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have i finally received some good news ?
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have i finally received some good news ?

in september i guess i had :

HBVDNA : 170 mil
HBSAG quant : 350k
fibromax : f0
First fibroscan F2; second fibroscan f0 (1 week difference)
HBEAG pos
HBEAB neg
HBSAB neg



now i've done the tests again, Fibromax (not fibrotest)  , fibrotest was ok few months ago . HBVDNA, HBSag quantity ,hbeag and hbeab .

the only result came was HBSAG quant. which is 224940 UI/mL  ...in in 6 months i lost 100k hbsag ...the only good news i heard so far ....i am so happy , what do you thing guys ?
37 Comments Post a Comment
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9624973_tn?1413019730
i am waiting for the rest of the results, i only did ALT a month ago which came 59 ....also pretty good result for me which always was between 80-120
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Avatar_m_tn
No real difference unless decl ine is continuous and reaches 1000-5000iu/ml.this immune clearance phase makes liver damage, null on many heavy on others best to start nucs when alt will increase a lot
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9624973_tn?1413019730
i will wait for the other test results and of course i hope this decline is not going to stop ...probably i'll check it again in a few months
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Avatar_m_tn
Are you chronic? How long you had it for?
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9624973_tn?1413019730
in june last year i found out and from tests resulted that i was chronic
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7951432_tn?1424719262
Hope your test will be good
I think you and me we are in. The same phase
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9624973_tn?1413019730
my hbvdna results this month : 1.506.930.400 UI/mL ( 6 months ago was 170 mil )

hbvdna logaritmic : 9.17 log UI/mL ...

that's pretty scary ..this while hbsag quant got down from 350k to 220k

i'm waiting for my fibromax result and i will set a meeting with my doctor right away ..

what do you think ?

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9624973_tn?1413019730
this was done with :

Plasma EDTA / Real-time PCR (TaqMan) version 2  ( detectiton limit 20UI/ml analitic sensibility 9 ui/ml

also i feel some discomfort on my right abdomen ...what should i do , start treatment right away ?
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7951432_tn?1424719262
My doc says no change I don't know what is your doc opinion?
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9624973_tn?1413019730
i haven't got the chance to show him my results . your doc says no change about your situation ?
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9624973_tn?1413019730
Any help guys ?
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Avatar_m_tn
Is not like the higher the hbvdna the more damage, if you are immune tollerant with no liver damage this could be even considered better than other stages with severe liver damage

as to the treatment i would wait if there is no liver damage or go for a nuc combo and then pegintf add on to break immune tollerance but for this you need some of those rare liver specialists going personalised treatment
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Avatar_m_tn
stef, so what are the main causes of liver cancer during hbs if not high hbv dna ? inflamation (inflammation) and liver damage ?
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9624973_tn?1413019730
from what i've read there is a big Uncertainty regarding hcc ...some say the higher hbv the higher risk of hcc ...some say it's safe while imunotolerant ..
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Avatar_m_tn
You are wrong from the start.you have to think that on immune tollerant there is so immune response and no damage  whatsoever to the liver, and also the data points to no increased hcc risk in this phase

you aalways need to start from the phase then think about hcc data and liver damage nad hbvdna, alt, hbsag.all the phases have different data because the immune response is different and one thing can be complitely the opposite according to the phase

so fist lets see which is the phase (immune tollerant, immune clearance, immune escape and so on), then we know what we can expect from other numbers.....also with high hbsag there is little damage
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7951432_tn?1424719262
Melcul i want to Say That m'y doc Saïd That There Is no difference between 500million or 70or 1million as viral load quantity.for this I want to know the opinion of your doc if he consider this as reduce!
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9624973_tn?1413019730
Noted flinsky, i will ask. Stef...how can i find out if i am imunotolerant or imun escape ?
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Avatar_f_tn
Melcul: Phase 1 – immune tolerance

In this phase, which usually lasts for 20−40 years, the host immune system is 'tolerant' to the virus, resulting in high levels of viral replication and persistently normal alanine aminotransferase. Patients also have hepatitis B e antigen (HBeAg) (a protein which is secreted during viral replication), but no antibodies to this antigen.

Recommendation

During this phase there is minimal damage and so a liver biopsy and antiviral treatment are not required. However, the majority of patients will eventually progress to phase 2 and develop active disease. Patients should therefore be advised that periodic monitoring of liver function is important to detect a rise in alanine aminotransferase.

Phase 2 – immune clearance
This phase is characterised by a more vigorous immune response resulting in liver damage with intermittently elevated alanine aminotransferase and elevated viral DNA. Repeated episodes of inflammation lead to fibrosis, and the duration and severity of this phase determines the degree of long-term liver damage. Approximately 30–40% of patients emerge from this phase with established cirrhosis. 3

During this phase, approximately 5–10% of patients each year will spontaneously lose HBeAg and develop antibodies to HBeAg. This is called seroconversion and is usually associated with reduced viral replication. The median age for seroconversion is 30−32 years.

Recommendation

It is common practice to initially observe patients with high alanine aminotransferase concentrations (greater than 2–5 times upper limit of normal) for three months to assess whether spontaneous HBeAg seroconversion will occur.

