very very good, i will also try it as soon as i get und and on combo tx to be supersafe anyway
please ask him to check his hbsag quantity since alinia acts lowering hbsag and achieving seroconversion this way, if he is also hbe positive he also must check hbe quantity of hbe and of course hbvdna quantity.
since asian people have very high virus quantity and much less immune response than caucasinas against hbv in general he needs to check all those parameters to see if it is working and i would suggest to combo with antiviral tenofovir if he doesn't see hbvdna und in 6 months
the best results are on hbe negative with 100% hbvund and with the highest seroconversion rates within 1 year, combo with an antiviral is needed to achieve the highest seroconversion rates especially with hbe pos
this is very good because i think trials on hbv will take very long time for the following reasons:
- little money, romark is a little pharma company
- little cost of compound and without patent or with low durability of patent
- a big pharma is selling thier compund in japan for hcv and they probably want to avoid damaging each other markets
- probably replicor will have very good results for seroconversion becoming the main drug and leaving little market to other meds
alinia would be the best med for inactive carriers since they have no other tx available, and since they have low hbsag and alinia works lowering it it would be a very good try
if we get to be 3-4 persons with different immune phases (hbe pos, hbe neg, inactive, low hbsag) trying it we can achieve significant data on its potency, i stress again the best candidates are inactive carriers because they have the lowest hbsag quantity and the strongest immune response among hbv cronic carriers
The guy's medical history:
1. HBe positive for a long time (don't know exact time) HBV DNA E-8 alt as normal
2.alt ast>2ULN used Adefovir then DNA decreased to E-6 (within 2 months), then no decrease
3. then stopped Adefovir, began IFN (1 month), no effect (DNA E-6)
4.then Lamivudine, effective, 3 months DNA und
5. then stop Lamivudine, then relapsed
6. then changed to enticavir, DNA und within 8 months
7. now, DNA und, but HBe still positive after taking enticavir for 2 years.
So he was really upset, cause his uncle died of liver cancer, so he added alinia to enticavir, just got started it, so, we'll wait and see. He knows all the knowledge about alinia and blood tests, so don't worry about it. He will take blood tests in three months.
The other guy who is going to begin alinia is resistant to all the tx (except tdf, which can't get from Mainland of China), and he can't use IFN either, those put him in a really dangerous situation, so he is on it (I guess he has already received it and began).
He is HBe positive, dna detected, that's all I know.
I am female, 30, HBe positive, DNA E-9, alt 130, ast 85, I want to try alinia first and see how it works after 3 months, if not effective, then add tdf, if effective, then continue until HBsAg negative.
"We do not have definite plans at this juncture to embark on formal studies of nitazoxanide in the treatment of chronic hepatitis B. However, I am hopeful that sometime later this year we will have the resources to conduct a phase II study using nitazoxanide in the treatment of chronic hepatitis B."
But we can see there are some clinical trials on HCV, flu, so I think we can figure out.
We have to try it ourselves, otherwise, we have to wait at least 3 years
of course consider that being hbe pos with such high hbvdna has very little chance on monotx with alinia so if you don't see any result within 3 month combo with tenofovir, especially to avoid hbv to adapt to it, even though resistance should not be possible.
the first guy is resistant to which antiviral?adefovir and lam?he must add tenofovir if resistant to lam because entecavir doesn't help a lot in this case and even if resistant to adefovir tenofovir still works although less effective.
for the guy who can't have tenofovir, he can order tenofovir generic on this website which is very safe, the name is tenvir, and i do suggest to do it:
prescription is required and this is a real pharmacy with address and phone number, this is also good for those who can't afford tenofovir becuase of high cost.
the generic is produced by cipla and has been approved by FDA for selling outside US since there is a viread patent in US, also HR suggested cipla products some years ago for those who can't afford viread, now they are even FDA approved
i also suggest if possible less stress working and in general and good diet and good sleeping since the immune system will do the job helped by alinia
also check that your vitamin D is at least 50ng/ml, also check zinc level and antiossidants, becuase they have all been found to be low on most hep B patients, so little sun or D supplements and fruits like nuts can help if they are low after checking by blood test.
soluble fiber has also been linked to strong boost of immune system by increasing il4 concentration (il4 is known to lower hbsag), soluble fiber is in fresh oranges, nuts, apples, strawberries and i don't know the name of this in english bread and pasta with the full wheat
the first guy isn't resistant to any antiviral. He switched to enticavir for avoding resistance, you can see that he responded to lam very well, but his doctor stupidly suggested him to stop it after DNA und. So for safety, he turned to enticavir.
I'll buy Vit D and take B-50, I would rather to take them directly than do blood tests, that will cost me much and I can feel that I absolutly lack Vit D.
