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need advice, right time for medication
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need advice, right time for medication

dear all,

its my first discussion, since i just join this forum. i come from asia's country, so im sorry if my english is not that good.

i am hbsag +, i was diagnosed with this since 1 year ago. i dont know how i get infected, but i think the biggest possibility was that i get it from my mother when she born me. im male, 24 years old.

last month, i just take another test, and the result was
hbsag+
hbeag+
hbvdna+, means the virus is above 100.000 copy
sgot 32 ( normal )
sgpt 56 (normal)

my doctor suggestion is not to take any medication for this time, since my sgot and sgpt is still within normal level. i just need to take blood exam every 3 months, to measure the sgot sgpt level. once it enter the limitation for getting medivation, he will give me antivirus medication. according to him, interferon alpha is the nest first line medication now.

i want to ask, what is in your opinion? is it better to hold on the medication for now on, or take medication as son as possible allthough my sgot sgpt level is still normal?

i know there is only small chance for me to get hbsag loss after treatment, however, i do still still hope for it.

is there any chance that my chance to loss my hepatitis b virus at all (hbsag - ) is getting higher if i start my medication now, compared with if i start my medication after my sgot and sgpt raised?

i hope someone in this forum dont want to share their opinion and or experience, to help me take my decision....

thank you all very muchhh
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Avatar_m_tn
first of all check your genotype and hbvdna level by a more sensitive assay to at least 20iu/ml (1000cpies/ml is way too high for the test to have any meaning).asians have lower alt/ast dispite very active and aggressive virus because immune response is lower and very high liver cancer rates due to low alt/high hbvdna, you also have hbe still positive which makes virus even more aggressive

i wouldn t follow your doctor on the alt level because they have poor meaning in asians if hbvdna is high i'd just follow hbvdna and liver damage to judge if treatment is needed.by the way what about the liver damage?fibroscan?biopsy?

your doctor is very right in the choice of interferon especially because you are young and still hbe positive, so i do suggest to start therapy if hbvdna>50iu/ml and genotype B or C, this is just a temprary treatment so it doesn t make sense to wait and keep hbe positive

start with nitazoxanide (nizonide500 by lupin) for at least 12 weeks and then add interferon, i do suggest to start with nizonide because many especially asians have no response to interferon, pretreatment with ntz will make interferon response sure and potent.
during therapy check hbsag quantity and if it decreases go on with interferon+nitazoxanide (1.5 or 2g daily) for more than 48 weeks until hbsag gets negative.interferon therapy has been changed to 96weeks and more if hbsg decreases to eradicate virus.
when you have finished interferon 48 or 96 weeks keep taking nitazoxanide since it has no important sides until hbsag eradication

in case you have no hbsag and hbvdna decrease by 12-24 weeks of interferon stop therapy because it is not working

d not start tenofovir or entecavir for now you are too young, only in case you have family history of liver cancer and no response to interferon/nitazoxanide it might have sense the use of tenofovir or entecavir
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Avatar_m_tn
my sgot sgpt level is still normal?
they are not normal, new normal level from about 2009 are less than 30 for men and less than 19 for women and alt 56 is not normal also for old levels, something like 10 years ago those levels might be considered normal

hbsag eradication, 30% by 5 years if your hbsag decreases during interferon, ntz from preclinical 25% by 1 year when your hbe gets negative.combo of both will increase the chance of eradication

is there any chance that my chance to loss my hepatitis b virus at all (hbsag - ) is getting higher if i start my medication now, compared with if i start my medication after my sgot and sgpt raised?
when alt/ast rise there is the activation of immune response, that is the best time to start therapy and interferon chances of hbsag eradication increases very much, there was a rate in this situation but i don t remember
it is also know that if you lose hbeag by 12 or 24 weeks, i dont remember, chances of hbsag eradication rises very very much and ntz is reported on preclinical as monotherapy to start hbe seroconversion (hbe decrease/hbeab increase) by 3 months

if you have no chance to check hbsag quantity or to use nitazoxanide i'd wait for both to be available for you


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Avatar_m_tn
boston reports on peginterferon combos in asian patients hbe positive:
hbsag negative after 96 weeks of peginterferon+adefovir or peginterferon+lamivudine

results: 30% on adv and 24% on lam of the surface antigen negative.

these combo trials are very very late and using drug which are no longer used on hbv treatment because too weak, the combo peginterferon+ntz or peginterferon+entecavir+ntz will give a higher percentage than 30% by 96weeks for sure.
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Avatar_m_tn
i want to ask, what is in your opinion?