All patients with a persistently abnormal alanine aminotransferase should therefore be referred to a hepatologist for consideration of a liver biopsy and treatment.

Phase 3 – immune control
In this phase the immune response suppresses viral replication to low or undetectable levels. Inflammation reduces and serum alanine aminotransferase normalises. The establishment of immune control is associated with HBeAg seroconversion, and these patients are thought not to have ongoing damage. Once seroconversion occurs, patients may stay in this phase indefinitely.

Recommendation

Although most patients in this phase do not require antiviral treatment, a significant proportion will already have established cirrhosis and require regular careful assessment (Table 3). Carefully performed ultrasound can reveal coarse echo texture suggestive of cirrhosis. Low albumin and elevated prothrombin time are markers of synthetic dysfunction seen in advanced disease, and low platelets (150 x 10 9 /L) may be due to portal hypertension. If any of these features are detected, a liver biopsy should be considered, and treatment is recommended for patients with confirmed cirrhosis and detectable viral DNA.
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Avatar_f_tn
So according to the explanation I think i am on immuno clearance phase.
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9624973_tn?1413019730
30-40% will develop chirosis? This if you do not follow with treatment? Or either way ? Doesn't specify ?
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9624973_tn?1413019730
and here, of course, add hcc risc as well... i think we really need a good treatment for this illness
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Avatar_m_tn
is "immune control" the same as "immune active" ?
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9624973_tn?1413019730
all tests came :

in september 2014 : (alt flaring 80-120)

HBVDNA : 170 mil
HBSAG quant : 350k
fibromax : f0
First fibroscan F2; second fibroscan f0 (1 week difference)
HBEAG pos
HBEAB neg
HBSAB neg


March 2015 ( alt 59- 79 during 2 months )

doctor requested fibromax not fibrotest,

Fibrotest : Score: 0.17(F0)  [0-1]
ActiTest : Score: 0.40(A1-A2)  [0-1]
Steatotest : Score: 0.34(S0-S1)  [0-1] ...still come with the same fat in the liver,actually grow 0,01

NashTest : Score : 0.25(N0) [0-1]

HBVDNA 1.5 billions (huge rise )
hbsag quant : 220k ( down from 350k )
hbeag positive
hbeab negative


Any advices ?
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7951432_tn?1424719262
Realy very high viral load but alat no too much high.were you hbe-or+ before?
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9624973_tn?1413019730
6 months ago when i discovered was positive
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9624973_tn?1413019730
shouldn't be a corelation between hbvdna and hbsag ? if i understood correctly if hbvdna rise, hbsag will rise too . how come i have 100k hbsag down and hbvdna higher x10 times . indeed hbvdna i took in 2 different labs, but i don't think this huge difference has something to do with it .
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Avatar_m_tn
Hi friends, Any review about this clinic as they are claiming that they have  treated around 7000 chronic hepatitis B patients so far. I got to know while searching on google.

http://www.drbijuonline.com/index.php

"chronic hepatitis is little more difficult to manage but we shall 100% cure with an average time span of 72 day’s treatment."

"We are not able to guarantee a cure in carrier state as we have 685 uncured HBV carriers till date. But we are hopeful still because of our 7000 and odd cured cases. There are cases cured within 3 days and cured only after 2.6 years. As an average we calculated the duration of treatment as 45 days. That doesn’t mean the cure will be established within 45 days."
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7951432_tn?1424719262
Realy I don't know the relation for me in 2012 I have decrease of viral load whereas an increase in hbsag.i think your doc will put you under treatment...since your hbe is +there is a chance that the treatment works well
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9624973_tn?1413019730
so, after seeing my doctor today, this are his conclusions :

i was wrong with hbvdna . last time when i checked, the results was: " >170 mil " (greater than 170 millions )
but now , was the exact amount of virus in the blood , 1.5 billions . hbsag dropped from 350k to 220k but he doesn't care about hbsag, he only cares about hbvdna..in my country hbsag is not to important .  my alt is droping , is somewhere around 60 now. still have fat liver , i didn't know i am not supposed to eat sweets which i eat every day .. he says that i am most probably imuno tolerant ...
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7951432_tn?1424719262
And......
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7951432_tn?1424719262
Did he put you under treatment?
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9624973_tn?1413019730
no treatment needed, he says that in the imuno tolerance phase, as stef sais you are healthy like there is no virus .
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9624973_tn?1413019730
he will further test me in 2 months ...my alt dropped and that's why he didnt' recommend me treatment for now .
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7951432_tn?1424719262
So deferent point of view.i have my alat stable at 70ui I with high viral load I don't know in such phase am I?
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9624973_tn?1413019730
well, mine came around 50-60 ...and i have fatty liver which also can be the cause . i asked him about risks and he said that while having this high hbvdna and seeing my alt droping from 120 to 60 he strongly believe that i am imuno-tolerant, either way , i am under observation and in 2 months i will have my alt /ast done again along with AFP - tumoral marker .  
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9624973_tn?1413019730
he said if i will have to go under treatment his first line of meds will be interferon because it doesn't the virus doesn't became resistant and i have 30% chances to become inactiv carrier ...which from what i've read here, is not really to much
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7951432_tn?1424719262
I think all we have to take our chance with interf
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