entecavir + pegasys for hepatitis B+D

[elenatogan]

Hello everybody!
I want tell all my story. In 2006 i founded that i have hepatitis B+D. Off couse i have a lot of analysis, my TGO and TGP was very high, viremy for hepatitis B and D was present. I started with Roferon (interferon) for 4 months but no result. My big problem was TGO very high (14 * normally). This treatment with Roferon has stoped. Then I started for 1 year with entecavirul 0.5 mg/day, but my analysis still very bad. Then my doctor's said that i have to start a combo treatment with Pegasys and Entecavir. Off, My god, I can support anymore another treatment, but let'go: i am young, still fight for my life. After one year with this combo, my analysis are perfect: TGO, TGP - normally, viremy are nedetecable for both us (B+D), and now i stopped every treatment and i have done the anti HBS vaccine and I have already anticorps. So I am health, it can be possible to escape by hepatits B and D. Now, we want to hae a baby...The show must go on :)

[stef2011]

http://www.journalofclinicalvirology.com/article/S1386-6532(09)00475-2/abstract


Volume 47, Issue 1, Pages 97-99 (January 2010)

Resolution of chronic hepatitis Delta after 1 year of combined therapy with pegylated interferon, tenofovir and emtricitabine

Wael Mansourab, Alexandra Ducancelleab, Frédéric Le Galc, Hélène Le Guillou-Guillemetteab, Pierre Abgueguend, Adeline Pivertab, Paul Calèsae, Emmanuel Gordienc, Françoise Lunelab
Received 3 June 2009; received in revised form 22 September 2009; accepted 24 September 2009. published online 16 November 2009.

Abstract
Background

Hepatitis Delta virus (HDV) Infection has a worldwide distribution, with approximately 20 millions infected persons. Interferon (IFN) is the only approved drug for the treatment of HDV infection which is still a difficult to treat disease.

Objectives

To report a successful treatment of a patient with a chronic severe hepatitis Delta using combination therapy with Pegylated interferon (PegIFN), Tenofovir disoproxil fumarate (TDF) and Emtricitabine (FTC).

Study Design

The patient, a 47 years -old male patient, originating from Dagestan (East Asia), suffered of chronic hepatitis Delta infection. The patient was HBsAg, HBeAg, and anti-Delta Ab (IgG) positive. Serum HBV-DNA level was elevated (more than 9logUI/mL). Serum HDV-RNA level was up to 5.6 log (copies/ml). Genotypes HBV/D and HDV-1 were demonstrated. The liver histology revealed chronic active hepatitis (Metavir score: A2F2).

The treatment was started with PegIFN (180μg/week) for two months and then TDF (300mg/day) (combined later with FTC) was added.

Results

Sustained response was obtained after 10 months of treatment and was accompanied by the clearance of serum hepatitis B virus surface antigen with seroconversion to anti-HBs.

Conclusion

This case report suggests that Delta infection may co-exist with high replicative HBV infection and that combination therapy with PegIFN and nucleoside/tide analogues seems to be more effective than IFN alone. Given that only a single case is reported, further studies including more patients are warranted.

[StephenCastlecrag]

"there is also an old clinical report about this combo therapy, i dont know if you have seen it googleing around"

No, I have not read any reports on combo therapy. As I said before, many years ago, some doctors recommended pre-treatment with Lamivudine before starting Interferon. Dr Misra on Hepblist practised it. Then someone did a clinical trial and found no differences and the practice was abandoned. But logic dictates that we should re-visit it again, but this time hbvdna should be 0 before starting Interferon. The question is: will interferon kick starts our immune system? Anyway, we have better tools now, such as HbSag quantity assay, to guide us. I am very hopeful that it will work for you.

[stef2011]

we have got normal nagalase ranges from this article:

healthy range enzyme levels, ranging from 0.38 to 0.63 nmole/min/mg protein, i guess the lower the better

unhealthy range, from 2.32 to 6.28 nmole/min/mg protein

time to lower nagalase on various trials 3.5-5months


Immunotherapy of metastatic breast cancer patients with vitamin D-binding protein-derived macrophage activating factor (GcMAF)

abstract (Introduction to this paper)
International Journal of Cancer / Volume 122, Issue 2, Date: 15 January 2008, Pages: 461-467
Nobuto Yamamoto, Hirofumi Suyama, Nobuyuki Yamamoto, Naofumi Ushijim

Abstract
Serum vitamin D3-binding protein (Gc protein) is the precursor for the principal macrophage activating factor (MAF). The MAF precursor activity of serum Gc protein of breast cancer patients was lost or reduced because Gc protein was deglycosylated by serum -N-acetylgalactosaminidase (Nagalase) secreted from cancerous cells. Patient serum Nagalase activity is proportional to tumor burden. The deglycosylated Gc protein cannot be converted to MAF, resulting in no macrophage activation and immunosuppression. Stepwise incubation of purified Gc protein with immobilized -galactosidase and sialidase generated probably the most potent macrophage activating factor (termed GcMAF) ever discovered, which produces no adverse effect in humans. Macrophages treated in vitro with GcMAF (100 pg/ml) are highly tumoricidal to mammary adenocarcinomas. Efficacy of GcMAF for treatment of metastatic breast cancer was investigated with 16 nonanemic patients who received weekly administration of GcMAF (100 ng). As GcMAF therapy progresses, the MAF precursor activity of patient Gc protein increased with a concomitant decrease in serum Nagalase. Because of proportionality of serum Nagalase activity to tumor burden, the time course progress of GcMAF therapy was assessed by serum Nagalase activity as a prognostic index. These patients had the initial Nagalase activities ranging from 2.32 to 6.28 nmole/min/mg protein. After about 16-22 administrations (approximately 3.5-5 months) of GcMAF, these patients had insignificantly low serum enzyme levels equivalent to healthy control enzyme levels, ranging from 0.38 to 0.63 nmole/min/mg protein, indicating eradication of the tumors. This therapeutic procedure resulted in no recurrence for more than 4 years. © 2007 Wiley-Liss, Inc.

[stef2011]

as to gcmaf i have found two labs that test nagalase (the substance supposed to suppress macrophage)

redlabs brussels (experimental free nag test for CFS only)

while this second lab test nagalase for anyone
http://www.europeanlaboratory.nl/

[stef2011]

there is also an old clinical report about this combo therapy, i dont know if you have seen it googleing around

another guy got hbv and hdv eradicated by 11months with the combo of interferon+truvada(tenofovir+FTC), he was hbeag pos and i dont remember if interferon was started first, anyway this combo lead to hbsag seroconversion very fast

other reports are from interferon+telbivudine with hbsag 1 log decrease by 24weeks only, the trial was stopped because of myophaty sides but telbivudine has this sides even mono so also this combo should be checked

[StephenCastlecrag]

Hepatitis B & D co-infection is harder to treat, so the story has a very good outcome.

I wish you every success with your new tenofovir/entecavir --> interferon treatment. It ties in with your own analysis. This could be ground-breaking as you suggested before. Do keep us posted. If the treatment works, it will benefit all of us.

[stef2011]

thank you so much for your feedback, i am about to start etv+interferon+alinia treatment, i hope i can get good results too
from latest research it looks like one year entecavir or tenofovir or both before starting interferon can restore the response to interferon therapy since hbv is able to block interferon

since response to treatment is different if hbeag is positive or negative, with hbeag negative with less hbsag seroocnversion, were you hbeag positive or negative?

what dose of interferon did you use?