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Avatar universal

When should a person to start antiviral treatment?

Hi.

Could anyone educate me some back groud?

First of all, high viral load is the related higher risk of HCC. (http://www.ccjm.org/content/76/Suppl_3/S6.full)

up to date guide line recommands to start antiviral treatment when hbvdna > 2,000 IU/mL and alt>2*uln.

I have searched the articles about the hbvdna level and hcc, some of them mentioned alt level but I could get out what the alt level is suitable for starting antiviral.

My question is:

If to be safer, could the guide be changed to only with hbvdna > 2,000 IU/mL then start antiviral treatment?

Thanks

Dan
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Avatar universal

yes i ve seen them but i didn t read both, just the one on tenofovir to see if it was tenofovir to lower vit d but i knew aready that it is not nucs to lower or improve vit d, it is the viruses and cancers blocking vit D on cronic infections

vit d is needed to make immune system work better because on cronic diseases there is a block on it.
Helpful - 0
Avatar universal
The one I take is only  1000 IU. You are aware that the two posters on Vit D at the AASLD 2011 are rather inconclusive about VIt D:
1. One said Tenofovir or Entecavir treatment does not seem to change the level of Vit D.
No effect of Tenofovir or Entecavir on Vitamin D levels in Chronic Hepatitis B mono-infected patients. Single centre ‘real life’ cohort experience
2. The second said most hbv patients are Vit D deficient.
Vitamin D Deficiency in Asian-American Patients with Chronic Hepatitis B in New York Downtown Hospital

At least we will have strong bones. LOL.
Helpful - 0
Avatar universal
for all interested on vitamin d3, i have found these websites and discussions on vitamin d3 quality and reliable sources

http://www.vitamindcouncil.org/
http://www.facebook.com/topic.php?uid=332321220632&topic=18270

bio-tech pills at 5000iu for daily use or 50000iu for weekly use look very good.these are dry pills so a fat meal or breaking te pill in oliv oil can improve absorption, and various other brands available in europe here

http://wlsproducts.nl/vitamines.php
http://bigvits.co.uk/products.asp?cid=68

i have also found that many US brands are not reliable and lower than advertised vit d quantity has been found in pills, reliable brands solgar and bio-tech, other info on
http://www.vitamindcouncil.org/
Helpful - 0
Avatar universal

by the way i have found all kinds of pills on amazon but will they be reliable?
Helpful - 0
Avatar universal

i am having a hard time with vit d3 because the pill doses are extremely low here in italy/europe, do you have any brand that can be bought online, possibly in europe too, with a 10000iu dose per pill or higher?

i am now using the liquid form but it is a mess because i need 40 drops to reach 10000iu and the bottle lasts only 1-2 weeks, liquid is really a bothering method
Helpful - 0
Avatar universal
Vitamin D is very cheap. In Australia, you can buy fat-free milk with added Vitamin D. I don't know about Ginseng, but Royal Jelly, I was told, has a lot of Vitamin B. I myself, take fish oil tablets and try to drink a lot of coffee.

Anything else we forgot to mention?
Helpful - 0
Avatar universal

i dont think vitamin d cannot be found at pharmacy there are severe diseases treated by vitamin d as rikets or osteoporosis, maybe you should check with a doctor
if you like you can order online but doses are very low on supplements because most  goverments have imposed doses lower than 5000iu which is the minimum to normalize serum levels.
solgar has 2200iu liquid and 5000iu in some countries, puritans has 5000iu pills too but lately i have found very low d levels despite using 10000iu daily from puritans pills so i am afraid puritans might be fake mixed pills
Helpful - 0
Avatar universal
Thank you ..
In my country (saudi arabia) .. Although i looked for vit d 5000 iu per day tablet .. Unfortuantely i didnt find it ..
Iam using milk thisle 400-600 mg daily .. Some days adding curucum and ginseng with royal jelly .. My length is 170 cm, my weight 77 kg .. my body looks normal .. Trying always to avoid  fat .. Waitng in news and google everyday about rep9ac and mycludex ..
And also driving safely ..

any comments are appreciated ..
Helpful - 0
Avatar universal
You got me. I am not a doctor. In the literature, there is a "healthy" range of ALT:  < 30 for male, < 19 for female.

Ideally, hbvdna should be undetectable. Personally, I don't think 1600 iu/mL is high, but then I am not a doctor. There are no absolutes, these criteria vary from patient to patient, genotype to genotype.

To me, taking antivirals over 40/50 years-old is like an insurance, just like taking pills for high blood pressure and cholesterol.

The best thing is to find a good Hepatitis B specialists, ordinary doctors don't know much about HBV.

In the meantime, stay slim, exercise regularly, make sure your Vit D level is normal, no smoking, no drinking, drink coffee instead, and relax. And drive carefully. LOL.
Helpful - 0
Avatar universal

to me themost important tests after 40yo are:
fibroscan
ultra deep sequence of all mutations and genotype to see the risk of hcc/cirrhosis directly from the type of virus

alt/ast and hbvdna are much less important if you have those highly spesific tests available, but of course alt>200 and hbvdna>1000000iu/ml needs to be suppressed.
in presence of no liver damage i'd go for interferon
Helpful - 0
Avatar universal
.. If you are usually over 40 with presistent of hbvdna and elevated ALT ..

What do you mean by ELEVATED hbvdna?


My ALT is about 36-39
My age 39y

Hbvdna 1600 iu/ml
Helpful - 0
Avatar universal

stephan is very right about age, i forgot that.....after about 40yo there is an increased risk of cirrhosis/HCC because something changes, probably too many mutants accumulated that make more damage to the liver despite hbvdna or alt

so after 40yo very close monitoring of liver damage by fibroscan is very necessary and nucs might be an option especially combo withinterferon to try clear hbv definitely
Helpful - 0
Avatar universal
Hi Dan,

When to treat is always a difficult question. I will give you my opinion:
1. First, try to ascertain what phase you are in: Immune tolerance, Immune Clearance, Immune inactive or HBeAg negative Chronic Hepatitis?
2. Usually, treatment is not recommended in the Immune Tolerance and Immune Inactive phases.
3. If you are in the Immune Clearance phase, the decision whether to treat or observe is not easy. You will have to take in factors such as your age, family history, genotype, and stage of your liver.
4. If you are in the HBeAg-ve chronic phase, you are usually over 40 with persistent hbvdna and elevated ALT, then it is recommended that you should receive treatment.

Having said all that, since you are in America, I recommend that you see a Hepatitis B specialist, there are many, and be guided by your specialist, after they have all the knowledge and experience. To find a good specialist, go to www.hepb.org or join the list: www.hblist.org and ask their members.

In China, the situation is different, good Hepatitis B specialists are hard to find and the cost of appropriate treatment is high.

StephenW.
Helpful - 0
Avatar universal

antivirals should be started only when there is liver damage, fibroscan allows to monitor liver damage even monthly so hbvdna is no longer a tool to choose when to start therapy

in italy and i think in europe too, expert liver specialists consider treatment by nucs only if liver damage detactable.on the contrary interferon can be used anytime

so nucs are necessary only if there is liver damage, if there is HCC risk with genotype B or C if there are precore  bcp mutnts to increase HCC risk

using nucs with no liver damage is useless because they can only stop liver damage while infection and hbv replication is not stopped but only lowered
Helpful - 0
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