created cancer they stop prescribing it immediately. The kidney demage - all the medicaments have any bad effects. It is an american product, all american products have many warnings because you sue eachother in the States for even smaller things..

[Engr_JDelacruz]

I think you have a point I should ask my doctor about this tenofovir. Entecavir is probably the most expensive antiviral here the Philippines yet it is widely prescribed. I have two gastro and they both prescribed Entecavir that's when I decided to take Entecavir but I will check with them this tenofovir. I'm really looking for the best antiviral but it is my personal opinion having four of my family members infected with hepa b for more than 15 years that no antiviral can solve this hepa b. Relapse is always imminent so I have researched on naturaphatic medicine to combine with antivirals. I have products like elemental selenium plus elemental zinc and copper which are immune booster. Maybe it can have a same effect as a tenofovir/interferon combo. Have you heard any research or study regarding this? Lowering viral load then boosting the immune system. Interferon is very expensive here and not many people can afford this much more to combine with antivirals which are also costly.  

[stef2011]

entecavir was approved but only being kept under stict control for tumors, of course this is hiden as much as possible for obvious reasons

http://datasheets.scbt.com/sc-204738.pdf
Carcinogenicity:
NOAEL 2 years oral (mouse): 0.4 mg/kg (males and females) tumour organs: lungs,
cardiovascular, liver. Effects include increase in food consumption, death,
decreased weight gain, decreased body weight. Effects considered species
specific and may not be relevant for humans. The relevance for human risk
assessment is unknown.
NOAEL 2 years oral (rat): 0.2 mg/kg (male and female) tumour organs: liver,
brain, skin, uterus/ cervix. Effects included decreased body weight. Microscopic
changes were observed in the following organs; pancreas, kidneys, testes.
Carcinogenicity Assessment: Limited evidence of carcinogenic potential.

when we take these drugs we have to find a balance between benefit and damage, hbv itslef makes liver cancer, so to me it is good to use these but of course not for life.
so as soon as etv failed on me after 2 years making even less than 20iu/ml hbvdna detactable (also failed to lower hbsag on the contrary it made an increase of hbsag on me) i imemdiately switched to tenfoovir, now that it is been shown kidneys damage is th same for tdf and etv i see no reason to keep etv for me

[stef2011]

http://www.hc-sc.gc.ca/dhp-mps/prodpharma/sbd-smd/drug-med/sbd_smd_2007_baraclude_102555-eng.php

my guess is use of etv for short periods like 5-10years might not be so dangerous, the bad is cancer takes decades to develop and get detactable, in any case i d not use any of these drugs for  more than 10 years and ths is also the point with researchers who are taking care of me so we will add interferon for long priods to clear most of hbsag and make possible future discontinuation of these antivirals

[DavidEurope]

I trust my doctor, he is a  very good French specialist, going to many international hepato conferences. He told me that Baraclude is a Rolls Royce among the antivirals. You can get cancer even if you dont have a hep and antivirals, so it is quite strange to say that it creates a cancer.. I analised all your contributions on this web, you persuade everybody to switch from Baraclude to tenofovir.. I cant take it. Even I think that combo therapy, what you promote here, is much more harmful for the organs. I even dont think that we have a same imune system as the mice. I appreciated your advices on the beginning, but now I can say that you scare the people.

[stef2011]

i dont promote anything tenofovir is simply the best hbv antiviral that's all, entecavir is just more expensive and has a longer patent but it has resistance which tdf has not and trials to clear hbsag by combo are made with tenofovir+peginterferon

so there is no point to use etv now unless the goal is take for it life without using the peginterferon trials, in any case your response is very bad hbvdna higher than 1000iu/ml after 6 months has had resistance in patients in the first trials and the guidelines indicate add on if hbvdna is detactable after 12months to prevent resistance, the optimal response is hbvdna response by 6months

[stef2011]

please don t mix cars with drugs, these antivirals are all "not an hbv cure", they just prevent liver damage/liver cancer but none of them cure hbv....
just a forced choice for those with liver damage until we see the results of interferon+tenofovir on more patients and myracludex results

[Engr_JDelacruz]

Maybe viral load of DavidEurope is surging upward when he took Entecavir that's why the reaction was not so fast for the past 4 months. When I took Entecavir on the first month my HBeAG went even higher around 1500 although its qualitative it shows negative response from the treatment. Second month the HBeAG dropped which is a good sign. I took HBsAG Quantification by roche which is less expensive the HBV DNA and my count just dropped from around 37000 to 33000. I continued with the medication on the fifth month I got another round of Lab test and my HBsAG quantification is down to 90 iu/ml and my HBeAG is around 10. Although I'm taking naturaphatic suplements, Entecavir gave fast result on eliminating viral load. Only side effect is on the kidneys that's why I take monthly monitoring of creatinine. I think all antivaral have limitation. You can achieve seroconversion of HBeAG but very difficult to seroconvert HBsAG.  