I am not so cautious as you, I don't think resistance to alinia is a problem. So I'll give it a shot. Plus, I have a brother, he has HBV, HBe +, DNA E-6, alt ast normal. If I succeed, that will help him. My father had HBV (from his mother), and he recovered automatically at his 50's (we don't know the exact time, cause he never take annul physical test) .
this is a real pharmacy to buy online or in the shop, it is in swiss, alinia from romark (not genreics) is about 109euro here
prescription is not required here for alinia since it is a very safe med even for baby 1 yo
before starting alinia it is ery important to have quantification of hbsag in iu/ml, today i spoke with a researcher and he said that baseline quantity is the most important and after tx is started recheck at the 6th month, if there is a decline of at least 1 log and it is continuous the tx is working.
the link is easy, hbsag is produced by cccdna in the liver cells so a decline of hbsag is a decline of cccdna.
cccdna is the template of the virus that aloows persistent infection in the liver, getting rid of cccdna is getting rid of hbv.quantification by s/n is not usefull for this
"before starting alinia it is ery important to have quantification of hbsag in iu/ml".
I knew that but my doctor refused to prescribe that test for me, he thinks DNA is enough. Given our different situations, I think DNA is enough for me until DNA und, after that, I should keep an eye on quatifications of hbsag and hbeag. I am in America now.
Thanks for your link. That website alinia is more expensive and reliable than generic. If I can find a generic alinia in America, that'll be great. Because I am still a student and pay by myself.
The two guys are keeping an eye on the quatification, so don't worry about it.
your doctor is of course very ignorant on this matter, that is the most important test.......maurizia brunetto is the researcher who studied this (you can google it to find studies), she has also discovered the precore mutant hbeag minus among other discoveries.
again it is very important to do the test before starting so you can see what is lowering hsag and how and if you are gaining immune control, for example the researcher in pisa asked me to check if the labs have my blood samples from 4 months ago before starting etv so that they can check everything starting before tx, but if it is really expensive skip that
that really a pity in USA you don't have control over your health for free, hope obama will change this (i pay zero in my hometown and about 7usd in pisa research center for hbsag and all other tests, everyone should be allowed to make all blood tests dispite money)
please see links below and how hbv works and what is the meaning of cccdna linked to hbsag in a picture i got from a conference, from there you can see that if we have an hbsag decline we know that cccdna is declining and eradication is getting closer.
hbvdna doesn't tell anything about immune control and eradication of hbv from liver cells, it just says replication of the virus is less but of course having hbvdna und doesn't mean there is no replication, and even worst cccdna replicating in the liver has almost no link with hbvdna.so hbsag, hbvdna, hbe, alt/ast, they all need to be quantified at a specialized lab.
our history is hbv spread from birth.
i have a good immune response and had inactive disease most of my life with hbe conversion at 19yo (before 19yo it was hbe neg, hbeab neg, dna neg, normal alt) which leads to complications of cirrhosis/cancer about only 3%.
having a good immune response is linked to having very alt flares like acute hepatitis, 1000 to up for many months with very low hbvdna, this is the immune system attaking the virus.if hbvdna is high during flares it is not immune system but the contrary it is virus attaking the liver.these flares are followed by hbvdna und or very low and alt/ast normal or almost normal.this state is also linked to a low hbsag.
all this means the immune system can see cccdna inside liver cells and kill them, this should lead to eradication of hbv but it is believed that over production of hbsag blocks the immune response and keeps hbv cronic.
my sister made interferon at about 22yo and made hbeab, this has lead to an inactive hbv until now (she s about 35yo)
hbvdna 300000iu/ml,hbsag 320S/N (about like mine), normal alt according to old range
i started etv because of my age and because i felt it was time to start a tx, but all researchers did not agree with my doctor's choice to start antiviral, since my active immune response they all prefered interferon, but that was not a choice anyway because have seen interferon on my sister and mother and it wasn't an easy thing on them.
the researcher in pisa said to keep etv anyway and see if my hbsag goes down and clears, they said we must check before tx and then after 6 months so they know if i am in the 5% who clears on etv or get immune control and can stop it and then try interferon.they don't agree on combo because mutation should not be an issue in my situation.i don't agree on interferon and prefer to try alinia but with thier control on hbsag, hbvdna by week and only after etv has safely lower hbsag and hbvdna more than und
anyway everything will be clear after i receive all hbs quantifications by the end of the month/early april
on april i will also know my liver damage because can retry fibroscan after 5 months away from the flares
of course all my explanation is not linked to cronic hbv with high hbvdna and low alt in the range of 200-300, in this case the immune system cannot see cccdna inside liver cells and eradication is not possible at the moment.
another good suggestion is start tx as i did with high alt flare with low hbvdna if it ever happens because this can lead to eradication or to good response to tx
Thanks for your links about hbsag. My doctor didn't agree that test, and I thought it would be very high anyway, because my DNA was almost the upper bound of the test.