--Personally, because of what I found about the antiviral route:

1. All available treatments only control, they don’t cure.
2. Percentage rate of cure by most treatments is the same as spontaneous recovery rate.
3. The high cost of treatment, especially when one becomes too sick to hold a job with the health insurance, is so high.
4. The no-end course with which one has to take the medications not to improve one’s condition but just to avoid flares.
5. The issue of resistance:  whatever medication that is effective now becomes less useful with time and has to be replaced by stronger newer drugs.
6. All these antiviral drugs which are all chemicals with their side effects also hurt the liver while they try to control HBV.
7. ……

I went the non-antiviral route.  It may not fit everyone but here it is:

http://www.medhelp.org/posts/Hepatitis-B/How-I-manage-my-HBV/show/1337595?page=1
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Avatar_f_tn
Dear Stefano,

many many thanx for your complete and comprehensive reply, i do know more things now. esp abaout the quite big chance to be totally heal, means hbs ag -, last time i hear its only 10% chance.

by the way, to the best of your knowledge, is nitazoxanide available in Asia? im in Indonesia, to be specific.
i know that interferon and pegasys is available here, as well as  baraclude.

so, first point, you do agree that the best time for me to start treatment is when my alt ast level is elevated? not know? i read many many journals from china india and us, and they all give the same opinion.

for your additional info, i have no family history in liver cancer or cirrhosis, so i think its a good history for me.
i have take usg tes, and the result is normal, i dont have any problem detected in my liver for now.

as i mentioned before, my doctor said to hold on the medication for now on, because of 2 reasons, the first one is because there is a chance for me to experienced self seroconversion from hbe + to anti hbe +, and, because my alt ast level is still normal. I dont knwo whether the standard is the same or now, but here, for male my age, the ast level is normal as long is belom 33 ( mine is 32) and alt below 50, ( mine is 56 ) my alt is a bit higher than normal, but what i heard is that one of the term of the medication is the ast alt is 2xnormal level?

i know about 4 stage in hepatitis b, which i believe im still in 1st stage, imune tolerant, and the one that should be aimed is the 3rd stage, the inactive carier. im also read that the problem that you mentioned, the high rate of cancer is happened when alt normal and dna high, is when it happened on this 3rd stage. i hope what i read is right, so i have less to worry...

about genotype, i think all asian is b and c ?

look forward for your reply

thank you
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Avatar_m_tn
by the way, to the best of your knowledge, is nitazoxanide available in Asia?
there are generics in all poor countries where people is more exposed to gastro infections by viruses/bactieria/parassites, especially south america, you might check in your country pharmacy if lupin brand called nizonide500 is available or other generic
i suggest lupin because  made a purity check on it so besides brand alinia fro romark, which is very expensive, i don t know the purity of other generics.
lupin is based in india but they produced generics all over the world, if you don t find it you can order online and if you don t know a very reputable online pharmacy i will suggest the one i use

as well as  baraclude.
by the way can you check for me the cost of baraclude there, another member told me it is cheaper than western countries.
i need to know because if i can t enter the trial of entecavir+pegasys i will have to pay for entecavir or pegasys because our helthcare doesn t cover for combos when still on trial.i will try this combo next year and only in case ntz fails to decrease hbsag

so, first point, you do agree that the best time for me to start treatment is when my alt ast level is elevated? not know? i read many many journals from china india and us, and they all give the same opinion.
yes because the immune system is active in that moment, you also experience a higher hbcab igm in that moment.

what i heard is that one of the term of the medication is the ast alt is 2xnormal level?
nomra level has been changed to years ago but even alt<40 is ok if you keep monitoring the situation

according to me you have to wait for a alt rise, in that moment you will probably have hbe seroconversion and develop hbeab antibody, the best moment is right after seroconversion before the precore/bcp mutants develop.in that moment you have the highest chances

it happened on this 3rd stage. i hope what i read is right.....
you are not immune tollerant since you have mild fibrosis f2 and abnormal alt, this is a good indication to keep monitoring and wait for the hbe seroconversion
immune tollerant have alt<30 (usually even lower than 20), no fibrosis f0, hbvdna in the billions.
as regards liver you have nothing to worry at all, you can monitor only

about genotype, i think all asian is b and c ?
yes but C is more aggressive, it is better to know which one you have





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Avatar_f_tn
stefano, again, many thanx for the reply and information.

