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if i start tt
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if i start tt

hi every body
i read a lotof your comments and the deferente situations of each one of you i just to know what is the 1st treatement to use with high viral load(more than 44millioniu/l because as i undertand from your expériences you don't all start with interferon?
and how to say this to my doc?she will tell me i know what i do!
are you who sugest to your doc the treatment or them?
thanks
16 Comments Post a Comment
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Avatar_f_tn
so stef what do you think about treeatement?
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Avatar_dr_f_tn
Hi, if the viral load is greater than 20,000 IU/mL and HBeAg is negative then Interferon-alfa (Roferon A, Intron A), pegylated interferon-alfa (Pegasys, Peg-Intron), lamivudine (Epivir-HBV), adefovir (Hepsera), entecavir (Baraclude), tenofovir (Viread) or telbivudine (Tyzeka) may be used as initial therapy. There are standard protocols for therapy of hepatitis B infections, so you can clarify your doubts with your treating doctor. Regards.
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Avatar_m_tn
check hbsag quantity and genotype, then you may try peg for 24 weeks and if no hbsag decline stop it because failed

the best path is tenofovir and then peg add on 3-5years later
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Avatar_m_tn
please avoid posts with antivirals banned from most western guidelines, firstline drugs are only tenofovir, entecavir and peginterferon.all the others are trouble for public health and patients because useless on the virus on the contrary they worsen status by dangerous mutants

lamivudine is proposed for a ban on hbv, hopfully soon
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7951432_tn?1400922437
ths a lot of ,for my doc she told me that treatement is based on hbe+or - alat asat and hbv load viral
i were hbe- but if it becomes + so here  the virus is  multilpying so interf is recomended and aloso if my alat asat are 3 times more than normal, but if i am hbe- and asat alat less than twice than normal and load viral is high here an other treatement lamivudine,  because she said that  hight alat asat show that our body try to defend it self and here is the best time to introduce interferon
The probleme with me is that my alat asat are getting down each 15days i do monitoring and they getting down next moth i will do adn hbv quantity
For the hbs ag she doesnt ask me to do that

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Avatar_m_tn
your doctor should be banned from practice, that info is wrong and more than 10 years outdated and this might even kill people
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7951432_tn?1400922437
she is well known and people come to her from deferent countries,really i am confused and what about the decrease of alt?
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Avatar_m_tn
It can't be a good doctor. before was believed that hbv-dna is the cause if liver cancer, after lowering and making undetecteable it the patients was believed to clear hbv. Now they see that Hbsag is the main cause, it remains there in liver. It means that Hbsag is the new aim for cure. if we have a drug that will disappear it we are all cured.
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Avatar_m_tn
decrease of alt is useless to clear the infection, high alt and declining hbsag is the effect of clearing the infection

alt test alone is of very little meaning if any, it has meaning correlated to all main tests like fibroscan, hbsag quant and hbvdna
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Avatar_m_tn
Marcellin P and denis ouzan are among the best

if you are talking about france be careful, one of the most expert world researchers/doctors said recently at a conference france liver specialists are killers, they killed a lot of patients in latest trials (he did not cleared if hbv or hcv trials)....this said he also said most liver specialists are stupid and ignorant and apply guidelines understanding nothing about the infections of hbv/hcv

i also say this from long time and another US researcher wrote a book about the ignorance of liver specilists trying to correct their mistakes/ignorance
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Avatar_m_tn
maybe you got wrong what the doctor said but f lam was proposed to treat hbv  in france that is crazy, lam is banned from guidelines, only peginterferon, tenofovir, entecavir can be used as firstline therapy
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Avatar_m_tn
few poor countires in africa and asia can use lam because no other drugs are affordable for their financies
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Avatar_m_tn
Steff2011 is absolutely right. You do not trust the doctors too much and spend time on researching the ongoing trends on Hepatitis B.

My doctor is a famous professor in my country. However, he is not as knowledgeable as Steff2011 and some friends here.
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Avatar_m_tn
Addition of pegylated interferon to nucleoside/nucleotide antivirals increases the likelihood of hepatitis B surface antigen (HBsAg) loss -- considered a cure -- in people with hepatitis B "e" antigen (HBeAg) negative chronic hepatitis B, according to a report in December 2013 edition of Journal of Clinical Virology.

Nucleoside/nucleotide analogs such as tenofovir (Viread) or entecavir (Baraclude) effectively suppress hepatitis B virus (HBV) replication, but they usually do not eradicate the virus and may need to be taken long term. Serological response, or changes in hepatitis B antigen and antibody status, is more difficult to achieve than virological response, or undetectable viral load.

Denis Ouzan of Institut Arnault Tzanck in France and colleagues conducted a study to evaluate whether adding pegylated interferon alfa-2a (Pegasys) leads to HBsAg loss in HBeAg negative patients with chronic hepatitis who have fully suppressed HBV DNA on stable long-term nucleoside/nucleotide analog treatment.

This prospective analysis included 10 HBeAg negative but HBsAg positive patients. Before starting pegylated interferon, their HBV viral load had been below the limit of detection for at least 3 years. Treatment with add-on pegylated interferon lasted a maximum of 96 weeks, depending on changes in HBsAg levels.

Results

HBsAg levels declined in 9 out of 10 patients.
Among these 9, 4 became HBsAg negative after 48 weeks on pegylated interferon, and they stopped interferon at that point.
These 4 patients also stopped nucleoside/nucleotide analogs, and HBsAg remained negative and HBV DNA remained undetectable for at least 18 months.
2 patients experienced HBs seroconversion.
The 5 patients without early HBsAg decline received pegylated interferon for 96 weeks.
1 patient became HBsAg negative at the end of interferon therapy, while another became HBsAg negative 6 months later.
Both stopped nucleoside/nucleotide analogs and did not relapse during 12 months of follow up.
The remaining 3 patients never became HBsAg negative.
Based on these findings, the study authors concluded, "In HBsAg positive, HBeAg negative patients with HBV DNA fully suppressed by long-term NA treatment, the addition of pegylated interferon for a maximum of 96 weeks based on HBsAg titer monitoring led to a loss of HBsAg and cessation of NA therapy in 6 out of 10 patients, with no relapse for 12-18 months of follow up."
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7951432_tn?1400922437
ok thanks lot members
stef
my last tests were
hbdna 44millionui/ml
alat 111/  <33
asat  59  2
i think i will change my doc because last time i said to her that my vit d level was 17 (35)very low and i took 3amples of 1million ui once a month for 3 times ;she told me it s enough and she didn t ask me to do an other test to check or prescribe me vit d as other members,this make me in doubt about her therapy!!!!
safisifa
now i have a full  vision on what therapy should be applied and i should negociate with any doc this
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Avatar_m_tn
Do not care the high level HBV DNA number of you. My HBV DNA was 557 million IU/ml 6 months ago. Now it is 26000 IU/ml with Entecavir treatment.
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