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comment needed for f3 hbv (hbeag became negative) patient please


Dear All,

My mum was diagnosed cirrhosis. 6 months ago I posted a question about it thanks to stef2011 I had some advises. her situation is changed.
http://www.medhelp.org/posts/Hepatitis-B/cirrhosis-diag---help-and-advice-needed-for-reading-results-/show/2047474#post_9686062

Below is the story. I am worrying about the strategy that her doctor following at the moment.
I need your advises. She was using entecavir 0.5.
After 6 month with entecavir 0.5, her hbeag became negative and her doctor
Increased entecavir to 1mg instead of combining with tenofovir.

I appreciate a lot, please if you can have a look and answer my questions in regard to her results.

1/ do you think increasing entecavir to 1mg is a good idea? (what should we expect? Or how can we understand increasing to 1mg works?)

2/ what exactly means that hbeag became (-)? Is virus mutated and hbvdna is not representing number of virus anymore?

3/ hbvdna seems going down but not still undetectable is it a bad sign?

4/ since she is f3 and not f4, would interferon be useful for her? Or let me ask if q hbsag is lower than 1000 would she still be able start interferon?
(I know I need info of q hbsag and genotype but in turkey they do not check :(  that I am now trying to find a lab to know)

5/ any advices ?

historical info;

4th november 2013 ====> started entekavir 0.5
hbv-dna=1020000 IU/ml
alt 40 U/L (ref 33)
ast 51 U/L (ref 32)
hbeag +

27th november 2013
hbv-dna=16400 IU/ml
alt 22 U/L (ref 33)
ast 25 U/L (ref 32)
hbeag +

17 december 2013
Fibroscan median 10.5 kpa (206 db/m  ====> F3 diagnosed!!!!)

27 february 2014
Hbv-dna = 696 iu/ml
Alt 26
Ast 21
hbeag +

04 april 2014
Alt 19
Ast 24
hbeag  grey zone
Antihbe grey zone

30april 2014  =====> entecavir incremented to 1 mg :(
Hbv-dna = 696 iu/ml
Alt 26
Ast 21
hbeag (-) ===> became negative
Hbeab (+)

P.s: she did not start vitd3 and gmcaf yet, she lives in Mediterranean region of turkey there are a lot of sun + she follows diet (berry fruit etc) ; fresh vegy, fruits etc, walking 2 times a day.

Thanks in advance!
halit
Best Answer
Avatar universal
if hbvdna 75iu/ml keep etv 1mg and check that it gets undetectable.no need of tdf add on at all

do check hbsag as soon as possible, when hbeag gets negative hbsag should be very low around 1500iu/ml
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Avatar universal
cirrhosis can have damaged kidneys, always keep an eye on kidneys.with vit d kidneys work more and better

there is also a problem with the liver which is damaged and cannot convert vit d so higher doses are needed.if 25.000iu cannot get vitd25oh to 100ng/ml you have to double the dose.vit d will be also beneficial for the liver
Helpful - 0
Avatar universal
due to high pth I was a bit worried what if she has ' Parathyroid Disease'

hbvers have all high pth, the worst the infection the higher pth.inactive carriers have the lowest pth and the highest vitd25oh without supplements
Helpful - 0
Avatar universal
thanks for rapid response!
due to high pth I was a bit worried what if she has ' Parathyroid Disease' or sth.

please find the translation below.

vitd3(25oh) 74,6 ng/mL
serum ca    9.6
ionized ca  1.25 mmoI/L
nCa (based on ph 7.4) 1.11 mmoI/L (according lab she normal range is 1.12-1.32)
blood ph 7.16 (according lab she normal range is 7.35-7.45)

creatinin (spot urine) 58  mg/dL
calcium (spot urine) 13,3 mg/dL
calcium/creatin (spot urine) 0.23
parathormon (pth) intact 66 pg/mL (according lab she normal range is 10.0-65.0)

she was diagnosed chirrosis due to hepb
she was using etv 0,5mg. her doctor first increased usage to 1mg
and then her doctor decided to move tdf instead of etv,