about the price for baraclude, i will try my best to check it for you.

by the way, i only have 1 further question, why u say i have mild fibrosis? because my usg show that there is no fibrosis.

and about my alt, yes, i think i should tell u the detail of my condition. maybe it will change your opinion about my alt level which is abnormal.

actually the first time i know that i have hbsag+ is august 2009. at that time, my alt and ast was normal, i mean below the upper limit. i dont remember the exact number. then, i check it again on july 2010. during august - july, i gain more than 10 kgs in weight and eat a lot fatty food. on july, my ast and alt is increase, and according to my doctor, its happened because my cholesterol level is very very bad. i also dont remember the exact number, but all my total cholesterol, hdl, ldl, and triglyceride are very very high. then my doctor give me some medication to help me dropped such cholesterol level, and if after that my ast and alt level dropped as well, he concluded that the elevated ast and alt at the beginning is caused by non virus. otherwise, if my cholesterol already dropped but my ast and alt is still high, it looks like caused by my hepatitis b.
the reason for this kind of judgement is that in indonesia, there are many patient with elevated ast and alt caused by high cholesterol level, which caused fatty liver. in my case, the usg i took show that i have mild fatty liver.

then, finally the first possibility is the one which happened now, since july, i checked it regularly every 1 month, my ast and alt dropped in line with my cholesterol level. and my body weight actually. i lost all 10 kgs already. my ast is below the upper limit, only my alt is a bit above upper limit. i know that the elevated ast and alt level is an indication of the active inflammation on liver, but since now my ast and alt is getting normal, my doctor conclude that im still at the first stage, the immune tolerant, so i need to keep monitoring alt and ast every 3 months, once it get elevated, he will give my pegasys in order to make me an inactive carrier, or even better, to loss hbsag, even though the chance is smaller.

many thanx, look forward for ur reply.
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Avatar_f_tn
sorry, i forgot to tell u also, my dna is also in billions, thats why it is in line with the characteristic of imune tolerant phase.

about the mutant virus, as far as i know, not all the patient experienced the mutant virus, right? thats why in some people, the inactive carier stage can last for a lifetime, because the virus is still in the same amount and not have any mutation, so not caused any liver damage, but in some other people, the virus can be mutated, thats why even though the anti hbe is +, the dna can raised again very high, and the hbeag-  cirrhosis happened, right?

so it can be said, if the mutant dont occur, the inactive carrier stage likely can be last for a long long time, since the mutant is the main reason for the 4th stage to occur, the reactivation stage.

please correct me if im wrong, stefano.

many thanx in advance.  
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Avatar_m_tn

sorry now i forgot all your tests but the rules to say if immune tollerant or not are the following:
hbvdna in the billions (but not necessary this only)
alt<30, in case of alt about 40-50 it is needed to check if alt abnormal is due to metabolic stress, fatty liver, too much fat in the diet, alcool or toxic drugs
biopsy or fibroscan with no fibrosis, biopsy is better to distiguish between immune tollerant to low immune response
hbe positive

it is more difficult to see for asians because they have low immune responses with:
very high hbvdna, low alt, different hbv genotypes, usually biopsy can rule out
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Avatar_f_tn
stefano, great thanx for your quick reply.

by the way, are you a doctor or other medical practitioner? i only know form your other message that u also have hbsag +. in what stage are u now?
u really know a lot and im hoping a can learn a lot from u as well, so i can understand better my disease.

many thanx.
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Avatar_m_tn

not a doctor, just studied disease and followed all studies and conferences especially in last year.
born hbsag pos, with many family member also infected, started treatment nov 2009 and regressed cirrhosis from 16.3kpa to 9kpa by etv+ntz+antioxidants/antifibrotics rich diet
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Avatar_m_tn

i chose to be followed by brunetto team in pisa, very good research center and brunetto is one of the best clinical scientists in the world
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Avatar_m_tn

december 2nd we will check ultrasound one year results in terms of cirrhosis regression and recheck fibrosis in gen or feb, i hope to reach fibrosis 5-6kpa (normal liver) by genuary
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Avatar_f_tn
i can see what is your choice of medication. from what ive read, people who get infected during birth or childhood usually experienced a long phase 1, can be up to 40 years. from your profile, i can guess that u are 40 when u start your medication. at that time, what is the parameter, so that u start ur medication? is it elevated alt, the sigh of phase 2, or u do fibroscan at that time? why u dont try to use interferon pegasys at first place, inspite of baraclude?

thanx for ur sharing.

