Below you can see an overview of my experience with hvb:
- hvb adn = 10045 copies/ml
- alt/ast = normal
December 2011 - I started pegasys monotherapy - 180 mg weekly
- adn hvb = not having checked
- alt/ast = still normal
September 2012 - week 42
hbsag quantity = 1235.55 ui/ml
October 2012 - week 46
hbsag quantity = 1467.35 ui/ml
alt = 50 (<35)
ast = 57 (<35)
November 2012 - after 48 weeks of pegasys
I changed doctor since I was simply sent back home and asked to come back in 6 months.
New doctor recommended me to take some blood tests:
- adn vhb = < 20 ui/ml
- hbsag quantity = 1388.82 ui/ml
- vitamin 25oh D = 21,3 ng/ml
- interleukin 28b = genotype TT (it seems that this genotype has higher rates of relapse)
New doctor also recommended some pills - vitamin E, omega 3&6, ursofalk & sylimarin
Today I had an appointment with the doctor and after seeing my blood tests results his comments were:
- I should start tenofovir to make sure that the adn vhb will become und. Tenofovir to be taken eraly in the morning with no food for a better absorbtion? (I thought it should be taken with meal)
- I should not take vitamin D although it is under the optim value. He thinks it is not the most important parameter? (I thought it was very important to keep the value high around 50 ng/ml)
- I should continue taking sylimarin, vitamin E, ursofalk, omega 3&6? (I thought that these should be avoided during treatment)
- We should look into the posibility to go fo a combo treatment with interferon at some point.
- I should check hbsag every 6 months while taking tenofovir.
I am a bit confused here(just like the doctor, LOL). if you want to maintain a declining HbSag why not continue with Interferon? If you want to maintain undetectable hbvdna, why not just use Tenofovir as the mono therapy in the first place? By starting Tenofovir after stopping Interferon, you will maintain undetectable hbvdna but will it help HbSag to decline further?
yes both doctors are incompetent she should keep intf in the first place since hbsag is around 1000iu/ml or add tdf to it just to boost hbsag decline.actually all other options are not curing or leading to an hbsag decline for sure
Your doctor is very confused! Your hbvdna is <= 20 iu/ml, that is UNDECTABLE!
This is the answer in the medical report:
"hbvdna < 20 ui/ml
- detection limit in linearity range is 20 ui/ml;
- analitical sensitivity = 9 ui/ml
Note that the analyzer indicated a very low value below the lower limit of linearity range"
If hvbdna was und why didn't they simply write und? And what is that analitical sensitivity?
So, why do you need to take Tenofovir???
As Stef also said I need to take Tenofovir to avoid relapsing. If it has any effect on hbsag .... I wish it had, but most probably it doesn't.
I found my doctor a bit more confusing this time.
Anyway I will consider the combo treatment at some point, although it seems that this time I have to pay everything myself or I can wait till I join a clinical trial group, as doctor said.
The following seems to be the best way to go:
- raise vit d > 50 ng (5000ui/day will do?)
- continue interferon and combo with tenofovir (although I stopped interferon for almost 3 weeks now)
- monitor hbsag
or.. it just crossed my mind:
- take tenofovir mono and add on interferon lambda when it will be available. Would this be better?
I've seen the doctor this morning again. I must add that he is considered to be an expert in hepatitis matter. He takes part to all conferences abroad which makes me hope that he is updated....
Although I am always confused after I see him and cooperation seems to be not so positive.
His comments were:
Since I have interleukin 28b genotype T/T he finds it useless to continue interferon because this genotype hardly responds. If it was interleukin 28b genotype C/C and hvb dna genotype A the situation would be different (100% cure with the combo treatment: tenofovir and interferon)
He also added that interleukin genotype T/T can easier lead to HCC and keeping adn hvb und is the best thing to do. Interferon should be used as a back up and added on in case of emergency only: raise in alt, high raise in hbsag, raise in adnhvb.
In the end, a bit irritated from all my questions he insisted that this is the best option for me: tenofovir mono for a non-definite time if things are stable and add on interferon if things get worse.
Is indeed this interleukin 28b genotype T/T such a predictive factor for responders?
The "lucky" ones to carry interleukin 28b genotype T/T have no chance to cure?
Should their goal be only to keep the hvb dna und in order to prevent from HCC?
I cannot continue interferon on my own. I need a good doctor to monitor the course of the treatment....
I think I will give up in hoping for the better.
I agree with stef2011 that IL28B is more useful as a predictor of response to Interferon treatment for HCV,and it is ambiguous in the case of HBV. Unless your doctor is an active researcher in this area, I am skeptical about his conclusion that interferon is useless for hbv patients with IL28B, since in your case, you responded with undetectable hbvdna .
It seems to me you now face 3 possible choices:
1. Start Tenofovir
2. Continue Interferon for another 48 weeks
3. Do nothing, check in 6 months
Personally, I favor no.3 but bear in mind I am not a doctor. I am wondering what country you live in, as youn seemed to have access to qhbsaq and il28b tests.
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