[I_wonder_why]

qor:

"I first started treatment since Jan 08, due to very high load of DNA (almost 600m copies) and high AST, ALT (200, 600 respectively). Echographie abdominale shows Liver were functioning well (all following tests showed same result).  As prescribed by doctor, I have been using Baraclude since."

I wonder why?

At the time the doctor prescribed Baraclude to the patient, didn't he know that most likely (>98% of the time) she has to take it for life?  Then shouldn't he have informed her before starting the treatment?  So that she may opt for interferon?  Or at least she would know the full impact of antivirals from treatment day 1.

[Engr_JDelacruz]

You don't have to take it for life. You just have to attain undetectable level of HBV DNA and HBeAG Seroconversion.

[I_wonder_why]

qor has already attained "undetectable level of HBV DNA and HBeAG Seroconversion."  Can she stop taking Baraclude?  Why does her doc and other comments here say otherwise?

[4est]

I'm not a doctor but I think that is better to play by doctors rules.

Stoping NUC's can lead to a virus mutation and increase in virus activity and also in immune reponse that will translate into more damage to the liver. Also this mutation cam become permanently and resistance to NUC's (e.g. people tretated with Lam can develop a YMDD mutation and in this case even if they move to Entecavir (a NUC more potent then Lam) have a increase chance to develop resistance to Entecavir)

Even if you stop treatment, this have to be done with doctor approvals and closely monitory for possibly problems.

In this moment even if some doctors suggest that stooping NUC's can rescue our immunity system and trigger an immunity atac over the virus this is not prove and no stooping strategy exist. (is possible to stop NUC's and or sis possible to stooped and add Inteferon, or is possible to add interferon and stooped after that, or add interferon and stooped during interferon treatment .....)

[stef2011]

hbeag negtive and hbvdna undetactable means nothing to the hbv infection, the virus is replicating even if hbvdna in undetactable in the blood, only a very low hbsag quantity can indicate that nucs can be stopped because it means the immune system has taken control of hbv (not hbvdna test or hbeag negative test, this was a wrong 10 years ago view of some doctors)

which is the safe level of hbsag to stop nucs safely is not available yet and still on study, we have a cccdna value study a lower value than 0.05copies/cells had no hbv reactivation stopping nucs

my point of view is stopping nucs is never safe unless hbsag negative and high hbsab

[I_wonder_why]

Should'nt qor's doctor have told her before starting Baraclude?

[stef2011]

yes but there are so many doctors just acting as drug makers sellers and not doctors, i guess only countries where doctors get to jail for non-informing patients do not have this problem

[grmr]

I thought nucs can be progressively stopped by adding on pegifn adn then slowly decrreasing nucs..

[stef2011]

yes of course that s the way to stop nucs if there is response to intf but hbvdna will get back unless hbsag is very low

[Engr_JDelacruz]

Doctors usually prescribe continuous intake of antiviral even if you have undetectable HBV DNA and HBeAG seroconversion because they are afraid of the relapse. I can tell you they don't have definite timeline for these antivirals. My mom took Lamivudine for 4 years until the doctor tell her to stop. After two years she had a relapse. She took Hepsera same thing happen when she stops after a couple of year the virus multiply again. Same also in Baraclude she took it for 3 years then after 2 years off she got a relapse again. Now she got alternative medicine and she's already HBeAG and SGPT normal. That's when we have the idea that antiviral alone cannot cure this disease. The concept of stef was right combo is the perfect approach to cure this disease. Antiviral plus interferon or for us antiviral plus immune boosters which comes from a naturaphatic approach because we don't have the budget for interferon and we don't like it's side effects. Lower the virus then boost immune system.  

[I_wonder_why]

Thanks for the sharing.

Antivirals are chemicals and hurt the liver.  If they have to be taken with no end sight, patients like qor really need to be fore-warned.  Sadly pharmaceuticals like to see patients take their products for life.