And I also read some articles about hbsag, hbeag monitoring the process of responce.
Now my big issue is that my alinia (from http://www.wisemeds.net/buy_online/Nitarid.shtml) seems disappeared, it's been 14 days, I haven't got it. I have to find a new pharmacy which doesn't require a prescription to order.
For me, cost is a big issue, every month, I pay 200$ for insurance, but if I take tenovofir, I have to pay another 200$ for it, and 20% for the tests.
well no you need both, if you have to choose between the two start with hbvdna which is the first to be affected altogether with alt
3 months is ok after this period you might choose if to keep it or combo with antiviral according to the potency of result
in the first studies i have posted on links it required 1 year for seroconversion so even if you see little result keep taking it, in your case hbe ag decline is the parameter that will tell you the time of seroconversion to hbab.
if you see etv and tdf studies they take 24-48weeks on most people just to have hbv und and for others take more than 1 year so alinia looks more potent anyway
no just check hbsag possibly with iu/ml unit for 5-10 years
use alinia only if it starts to increase or if you see people clearing hbv from alinia from posts here, if hbsag keeps decreasing or steady at very low level you can just monitor and have nothing to worry about
please share sides, me and cherry are trying to understand best high dosage
from hcv combo trial they used a maximum dasage of 2700mg/day and a minimum 500mg/day (the high dosage is on a slow release tablet), on the 2700mg/day the result is 100% hcv und in a short time and in the 500mg it is about 63% it is a huge difference.
on alinia trials they used 1g,2g and 4g without anysides but unfortunately they made this trial for short time
yes I am on the etv-alinia combo now;
0.5 mg etv and 500mg*2 alinia everyday;
I have used etv for 2 years, dna is und when on etv for 8 months
the hbe 2009-02 is 169 s/co and
2009-08 is 12 s/co 2010-02-15 is 4.37 s/co;
I start to alinia 500mg*2 from 2010-03-01
Hoping that ,the alinia will cut short my hbv curing lasting time
Chery give me a lot reports about drugs knowleage and alinia, I also think the
best dosage will higher than 500mg*2; but i am not change the dosage
At first my alt ast is about 190 120; the hbvdna is 8 log;
then i used adv for 11 month ,the hbvdna is up and down between 5-6 log
then interferon for 5 months, in the middle 3 months ,I also used lam for 3
month; in the second month adding lam,the hbvdna change to und;
when stop the lam for 1 month,the dna increase to 6 log;
and then start to etv ; one month on etv ,the hbvdna change from 6 log to 3
log and this state last 8 month;and then und;
you are clearly close to hbe negative, hope alinia will help on this in a couple of months
please let me know of your hbe count at 1 one month of alinia so that we know etv and alinia can work in synergy
i will be starting at the end of the month because after 4 month on etv hbv is not und yet, if i see ther eis synegy from you i will start directly on the 2g daily dose otherwise i will use the 1g daily dose
tdf+ftc should be the best combo because etv has very low rates of seroconversion but at this point we are on etv so we better keep it.
if we see an hbsag decline to 1-2log in the future we might add this combo since we are sure to go hbs neg.
i have also found reports on antivirals active against cccdna:
ftc is the only one with a decline of 50% of cccdna
tenofovir, i haven't found any study on cccdna
etv, they say it doesn't eradicate cccdna but they didn't say if it is active or not
all other antivirals have no strong influence on cccdna
at this point we should find something on tenofovir and etv related to cccdna, next week i will talk to one close to pisa researchers and i will try to ask him, when i asked about tdf+etv combo he said tdf+ftc is much better
well it is different for anybody but it will be wihin one year for sure, on monotherapy it took from as little as 12 weeks to 1 year,
since their hbe was very high and yours is very low thanks to etv i would say within 6 months, it might took long only if synergy with etv fails
found a study with high dosage, started at 1g/day and if needed moved at 2g/day or 4g/day.
they use is reported as indefinitely when people got relapse when stopping therapy.the study is on Cryptosporidial Diarrhea (alinia is active against many viruses and parasites, flu, hcv and hbv are among the many ones)
so if needed we can move to higher doses quite safely as they are doing on hcv trial (the most active dose was 2700mg/day) taking it with food which henance absorption.