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Avatar_m_tn
i was inactive hbvdna und from very early teen and always hbe neg even without hbeab antibody, i had an acute hbv again at 18-19yo with hbeab seroconversion and then inactive again.
the big mistake is that without fibroscan you cannot monitor liver damage by biopsy because it can build up very fast and the most important thing is to check for the liver mutants you have together with hbvdna/alt.it was the mutants to make cirrhosis in my case, the latest research just presented shows that some mutants of X hbv protein block liver growth and regeneration leading the liver to cirrhosis or liver cancer

the big problem is all tools for correct hbv diagnose are missing and only in the research centers are getting available in the last 2-3 years, those checking in normal hospitals without fibroscan or frequent biopsies are just making a guess and running a big risk just like i did
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Avatar_m_tn
at that time, what is the parameter, so that u start ur medication?
compensated micronodular cirrhosis with nodules ranging from 1 to 3mm and a focal lesion 3mm, fibroscan 15.9kpa in nov 2009 which increased to 16.3 in march 2010 (before cirrhosis regression there is an increase in stffness and a change from micronodular cirrhosis to macronodular until nodules are absorbed and dissapear).
i got hbvdna und in july and fibrosis jumped from 13.9 to 9kpa in 3 months, i hope january will be around 5-6kpa (normal liver with no fibrosis)

is it elevated alt, the sigh of phase 2, or u do fibroscan at that time

alt are useless and usually normal in cirrhosis, i just made a fibroscan because i had a alt flare at 600 in nov 2009 so i asked the doctor to start therapy, if it was for the doctor we still didn t know about cirrhosis and didn t check by fibroscan, i was very lucky i wanted to start treatment and then we discovered how badly i was

why u dont try to use interferon pegasys at first place, inspite of baraclude
at this stage of damage it is useless and can make much more damage, i should have tried it when young but i saw my mother and my sister on it and it was useless plus many sides

etv is the best antiviral that has shown cirrhosis regression on all treated by about 3 years, pegasys cannot do this at all plus it increases liver damage, only in the case of hbsag seroconversion you can have hope for cirrhosis regression and this equals to 0% hope

interferon can be useful in combo with antivirals, antivirals make hbvdna und and rebuild immune system by no dna, at this time it is wise to try interferon alone or in combo.
trying interferon alone is just a guess, only 11% get hbsag negative by 5 years and it is not potent enough to make hbvdna und and low alt/ast and any fibrosis regression at my stage

it makes sense to combo interferon with nitazoxanide and etv, this is our strategy but i want to recover all liver fibrosis before any interferon, i am also checking interferon lambda which is on trial and have no sides like pegasys.
unfortunately there is a trial in florence on hbe pos hbv only, i hope they won t find enoguh people for the trial here because hbe pos is extremely rare in italy, if they need a lot of patients they won t find them for sure here




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Avatar_m_tn
brunetto research showed the highest seroconversion rates of interferon when hbsag levels are like those of inactive carriers, around 1000-1500iu/ml, we are waiting to see if etv+ntz can reach this low level and only in that case we will use interferon.

it makes no sense to try it if failure is almost certain......until now i have reached the lowest hbsag level at 2292iu/ml in april by use of ntz at staggered 1-1,5g daily and relapsed with ntz 1g to 7272iu/ml in july, from then i have kept the dose to 1,5 or 2g daily and in septmeber it lowered again to less than 4000iu/ml (don t know exact level because test was in s/n unit, result 255s/n).
i will have october 22nd hbsag level when i go to pisa again on december 2nd, i make hbsag tests every 2 months in iu/ml and monthly in s/n unit.

s/n can tell you if decreasing or increasing but not the exact level, i only know that very low levels are at about 20-100s/n.
iu/ml tells you exactly the hbsag level but it is too complicated to have this test at the hospitals close to my home, you have to be their patient to have it done
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1292648_tn?1303161853
You are lucy to be able to have all hose tests done and get treatment on time.I can not belive thet USA is not doing the same, fabroscan and HBsA levels.Do you expect to stey on antivirals  for rest of your life after your liver returns to normal? And you sad your mom and sister had interferon treament, ,I meen I have my 6 monts folow up on 19th if I diside to do the treatment I shuld go with interferon I am onley 33 Are the sides so bad that I wuldn't be able to take care of my family(kids)?And my alt was 22 and 3 month after 19 and 3 monh after 21 doctors here call it  mormal I think 19 was normal for women?my dna was 470UI/ml last time before thet around 1000-2800 Do you think if my dna goes up I wuld be candidae for treatment I am also hbeag negative .
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Avatar_m_tn
europe (except UK) has totally free healthcare system so it is becomes very different to US, US is only focused on drugs making and sales and hopefully this will end by indian generics competition
fibroscans are made in france that's the reason you don t have it but they will spread soon over US too because there is a US factory making them and since there was no reason to mae them in US i think they were waiting for patents or cheaper machines to be made in US