Is your mom recovered?  Does she still take antivirals?  Does she lead a normal life?  Working full time and take care of the family etc.?

Thanks.

[stef2011]

they dont damage the liver but since they are dna chain terminators t is believed that over decades of use mitocondrial toxicity may happen due to little interference with our own dna processes, on thing is certain they can t be taken for life or started as young

[I_wonder_why]

"they dont damage the liver"

How come?

[stef2011]

they are useless for hbv, they are designed only to regress/block liver damage and they do no damage to the liver

[Engr_JDelacruz]

Yes my mom is doin good. She's a healthy carrier now. Normal alt/ast, HBeAG seroconvert. She's taking daily does of vitamins plus selenium. She still monitors blood test every six months. No more antivirals for her now. As for me I'm taking antiviral right now (Baraclude). I'm on my sixth month and I'm planning to stop this as soon as I got undetectable HBV DNA and HBeAG seroconversion. Then I'll take the natural medicine as immune booster. My goal is HBsAG seroconversion or become a healthy carrier atleast.

[I_wonder_why]

Well!  Your mom is a case of ending antiviral treatment!  That is great!

What does selenium do?

Do doctors commonly prescribe it?

Thanks.

[Engr_JDelacruz]

Yes. Selenium is anti-cancer and immune booster. You can see it's effect a month after you take it. It will improve your alt/asl. However you still need antivirals especially if your virus is surging upward because even if your liver is protected the multiplication of virus might eventually take it's toll that's why you need to lower down the virus. Naturapathic doctors are the one's who prescribe it. I just happened to see it's effects because we used it and our blood test show good results. This is based on our experience.    

[I_wonder_why]

Thank you for the explanation.

Waiting to hear more good news from you!

[DavidEurope]

Guys, I have asked my doctor. It is very rare that someone becomes resistant for entecavir, it is even very rare that it destroyes kidneys. I have asked him also what will happen if someone becomes resistant, he said that there is also any other new molecule of antiviral. However, I found any information on internet but I dont trust it too much, that during next 10 years they should find a real medicament against hepatide B. The research goes so fast now. But acctually why they should search any ultimate medicament? To keep us sick with all those antivirals is so lucrative for all the pharmaceutic companies. But we have to believe. That´s it.

[johnson2012]

Hi stef2011 & everytone else,
Sorry for my English, I am male, 25 years old. I have started Baraclude 0.5mg treatment for almost a year.  Currently my liver function, AST, AKT are normal, with undetectable virus count.

Everything seems fine, just recently, I feel kind of tired. When I google, I found there's a side affect called Lactic acidosis that have been reported with the use of Baraclude. Symptoms of Lactic acidosis includeds weakness and tiredness; shortness of breath; weakness in the arms and legs.

Maybe I'm over worrying, but I think I have a little bite of everything, I feel kind of tired (not huge, I can still work and eat, but not as energy as usall), sometime I feel shortness of breath and alone with the tiredness, I also feel weakness in arm and legs (just like after a viguous work out).

Do you know what could be the cause? Is this normal?
Thank you very much for helping with my case.

John

[johnson2012]

Hi stef2011 & everytone else,
Sorry for my English, I am male, 25 years old. I have started Baraclude 0.5mg treatment for almost a year.  Currently my liver function, AST, AKT are normal, with undetectable virus count.

Everything seems fine, just recently, I feel kind of tired. When I google, I found there's a side affect called Lactic acidosis that have been reported with the use of Baraclude. Symptoms of Lactic acidosis includeds weakness and tiredness; shortness of breath; weakness in the arms and legs.

Maybe I'm over worrying, but I think I have a little bite of everything, I feel kind of tired (not huge, I can still work and eat, but not as energy as usall), sometime I feel shortness of breath and alone with the tiredness, I also feel weakness in arm and legs (just like after a viguous work out).

Do you know what could be the cause? Is this normal?
Thank you very much for helping with my case.