So we can take 500mg every 12hr for the 1g a day, every 6hr for the 2g a day and so on.the maximum dose tried has been 4g/day but i would stop at the hcv trial maximum dose.
then we lower only if we get the mild sides of this med which are reported in very low percentage and very mild (abdominal pain and mild diarrhea).
hcv trial link page 28 results on 2700mg/day slow release tablet:
another article about doses, doses up to 4g/day have been found safe but on these high doses there are more episodes of sides like abdominal pain or diarrea but sides have not been so severe to lead to discontinuation of drug.
no i just take supplments and then check that blood level is in range, i know selenium is toxic if that is out of range
there is a research on selenium supplements made on a huge number of people for 4-5years at 0.2mg per day and it lowered liver cancer rates when they stopped liver cancer rate returned to normal.
0.2mg is very little so you don't get out of range but in anycase i check for everything by blood tests otherwise there is no points in these supplementation.
all the supplments i take are extracted from natural sources or diet (very expensive...) and this is very important because synthetic supplements are not proven to make any good, i do not suggest supplements from artificial sources.
vitamin D is now from the sun since in my area we have very strong sun from mid april to october (15min sun gets more than needed vitamin D)
we are still on first weeks of therapy but we have had some little results already, although i would wait for 12-24weeks to say.
only one hbe pos have had a big result already, seroconverted to hbe neg and hbeab pos in 3 weeks
alinia works by pkr and eiF2 alpha phosphorylation which blocks cell viral antigens production hbsag and hbeag, of course we don't know the potency of this action, the best results are on time release tablets at 2700mg per day which avoid side at this high dosage but these are available only on hcv trial and not marketed yet.
i have tried 1500mg per day on normal alinia tablet for one week but lowered to normal dosage 1000mg per day since i felt some change on stools even if had no diarrhea or other sides.manufaturer told us that over 1000mg per day there is diarrhea possibility increased
alinia can also kill our intestinal bacteria like antibiotics and cause diarrhea so it is better to stay on normal dosage 1000mg/day and use probiotics
i wouldn't use it during pregnancy even if this drug is so safe that it can be used on 1yo babies
Pregnancy: Teratogenic Effects
Pregnancy Category B: Reproduction studies have been performed at doses up to 3200 mg/kg/day in rats (approximately 26 times the clinical adult dose adjusted for body surface area) and 100 mg/kg/day in rabbits (approximately 2 times the clinical adult dose adjusted for surface area) and have revealed no evidence of impaired fertility or harm to the fetus due to nitazoxanide. There are, however, no adequate and well-controlled studies in pregnant women.
forgot to mention tenvir and tenofovir have exactly the same ingredient but if you have to choose between alinia and tenofovir during pregnancy i would go for alinia.
they are both category B but tenofovir can have very heavy sides although rare, alinia's most heavy side is diarrhea which is nothing compared to tenofovir sides, plus tenofovir cannot be used on babie while alinia has been made especially as a cure for babies diarrhea and diarrhea on aids patients (they just noticed alinia wroks on hcv and hbv from hiv coinfected with hbv-hcv)
Very interesting. My doctor said it is ok to use Tenofovir during pregnancy. Also, there is an AntiRetroviral Pregnancy international Registry to report any birth defects or anomalies. There are no anomalies. Many HIV and HBV carriers reported pregnancy during tx with Tenof but no higher (than normal) birth defects have been recorded.Tenof is also classified Category B.
See this report:
interesting report of a coinfected hcv-hbv who was on trial for hcv for 24 weeks, in this trial there were also patients with mildly decompensated cirrhosis that proved alinia to be safe even in this catergory.
the coinfected had hbvdna at about 1000copies/ml which got und at first visit at 4 weeks (so it could have been und even before), too bad the study was on hcv so there is no hbe and hbs antigen quantification.
alinia monotherapy is very weak on hcv and results were very little, on the contrary on hbv even monotherapy looks very potent and safe.
we also have the sixth person, my sister will start alinia monotherapy today.
this way we have all types of examples since aisan and caucasians have different immune system response, different hbvdna values and in general different genotypes (asians respond less to therapies and caucasians easier):
me and my sister caucasians, genotypes A or D which usually have lower hbsag, lower hbvdna and hbe negative/hbeab positive.i am combo with etv and my sister monotherapy.
the other patients are asians with very high hbvdna and hbsag and hbe positive, in this case the response will be probably slower and will need combo with antivirals to lower hbvdna faster.
some are already combo with etv and other monotherapy, the main step of asians is to seroconvert to hbe neg and hbeab pos, this way hbsag and hbvdna will get very low and hbsag seroconversion can be theorically achieved
I want to stop tenof for cost reasons and because my dr never mentioned it was a contract for life! what is the best strategy considering Alinia?