in italy healthcare is considered the most important thing since you lose elections if you fail to provide good free healthcare, only the very south regions of the country can be dangerous because of bad doctors......so you can have anything free.i didn t know about US healthcare problems and i found out in this community.

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Avatar_m_tn
mmmh was wrong some european countries have free healthcare, UK and poor eastern states are probably in a bad situation but italy, france, spain, germany, scandinavia, sweden have very good ones and mostly free

Do you expect to stey on antivirals  for rest of your life after your liver returns to normal?
until cirrhosis has complete reversal and even if hbsag negative i have to wait for cirrhosis reversal but since i am already f2/f3 borderline in less than a year it will be a fast process and not 5-6 years as i thought when i started etv
if hbsag is positive there is no way to stop antivirals plus i have hbv mutants with highest cancer risk, so i don t even think to stop them until complete hbsag negative

I shuld go with interferon I am onley 33 Are the sides so bad that I wuldn't be able to take care of my family(kids)?
if there is no liver damage or precore/bcp mutants which confers highest cancer risk, i'd definitively wait because there is a new interferon called interferon lambda which is active only on liver cells so there is much less sides and damage.pegasys has heavy sides for some and no sides for ohters so you might try it to see
if you start i'd combo with alinia or an antiviral because results of pegasys alone are not that great, 11% chances in 5 years is nothing

And my alt was 22 and 3 month after 19 and 3 monh after 21 doctors here call it  mormal I think 19 was normal for women?
absolutely normal, if hbvdna is less than 2000iu/ml, no liver damage, no precore/bc mutants, you don t need any therapy for now.if hbe negative you might try nitazoxanide since it has no sides and no resistance but no interferon or other antivirals

my dna was 470UI/ml last time before thet around 1000-2800 Do you think if my dna goes up I wuld be candidae for treatment I am also hbeag negative.
try nitazoxanide for 6months/1year and see if it can keep hbvdna und and decrease hbsag, this is the only drug with no danger for resistance or other that you might try.the only big issue in US is how to see if it lowers hbsag
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1292648_tn?1303161853
Thank you so much I feel bedder now,nitaazoxanide is definitly somthig I am willing to try in future,There was byopsy done 3 years ago showd no demage but I always think they missed somthing out.
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Avatar_m_tn
biopsy can have limitations but the error is about 1 stage less than real damage, since you are 0 don t worry at all you have zero damage.
liver damage usually shows up at 40-50yo

error is due to:
sample of the liver being too small
fibrosis is not the same in the whole liver but the dufference can be about stage
error reading histology by doctor

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Avatar_f_tn
trying interferon alone is just a guess, only 11% get hbsag negative by 5 years

u mean, after use pegasys for a year, there is an 11% chance for the patient to loss his hbsag in the next 4 years? it means he will get anti hbs?

i am also checking interferon lambda which is on trial and have no sides like pegasys.

i hear that lambda is only for hepatitis c, no?

if hbsag is positive there is no way to stop antivirals plus i have hbv mutants with highest cancer risk, so i don t even think to stop them until complete hbsag negative

in your case, with your choice of medication, how is the chance of hbsag loss? how many percentage in how many years?

sorry, to be a honest i get confused by your explanation, i can understand, but not all of them. would u mind to just share how is the history of yur treatment / comndition, i mean, u say that u get low dna and hbe ag - from early teen, hos is it? you reach it by medication or not? and is it means that from ur eary teen until when ur 40, u dont meet any other problem in your liver, and the problem is come on 2009, thats why u star therapy?
so its means u never use pegays before?

sorry, i got lost.

thanx a lot
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Avatar_m_tn
u mean, after use pegasys for a year, there is an 11% chance for the patient to loss his hbsag in the next 4 years? it means he will get anti hbs?
yes, and an hbsag baseline 1000-1500iu/ml is the strongest predictive value

i hear that lambda is only for hepatitis c, no?
it is not, the trials are on hcv and hbv but on hbv only for hbe pos now, interferon lambda is just like interferon but only liver cells are receptors for that while peginterferon gets inside brain and bone marrow too that's why peginterferon has sides on brain until rare cases of suicial tendensies, decrease of immune function, problems with blood cells decreasing....