John

[DavidEurope]

Johnson, you should not be scared. Just say to your doctor what are you thinking about and if you have some doubts, but weakness is a normal side-effect of Baraclude... it musn´t be still a Lactic acidosis... However, you should be regulary nomitored by your doctor - a regular blood test. I think you should not trust the internet information too seriously... Then Baraclude is american product, so as you know everybody sues everybody in the States, so all the producers (then of course also the producers of pharmaceutics) protect themself in the product leaflets, they rather mention all the risks, even the small risks.. Just think positively. Even dont trust this web page too seriously, there is a lot of pharmaceutic producer´s people who will tell you that Baraclude is not good, etc... Baraclude is very good, dont worry. But really, if you have any doubts, speak with your doctor. ciao

[DavidEurope]

A new vaccine against chronic hepatitis B tested in Cuba, have anyone of you heart about it? http://www.cubanews.ain.cu/2012/0302Clinical-Studies.htm

[DavidEurope]

...and this: http://www.nature.com/icb/journal/v82/n5/abs/icb200481a.html

[DavidEurope]

Guys, I have sent the e-mail to that Cubanien research centre and the director answered me this: I am sending two papers. The clinical trial Phase II-III is ending. The vaccine is not registered yet for general use. Clinical trials are ongoing in Cuba and Bangladesh and new trials should start in Brazil and Europe next year.
Regards,
Gerardo Guillen

Then those two PDF are a huge info info about the trials results etc.. It sounds very good. if you give me your e-mail addresses I can forward it to you.

[4est]

create a new thread for this in order to be more visible and to monitorised.

[DavidEurope]

I did

[DavidEurope]

Does anybody has an idea how long time the trials take?

New therapeutic Cuban nasal vaccine against chronic hep. B

The clinical trial Phase II-III is ending. The vaccine is not registered yet for general use. Clinical trials are ongoing in Cuba and Bangladesh and new trials should start in Brazil and Europe next year.
(I just copy a part of the study document, it is quite big file)
The nasal vaccine candidate (NASVAC), comprising hepatitis B virus (HBV) surface
(HBsAg) and core antigens (HBcAg), has been shown to be highly immunogenic in animal models.
Methods: A phase I double-blinded, placebo-controlled randomized clinical trial was carried out in
19 healthy male adults with no serologic markers of immunity/infection to HBV. This study was
aimed at exploring the safety and immunogenic profile of nasal co-administration of both HBV
recombinant antigens. The trial was performed according to Good Clinical Practice guidelines.
Participants ranged in age from 18 to 45 years and were randomly allocated to receive a mixture
of 50 mg HBsAg and 50 mg HBcAg or 0.9% physiologic saline solution, as a placebo, via nasal spray
in a five-dose schedule at 0, 7, 15, 30, and 60 days. A total volume of 0.5 ml was administered in two dosages of 125 ml per nostril. Adverse events were actively recorded 1 h, 6 h, 12 h, 24 h,
48 h, 72 h, 7 days and 30 days after each dose. Anti-HBs and anti-HBc titers were evaluated
using corresponding ELISA kits at days 30 and 90.
Results: The vaccine candidate was safe and well tolerated. Adverse reactions included sneezing
(34.1%), rhinorrhea (12.2%), nasal stuffiness (9.8%), palate itching (9.8%), headache (9.8%), and
general malaise (7.3%). These reactions were all self-limiting and mild in intensity. No severe or
unexpected events were recorded during the trial. The vaccine elicited anti-HBc seroconversion in
100% of subjects as early as day 30 of the immunization schedule, while a seroprotective anti-HBs
titer (10 IU/l) was at a maximum at day 90 (75%). All subjects in the placebo group remained
seronegative during the trial.
Conclusion: The HBsAg—HBcAg vaccine candidate was safe, well tolerated and immunogenic in
this phase I study in healthy adults. To our knowledge, this is the first demonstration of safety and
immunogenicity for a nasal vaccine candidate comprising HBV antigens.

[DavidEurope]

So, finaly I got my DNA HBV result of 5th. month of Baraclude:

1. month - 187980 IU/ml
2. month - 40000 IU/ml
3. month - 37900 IU/ml
4. month -  9000 IU/ml
5. month - 3980 IU/ml

My doctor says that next month I could be undetectable. I have a little increased AST,ALT but my doctor says it is a good sign, it heppens in 5th and 6th months of entecavir because the immune system starts to fight the virus..

[Engr_JDelacruz]

Good! Maybe HBV DNA in you country is cheap. My doctor scheduled my HBV DNA on the 9th month. I'll stop taking entecavir upon achieving hbeag negative and undetectable HBV DNA. I'm also on my 5th month now I have almost normal alt/asl, hbeag is down from 1500 to just 8. I'm still taking selenium combined with entecavir for liver protection. Just keep posting for updates. Also if you can ask your doctor if it's ok to stop entecavir immediately after achieving undetectable HBV DNA and hbeag negative.