How easily did you get Alinia prescribed off-label? What if I use it in Combo with tenof for 1 year and then stop?
you can start combo with tenofovir or tenvir and then after you are hbvdna und and alt normal you must get hbsag quantification, if you have a decline of hbsag until values lower than 200 s/n or lower than 1000iu/ml it means that you have immune control, if you see a continuous decline stop only after hbsab are formed and keep alinia for another 5-6months
if you see that hbsag is steady and doesn't decrease you can combo for one year and then use only alinia.alinia works on immune system so theoretically after you reach a low hbsag you should be able to safely stop it but we are waiting for an answer from manufacturer about this
chances of hbsag seroconversion on combo with antiviral should be high especially if you are hbe neg and hbsag quantity low
- HbeAg Negative, HbeAB positive
- I asked dr about calculating hbsag quantity, he said we do not do this in Canada!!
- Virus is undetectable after 3 months of Tenof (initially 59000UI/ml.
- ALT has been around 30 since many years, never more than that but according to Dr, it is still high as the new upper limit is 19 for women. Labs display wrong normal ranges (up to 40), I have been ALT around19 when I was maybe 25 or 26 but I am 37 now.
- Fibrosis stage F1. Thanks.
hbsag quantity is very important, without it there is no way to see results after you are und, you need to find a good lab to make it, it is impossible you don't have it in canada
in italy is everywhere, at the moment it is essential to see if interferon works so even in canada they must have it where they do interferon therapy.
the kits for hbsag quantification are made by abbott in US, i have seen people from third world countries with this test so you doctor is probably not aware of specialized labs in canada
the second guy's DNA has decreased 1 log again, very good, i don't remember if that's second or third week
as to me i have checked only alt at second week and they are the same as before, still at 45, they get normal when hbvdna gets und, my hbvdna was about 200iu/ml ( 1160copies/ml) early march i hope to find it und in 4 weeks alinia therapy
etv has had an homogeneous hbvdna decrease at 0,5log per month from 15 dec 2009 so it will be easy to see if alinia will boost response (if i kept etv monotherapy hbvdna und was for july or august).
cherrynancy found the data about 2 cases, one monotherapy and one combo with adv failure (patient also had lam failure).
one hbeag pos with 5log iu/ml hbvdna and one with very high viral load 6log iu/ml who had no results on lam or adv (the article doesn't say about resistance to lam or adv), both seroconverted to hbsab antibody in 2 years.
i hope we can also find all data about the 8 hbeag negative monotherapy cases which gave better results compared to the hbe positive cases
also data about the 4 hbe pos cases on monotherpy.
60yo, lam and adv no response, HBeAg-positive
NTZ 1g/day+adv, when ntz was added to adv hbvdna 8,380,000 IU/mL and ALT was 82 IU/L.adv+ntz for 2 years
after 1 year HBV DNA 71000iu/ml, ALT 61iu/l
after 2 years HBV DNA undetectable, ALT was 19 IU/L, and HBeAg and HBsAg were negative.
17yo, HbeAg-positive, HBV DNA 310,000 copies/mL, ALT 25 IU/mL, grade
3/18 inflammation and stage 1/6 fibrosis on biopsy.
NTZ 1g/day through month 5, was off treatment for 3 months secondary to
elevated ALT levels, and then was treated with 500 mg/d through month
undetectable HBV DNA at month 13, negative HBeAg at month 12, and negative HBsAg at month 21.
i have found another case report on lam resistant strain and high viral load 6log copies.only 4 weeks to get hbeab positive and 8 weeks for hbvdna und and normal alt, discontinuation after only 24 weeks and follow up for other 24 weeks:
T1852. Nitazoxanide in Treating Chronic Hepatitis B: In vitro Activity and a Clinical Case Report
J. Rossignol; B. E. Korba; S. M. Kabil
Nitazoxanide is an anti-infective drug from a new class called the thiazolides. It is marketed in the United States for treating gastroenteritis caused by Cryptosporidium parvum and Giardia lamblia and is in late stages of development for treating Clostridium difficile-associated disease. Based on earlier screening suggesting antiviral properties of the thiazolides, we tested nitazoxanide and its active circulating metabolite, tizoxanide, against hepatitis B virus in cell cultures. We also report the results of a patient with chronic hepatitis B treated with nitazoxanide after previously failing a long course of lamivudine.
Nitazoxanide, tizoxanide and lamivudine were evaluated for activity against hepatitis B virus in 2.2.15 cell cultures. A 48 year-old Egyptian male with chronic hepatitis B refractory to lamivudine was treated with nitazoxanide. He was HBeAg-positive before treatment with a viral load of 5,250,000 copies per mm3 and ALT of 53. Nitazoxanide was administered by oral route, 500 mg twice daily with food for 24 weeks, and the patient was evaluated every 4 weeks during treatment. Evaluations included physical examination, laboratory safety tests and RT PCR for quantitation of HBV DNA.