i do hope they won t find patients for the trial in italy, on genotype D and in italy there are almost no hbe positives

in your case, with your choice of medication, how is the chance of hbsag loss?
if hbsag keeps decreasing like in april or june the chances are very very very very high, it is not possible to say percentages because all combos i am doing have been used as off label therapies, so we have only case reports, no trials, of course the percentage is higher, on monotherapy:

etv hbsag seroconversion about 5% on genotype D on hbe neg in italy by 2 years

peginterferon, 11%

nitazoxanide, only case reports, monotherapy 25% on hbe neg by 1 year, but it was only 8 people so statistically non significance

but all ths percentages have no real meaning you just have to try and see if hbsag stay steady, increasing or decreasing, if decreasing continuatively of a good number the chances are very very high, if steady almost none
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Avatar_m_tn

i think that a combo of ntz+etv+interferon lambda can reach very very high percentages if there is even a minimum decrease of hbsag because those drugs have mild sides so this combo might be continued for years.

as to my story you have to understand that cronic (chronic) hbv doesn t have high hbvdna and high alt, it is ususly inactive for most of our lives and it is immune system to make hbe negative and hbvdna und

to reach cirrhosis or liver cancer it is all a matter of mutants present, oxidative stress on liver and a couple of years of hbv replication.

for example occult hbv is though to be due to mutants in hbsag, it has hbsag negative, antihbs pos, hbvdna very very low or und, alt normal or slightly elevated, in contrast it is very aggressive and leads to liver cancer or cirrhosis fast
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Avatar_f_tn
how can we avoid occult hbv? in case you and i finally reach hbsag negative one day, how can we avoid this occult hbv?

is it common for occult hbv? because i think if u already hbsag - and the anti hbs is occur, and the dna is end, it means that u totally heal, the virus is no longer exist in your body

Oh my God, i became frustrate, then how can we be totally heal from this virus?
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Avatar_m_tn
the best thing is keep antiviral at least 6 months after hbsag seroconversion and then discontinue very slowly and check hbvdna with superqual at NGI, sensitivity 0.19iu/ml

if any hbvdna is detactable keep drug until complete hbvdna negativity
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Avatar_m_tn
occult hbv is extremely rare, at least it looks like that for data we have now
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Avatar_f_tn
what a relieve. thanx for ur info stefano.
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Avatar_f_tn
FEU hospital ako nagpalabtest at isang clinic malapit sa amin,parehas nagnegative....Gumamit ng Korean Red Ginseng at finalow ko ung exact procedure na 3 times a day minsan sumosobra pa sa kagustuhang gumaling kaagad...marami na akong nilapitan na doctor dati at lahat sila ay nagsabing walang gamot ang hepa B... pero masasabi ko na marami nang gumaling dahil isa ako sa mga nakinig ng testimonial ng korean red ginseng...ang procedure ng paginum ay 1 hr before meal at bawal ang vitamin c, sinamahan ko rin ng soft diet na puro gulay para di mapuwersa ang atay ko...nagbakasakali lang ako sa kagustuhang gumaling kaya nagtry ako nito.
Bago ako nagsimula ay nagpakuha muna ako ng HBsAG na my Patient's ABS para malaman ko kung gaano ako kalayo sa cut-off value...Ang cut-off value ay 1.000 pero ang lumabas sa akin ay 1124, after a month ng paggamit ay naging 441.3,tapos bumaba ng bumaba hangang naging less than 1.
Kakausap ko lang sa may ari ng Lizada Korean Red Ginseng na c Ms. Digna at sya ay natuwa sa aking ibinalita.. ito ang kanilang exact address Room 601 manufature building plaza sta cruz manila, tel number 736 7732...
Paki pasa sa ibang gustong magtry... Note: wala po akong kikitain sa bawat bote ng ginseng na bibilin nyo sa kanya at hindi ko po sya kamag-anak...ang malinis ko lang na intensyon ay makatulong sa inyo... magpapatotoo rin ako sa office nila ng libre na dala ang lab results... god bless sa inyong lahat!
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Avatar_m_tn
mga ilang buwan ka umiinom nang red ginseng?
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Avatar_m_tn
acute or chronic?
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