this forum tread was opened for her results
please see above her earlier results

here I post historical list again

4/11/2013 hbvdna 1020000 iu/ml -> etv 0,5mg started
27/11/2013 hbvdna 16400 iu/ml
17/12/2013 fibroscan 10,5 kpa (f3 diagnosed)
27/02/2014 hbvdna 696 iu/ml
04/04/2014 hbeag grey zone
30/04/2014 hbvdna 75 iu/ml -> etv 1mg started
30/04/2014 hbeag (-) negative
10/05/2014 vitd(25OH) 8.1 ng/ml -> vitd started
10/05/2014 hbsag (kantitatif) 8313 IU/mL
29/05/2014 hbvdna 48 iu/ml
04/07/2014 hbeag (-) negative
04/07/2014 hbvdna (-) negative
25/08/2014 hbeag (-) negative
25/08/2014 hbvdna 20 iu/ml
19/09/2014 HBsAg (Kantitatif) 7965 IU/mL
16/09/2014 vitd(25OH) 39,6 ng/ml

Helpful - 0
Avatar universal
no she has to increase vit d 3 more, the higher vit d3 the lower pth. pth is still too high and this means she is taking calcium from bones

is she hbv carrier?

please translate all tests, but anyway they are all good despite pth too high.

also make her drink 2.5l of water daily and no dairies
Helpful - 0
Avatar universal
idrar means urine
Helpful - 0
Avatar universal
Stef,
my mum uses 25000 ui/ml vitd per day approximetely since 1,5 months

based on your advises I asked her to do a blood check for pth and calcium

pth is 66 pg/ml!

can you please check URL
http://i62.tinypic.com/ibyntv.jpg

is she in danger? should we go to doctor ? (I am sure they will say stop vitd immediately)

should she decrease use of vitd?

thanks for your advises.
Helpful - 0
Avatar universal
Don't worry, less virus better for liver. Fortunately the liver is the only human organ that regenerates itself.
Helpful - 0
9624973 tn?1413016130
from my understanding, the imune system kills the infected cells, so when the hbsag and hbvdna goes down, the liver cells are under attack and the fibrosis is rising
Helpful - 0
Avatar universal
I am just curious how come her Hbsag level and hbvdna level decrease but fibrosis increase?
Helpful - 0
Avatar universal
Everything is ok, for heptech just send them an email for help on how ordering

i hope you see same fast results as me and fibroscan starts lowering at next check by 6 mknths
Helpful - 0
Avatar universal
btw, i thought my mum was using viread but i see that it is zentovir  
it is also tenofovir. I hope there is no difference :(
Helpful - 0
Avatar universal
the latest hbvdan is 20iu/ml
the latest alt -> in july it was 19. (I will check again)


I ordered two box of each

Liposomal Curcumin Cu (II)
Liposomal Resveratrol
Liposomal Glutathione
Liposomal Vitamin C

I sent an email to heptech apparently I cannot buy directly from web.
Can you guide me how to buy from belgium?

I also sent an email to gcmaf.eu, before ordering I sent them an email with the results I had.

I checked fish oil from amazon especially from nordic naturals the max dha and epa I was able to find is;
https://www.nordicnaturals.com/uk/uk_nl_Arctic_CLO_Liq.php

I ordered 2 bottle.

I hope it is OK?


Helpful - 0
Avatar universal
is your mum hbvdna und and alt less than 19?

keep in mind that antivirals alone are not enough to regress fibrosis fast, they are very slow if you dont help with diet and better supplements

forgot fish oil, add that too, check that dha and epa is 2.7g daily and use nordic naturals or longlife from italy, these are filtered good for mercury and pcbs
Helpful - 0
Avatar universal
no absolutely no alinia, it has no studies and i tried it with no effect at all

good to use heptech, vit d and gcmaf.if you can afford add also maxhealthlabs liposomes like gsh, vit c, resveratrol and curcumin.although these are in heptech too liposomals have superior/better cellular absorption
Helpful - 0
Avatar universal
finally in turkey a new law submitted and her assurance company authorised to give tdf (viread)
since yesterday she started taking only vtdf daily.
Helpful - 0
Avatar universal
bad news,
even though my mum was on etv (baraclude) tratment since than 10 months fibrosis elevated
17/12/2013 fibroscan 10,5 kpa (f3 diagnosed)
23/09/2014 fibroscan 12,5 kpa (f3-f4 )

im very sad.