Further in vitro experiments showed that nitazoxanide suppressed HBeAg and HBsAg suggesting a mechanism of action that differs from other antiviral drugs. The patient treated with nitazoxanide was HBeAb-positive after 4 weeks of treatment with a 2 log10 reduction of viral load (51,000 copies per mm3 down from 5,250,000 at baseline) and a slight increase in ALT (60 up from 53 at baseline). At weeks 8, 12, 16, 20 and 24, he was HBeAg-negative with undetectable serum HBV DNA and normal ALT. No significant adverse events have been reported. The patient discontinued treatment after 24 weeks and is being followed up for 24 weeks to evaluate the duration of response.
Our results suggest that nitazoxanide is effective in treating chronic hepatitis B with a mechanism of action that differs from traditional antiviral drugs. A double-blind placebo-controlled study is being conducted to evaluate the role of nitazoxanide in treating patients with chronic hepatitis B.
i only wish i had started with alinia instead of etv.
this is very good for a etv/alinia comparison since me and my sister have same baseline values:
same genotype D and same hbe negative hbeab postive, same hbvdna load at 5 logs iu/ml, same hbsag quantity at 2 log s/n
we can have only different muations since she made hbeab positive by interferon so she can have wild type, i have precore e-minus hbv
me: etv took me 4 months to get to less than 300iu/ml
my sister: alinia took about 3 weeks to get to less than 300iu/ml
i cannot stop i have cirrohosis, i'd keep it even if i make hbsab for at least one year, just for mega security
i am just happy i started ntz as i received it because today i recevied hbv genome and i have a natural mutation with reduced response to lam and adv (it is not lam/adv resistance mutation), ntz puts me in a safer condition anyway since is active against hbv mutants
the only way to know what happens and how slow is the relapse is hbsag or cccdna quantity, if you reach a level of 500iu/ml there is immune control so relapse should be very slow
in 1-2 weeks we should have data from another guy on hbe negative hbv, if he is already negative we can say that ntz is very active and fast on hbe negative and viral loads lower than 5logs iu/ml (this also reflects first clinical data)
she means if she can stop alinia without hbsab seroconversion and if alt or hbvdna relapse with high flare
it all depends on immune response and the more cccdna and hbsag the more immune response is suppressed.Since alinia is active lowering hbsag and cccdna the relapse should be very low or no relapse
in your case you have nothing to worry since you have started with inactive hbv with very low hbvdna so if you stop before hbs seroconversion the worst you can get is go back to pretreatment situation
too bad you cannot check hbsag, you are the one with the lowest value baseline since you were inactive so you should have the fastest results in decline in theory
The stupid labs here do only a qualitative verification, they just tell you if it is HBsAg is positive or negative. I just met yesterday with the other doctor. She is basically saying that guidelines changes since few years and that many people in the mediterranean area have HbeAg Neg because the Virus has mutate and doesn'T express Hbe replication properly...So she concluded, the decision of starting the treatment was good and I asked her if I could stop if because I may not be able to afford the cost for TNF, she said you can, the worst case scenario would be that you would be back to the initial state which is still good (F1 and not so high viral load and ALT) and she was very reassuring regarding there would be new medications, etc. I really like her, she seems very human compared to my 1st dr.
I also asked her about Alinia, she said this may cause tolerance issues, she was googling it and she got medhelp forums hehehe. She added that she can not prescribe something not yet approved by Canada and FDA for HepB and they seem to be in phase 2 studies for Alinia Hep B.
Yeah, I don't know what to do to have an idea on my HBsAg. I may try to ask a dr in another province and see what he says.
I am very happy for you Stefano. I wish the drop will continue until zero. I will pray for you.
thank you, in your case i'd start combo instead of stopping complitely if your hbe is negative, but if you are still hbe positive results are not so fast
alinia has no tollerance issues and no mutations so it is safer than nucs, i wouldn't have been so mad to check carefully what is known about the drug and start something dangerous on cirrhosis but your doc is abolutely right prescribing off label can be legally dangerous for a doctor.if you are not in a rush just follow our trial and see results
hbe negative is good wehter wild type or precore.the mutation is due to immune system pressure the virus stops hbe production so it can keep replicating although at low level.
precore is found everywhere but in genotype D and mediterranean area is the predominant form of hbv (maybe the genotype or maybe immune strength)
precore is not the only mutation, if you have seen my other posts i have about 5 mutations, these mutations can make hbv much weaker since it did mutations in order to keep replication but they can also be dangerous in the case the mutation makes resistance to nucs so it is very very important to check the mutations before starting nucs
for example i have a secondary natural mutation which makes lam and adv less potent andlead easily to resistance, if i had started those without a genome check in previous years now i would have no therapy since lam and adv resistance mutations make all drug useless
i bet you didn't have hbv genome check before starting tdf, although rare these resistance mutations are found in as high as 10% naive patients
as to hbsag i would check carefully at research center university or hospitals, where they make research they must have it, anyway don't expect to see big drops in short time tenofovir and entecavir have about 1 log decline per year on 17% patients only and on hbe positive only
actually hbsag is essential on interferon which can have 1-3 logs drops hbsag and alinia, less usefull on nucs, probably us and canada use nucs so they don't use hbsag quantity
anyway on tdf you are safe since there are no resistance muattions detected until now only reduced response on some mutations that you cannot have since hbv und already
i do suggest hbv genome test to everyone before starting nucs therapy where available:
in my case the rtQ215S mutation present as >20% hbv population, happened naive and not very rare on genotype D, have lowered response on lam and adv although not resistance, theoretically lowered response <10 folds on tdf but this lowered response have never been confirmed in vivo, so etv was the best nuc choice since rtQ215S doesn,'t reduce or lead to any resistance on etv
let's hope for hbsag drop to keep like this, doctor said to check every month and if it reaches 1 log decline it will probably keep going down to seroconversion although there is no 100% prediction until hbsag reaches 10iu/ml and no time prediction to seroconversion
theoretically the big drop should keep going on until and after hbvdna negative so that's good drop started before hbvdna und, on the other hand flares less than 1 log can happen so let's hope for the best, i will recheck at 12 weeks therapy since i already made 8 week test for hbvdna, alt, genome mutations
No I never did a genome checkup before starting on TDF and although I am Hbe Neg since a long time I don't know which genotype I am. I am also from the mediterranean area so big chances are that I would be genotype D as it is predominating in all the mediterranean.
I would definitely go with a combo tdf + alinia after baby will be born. Right now, I just do 3 months checkups on dna and ALT. I guess you are right, in north America, they seem to prefer using Nucs so they don't prescribe any genome checkups or HBsAg quantitative checkups. That is really bad.
Thanks for all the info. I will spend sometime reading your posts and trying to understand all of them and do my research :)
8 weeks alinia (ntz) combo with entecavir, hbvdna und (it is the 8th week of ntz and the 6th month of etv), about one week later alt are getting to high normal range 37 and decreasing
hbsag update on the 12th week (10-14th june)
2nd guy in the gruop, asian:
13th week ntz mono, hbsag drop from 16000iu/ml to 14000iu/ml, hbsab antibody from o to 0.4iu/ml
hbe seroconversion at 3rd week - hbe negative and hbeab positive
hbvdna from 2.70E7 copies/ml to 1.9E6 copies/ml
alt from 52 to 77
i strongly suggested to start tnf combo because ntz is not potent enough on high hbvdna loads, still on mono ntz
5th guy in the group, asian:
LAM, TNF, NTZ - adv resistance-hbe positive (ntz will work on lam and adv resistance)
hbvdna from 1.4E3 to <1000copies/ml
unfortunately tests are old so we don't know hbvdna quantity less than 1000
also hbsag and hbeag are made with s/n and s/co unit so are not reliable for quantification, hope this guy will be able to make tests in iu/ml for hbvdna-hbsag-hbeag
the guy is not very happy but with adv resistance getting hbvdna to und is very very important
Stefano...thanks for posting update of the Alinia group. However the result is not looking that bad and congrats you now got to UND with ur DNA result and for the second guy with mono, was he hbeag positive and hbeab negative before ntz ? Didnt really get that and its like ntz works faster or better on low DNA and hbeab positive, am right ? ALT going up while on ntz guess is a concern or not ? when should it be expected to normalized ?
was he hbeag positive and hbeab negative before ntz? yes
ntz works faster or better on low DNA and hbeab positive, am right ?
absolutely yes.it has different cellular pathways to low antigens and to low hbvdna, but it works similar to normal immune system which lowers hbvdna by lowering antigens.hbvdna is low positive often even after acute hbv recovery and hbsab positive
ALT going up while on ntz guess is a concern or not ?
no it is a goos sign but hbvdna must be lowering
Hbsag 4482 iu/ml two month ago is 4642 iu/ml
Hbeag 3.29 s/co 1.0 is und , tow months ago is 1.53 s/co ,three months ago is 1.68 s/co
change to this:
Hbsag 4482 iu/ml two months ago is 4642 iu/ml
Hbeag 3.29 s/co less than 1.0 is und two months ago is 3.84 s/co ,three months ago is 4.73 s/co
Hbeab 1.68 s/co greater than 1.0 is und two months ago is 1.53 s/co ,three months ago is 1.68 s/co
yes, also consider than i have staggered 500mg X 3 X day april (one week 1g the other 1,5g)
may 500mg X 2 X day since 23rd when i recevied the hbsag drop so i switched back to 1,5g (3pills)
now i am continuously on 500mg X 3X day (3 pills per day), so i suggest to everybody who is having response to use 3 pills per day not two
alinia affects bacteria in the stomach like antibiotic so it is better to take antibiotic resistant bacteria (i use 6caps of enterogermina from sanofi aventis, maybe different name in other countries, http://www.galenotech.org/erborist/Enterogermina.pdf), this prevents diarrea sides and i feel i might even switch to 4 pills per day but being on cirrhosis i prefer to keep the lower dosage.