im planning to buy
http://www.heptech.com/index.php  
and https://www.gcmaf.eu/

for sure more vitD s are on the way.

do you advise alinia? as well I am reading your posts
Helpful - 0
Avatar universal
thank you stef, I buy vitd for her from belgium.
more vitd is on the way
Id like to ask one more question please;

what is exact name of 'pth' she never did a pth test?
thanks again.
Helpful - 0
Avatar universal
tenofovir is definitely more potent than etv, so it is your case to change but you have no rush, hbvdna 20iu/ml is not worrying too much

your vitd is still too low, take at least 10.000iu daily and make it 100ng/ml with pth less than 20pg/ml
Helpful - 0
Avatar universal
you wrote me earlier actually, I should have read better;
"etv 1mg does not add much potency, try for 2 months and if hbvdna not und go for tdf combo and once hbvdna und go for tdf mono "

do you think that is still the case?
Helpful - 0
Avatar universal
Stef & All,

I need your advises please,
according to below updated values
Could you please comment and advise?

last month doctor advised to start using tenofovir but due to health assurance
policy my mum has to wait to finish 12th month with etv (baraclude)
I am willing to pay myself and start tdf as soon as possible
(I dont know how can I do it in Turkey but lets see).

1/ do you think hbv started resisting?
2/ do you think tenofovir switch needs very urgent?
3/ do you think combo (etc+tdf) is better than only tdf?
4/ do you think for an f3 patient (like my mum) interferon treatmant would help?

4/11/2013 hbvdna 1020000 iu/ml -> etv 0,5mg started
27/11/2013 hbvdna 16400 iu/ml
17/12/2013 fibroscan 10,5 kpa (f3 diagnosed)
27/02/2014 hbvdna 696 iu/ml
04/04/2014 hbeag grey zone
30/04/2014 hbvdna 75 iu/ml -> etv 1mg started
30/04/2014 hbeag (-) negative
10/05/2014 vitd(25OH) 8.1 ng/ml -> vitd started
10/05/2014 hbsag (kantitatif) 8313 IU/mL
29/05/2014 hbvdna 48 iu/ml
04/07/2014 hbeag (-) negative
04/07/2014 hbvdna (-) negative
25/08/2014 hbeag (-) negative
25/08/2014 hbvdna 20 iu/ml
19/09/2014 HBsAg (Kantitatif) 7965 IU/mL
16/09/2014 vitd(25OH) 39,6 ng/ml

thank you.
Halit
Helpful - 0
Avatar universal
bad results being not undetectable by 7 months, tenofovir would have been better of a combo of etv+tdf, in cases of severe liver damage there is no time to waste

if you take less than 10.000iu daily of d3 you wont get any results in a severely damaged liver, levels must be corrected by 1-2 months.also keep in mind skin of healthy people in equatorial countries all day at the beach make 20.000iu of d3 per day....
Helpful - 0
Avatar universal
4/11/2013 hbvdna 1020000 iu/ml -> etv 0,5mg
27/11/2013 hbvdna 16400 iu/ml
27/02/2014 hbvdna 696 iu/ml
30/04/2014 hbvdna 75 iu/ml -> etv 1mg
29/05/2014 hbvdna 48 iu/ml

still not undetectable :(
she started taking vitd, (even though low dosage ) not tested again yet
Helpful - 0
Avatar universal
i dont know why doctors even here in France are not interrested in vit d in hbv patients?now reading the importance of vit d ,it s up to me to ask doctor to analyse my vit d level ,the last time i talk to my doc about this she told me that taking 3 amples of vitd3 1 million unit for 3 monthes is enough but now i should nsist on her and all hbv patients shoul do
Helpful - 0
Avatar universal
what about that;

her gastro specialist prescribed her ZENTIUS D which contains only
600 mg kalsiyum,
400 I.U. Vitamin D3 which is extermely less than what you advised.

she also will have appointment with another department which is specialist for bone density test.

if nothing comes up from doctors I will take the reponsiblity and let her take higher dosage.
Helpful - 0
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