normal dosage 1000mg per day with food, best results dosage without diarrea 1500mg per day, best results dosage but with diarrea 2700mg
i am happy about your results, we have seen that ntz is very slow on hbe positive but still decreasing hbsag, i guess when you get hbe negative you should go very fast on hbsag drop
on the hbe positive trials the seroconversion hbe negative happened after 3 months for all patients so i do hope you are close to it, if you can take probiotics and had no diarrea till now, try the 3 pills per day
today i emailed to the second guy in the group and he updated me about his situation:
his hbsab antibody has become positive at 4.03 so it is definitely positive and hbsag droped from 16000 to 14000iu/ml but he used ntz 3pills per day for two weeks and 4 pills per day for two weeks, on the two pills per day he had no effect on hbsag on previous month but had hbe seroconversion and 2 log drop of hbvdna
since i had a big drop of hbsag on the 3 pills per day dose too i think that this is the best dose for a big drop of hbsag not the two pills per day
i will try to increase to 4 pills per day too since i am perfectly ok on the 3 pills per day dose and will see hbsag in 2 weeks and hbsab antibody which is always been 0.00mUI/ml for me
i will also check if alt gets lower than 20 by ntz 4 pills per day which is 2000mg per day
by the way i was also reading yesterday the trials of ntz on hiv patients with a parassite which made diarrea (a trial held in a new york hospital for fda approval of ntz many years ago) and the doctor said that he prefered the 2000mg dose instead of the 1000mg because results were better and there were no sides
these are his tests, considering he is asian, started hbe positive high and hbvdna still 6log i think this result suggests to try this dose on hbe negative and hbvdna und: HBsAb 4.03 mIU/mL 0-10
this is not a protective antibody because less than 10 is useless but still a low positive according to me
about his situation i think he must get und by tenofovir otherwise the process will be very slow or steady on hbe and hbeab and especially hbvdna
i found this article on the meaning of hbsab very low and of course the situation is very different, hbvdna und, hbe negative and hcv coinfection but i think this shows that a very low hbsab titer can have a meaning in some cases and can go up (at least much better 4 than 0.00mIU/ml)
anyway let's wait to see if anything happens on the hbe complitely negative and high hbeab, hbvdna und on this 2g daily dose
The new guy is now hbeab positive (seroconventioned with ENT, and continuing with Adf), DNA und, alt normal.
Cherrynancy and dddpppbox know him probably in that they are publishing news in the same chinese hbv forum.
it just came up to my mind that replicor compond have a similar way of action, it first makes hbsab appear and then makes reduction of hbsag
all drugs and natural recovery work different, they all make the antigens negative first and after you see the antibodies to appear.
i do hope that 2g dose makes hbsab>10mIU/ml to the second guy and other people so that we can assume that ntz and replicor rep9 AC have similar way of action complitely different from other drugs and natural recovery.
Interim data on the efficacy of the amphipathic DNA polymer REP 9AC in the treatment of chronic hepatitis B in 6 patients will be presented. Interim results will show that REP 9AC treatment rapidly leads to the detection of anti-HBsAg antibodies and the reduction and or clearance of serum HBsAg within the first 12 weeks of treatment in human patients. These findings are associated with substantial and sustained reductions in serum HBV titers which may be due to an improved immune response to the infection. This is exemplified by the first patient who had 2,000,000 copies of the virus / ml in his blood, was then treated for a total of 23 weeks and who has so far maintained a sustained virologic response (<70 copies of the virus / ml in his blood) for a period of 6 months off treatment.
for those who have no idea of importance of hbsag reductions during therapy i have posted 2 graphics from locarnini presentation that shows hbsag/cccdna correlation and hbsag/intraepatic hbvdna and serum hbvdna
not only you all hbe positive are less sensitive and since you are already und you see result only on antigens but when hbe become negative you will go faster
hbe positive means having much higer cccdna and mcuh immune system suppression from both hbe and hbsag
anyway cherrynancy contacted ntz producers and those who are making the hcv trials and ntz is very safe at 2g, there is only some people who has diarrea on this dosage but for those without any diarrea this dosage is much better
try one month of 2g daily and then check results, use also probiotics to prevent diaarea although who tried the 2g had no diarrea even without probiotics