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nucs peg add on combo with 100% response and 91% hbsag loss
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nucs peg add on combo with 100% response and 91% hbsag loss

this was posted already but it is better to enhance this data for all members and for all readers and keep this thread up all the time and separated

baseline hbsag<1000iu/ml has 100% response and 91% hbsag loss

http://medicalxpress.com/news/2014-04-optimal-combination-therapy-chronic-hepatitis.html
154 Comments Post a Comment
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Avatar_m_tn
My qHBSAG is above 52000 IU/ml...
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Avatar_m_tn
my qHBsAg is above 65000 Iu/ml aslo...
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Avatar_m_tn
my qHBsAg is above 65000 Iu/ml aslo...
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Avatar_m_tn
We all will have probably the same fate as hep c carriers. That;s how they are getting cured, and I hope will work for us as well, finger crossed, good sign
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Avatar_m_tn
after 5 to 10 years of most potent tdf or etv most patients have low hbsag, if not 1000iu/ml at least in the range of response....just a matter of time to reach lower values while on treatment
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Avatar_m_tn
How does your doctor comment about your high level of qHBSAG?
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Avatar_m_tn
nothing , just keep Nucs ON ...
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Avatar_m_tn
and he is right we know nucs lower intrahepatic hbvdna and cccdna close to 100% by 5-10years (no effects in less than 5 years), of course the most potent like tdf the better over the weaker antivirals like etv and ban of wealest like adv, lam and so on

cd8 will recover functionality and pegg add on will restore nk cells to to clear hbv

it is all studied, proven and easy, just be patient and results will come
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Avatar_m_tn
I could not imagine what I do if you were not here Steff. Because doctors do not explain the situation and tend to not telling anything about current and future status of us. Thanks for your efforts.

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Avatar_m_tn
let's keep this theard always first page, this is the most researched info for all hbvers
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7951432_tn?1400922437
d
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Avatar_m_tn
I agree Steff because it's our cure, and letting know for new members here
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Avatar_m_tn
Forgot to say that this research done by my medical center (University of Ankara). I think I am one of the patients mentioned in the research :) However, my doctor is not the research presenter doctor.
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Avatar_m_tn
Turkey has excellent medication fields, a lot of Turkey's doctors are well-known around the world. Here in New York we have one of the best Turkish American surgeon, Dr Mehmet Oz
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Avatar_m_tn
they knew all that 10 years ago that combo therapy works best. This is no new news.

I can believe, how slow the process with HBV treatment is. Still beating the same dead horse.

Where is gene therapy to knock out viruses? Where are immune system modification therapies?
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7951432_tn?1400922437
be optimist viran b  at least there are now drugs wich permit us to avoid liver damage for a long time,may be in the near future there will be a cure like the one for hep c developped recently,and this combo permit to many patients to be cured
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7951432_tn?1400922437
http://www.hepb.org/french/living_w_hepb.html
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Avatar_m_tn
Mehmet Oz is a showman rather than doctor :)

He always talks about how to live healthy rather than a cure of any illness.
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Avatar_m_tn
I totally agree with you. This is not a new news. We need more.
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7951432_tn?1400922437
http://www.hepatites.net/index.php?name ... mp;t=22654
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Avatar_m_tn
Hello Steff,

I read some researches that interferon does not work well in patients with HBEAG negative.

Before ETV treatment (6 months ago) I was HBEAG positive, but one month ago my HBEAG became negative and ALT flared from 90 to 330 (I do not know about ANTI-HBE status).

Does it mean that Interferon does not work for me? What do you think?  
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Avatar_m_tn
you have all the answers reading the research above.do not read around on the internet and do not read anything older than 2012 and which is not sequential treatment because wrong and obsolete by now

nothing work without sequential, pegintf monotherapy is 7-11% hbsag clearance, this is nothing when off therapy hbsag clearance is about 4% per year
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Avatar_m_tn
SafiSifa, you just said that your doctor do not explains about this disease. I noticed something in this forum that almost all members have the same problem. Do you know what? my opinion, as the Steff says do not look the old posts, because the new news are coming out and even many doctors are not aware, so they are afraid to talk with patients about anything they don't know. I had last week my visit,and even though my doctor is a professor of liver, he wasn't aware for the latest news of international liver conference. I showed the link that Steff posted, and he became very optimistic. He said: yes soon will be the same thing as for hep C.
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Avatar_m_tn
So, I think in my case,my doctor is absolutely excellent,but they are very busy with patients and they don't see every month every update, We all have to be careful and to collaborate with our doctors. Thanks god today we have all tools to keep ourself updated through internet. This is my message to you all. We should be happy because at least things have changed,we are not living as 10 years ago where it was only lamiv. we have more chances to be cured: keep in mind vitd3 and sequential treatment the thread above.
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Avatar_n_tn
but the research posted by you pertains to hbeag positive patients... how about hbeag negative patients??
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Avatar_m_tn
they are all hbeag neg
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1191262_tn?1366766621
Interesting.
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Avatar_m_tn
Hi Stef

Can you kindly explain the difference in hbeag positive or negative and the implications in terms of treatment options and effectiveness?

Thanks vm.
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Avatar_m_tn
none, hbeag pos responds better than hbeag neg

but this study was on hbeag neg

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Avatar_m_tn
Hi Stef,

Are you sure in that these results are valid also for hbeag neg patients?
I am reading and reading again the news but I cannot find it.
Do you have more detailed sources about this research?

"192 patients who had received at least two years treatment with NUCs without achieving HBeAg loss or seroconversion were treated with 48-week combination therapy with additional Peg-IFN to on-going NUCs or NUCs monotherapy."
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Avatar_m_tn
data is extrapolated from many studies on sequential combination treatment:

they found that hbsag loss is 91% when baseline hbsag<1000iu/ml on patients on longterm nucs, they did not clear if these with baseline hbsag<1000iu/ml before add on were hbeag pos or hbeag neg because hbsag loss 91% was correlated to hbsag<1000iu/ml
anyway i presume they were hbeag neg because with such low hbsag on longterm nucs treatment to be hbeag positive, but again it was not the reason for hbsag low so high

the data is this:
those on long term nucs with hbsag1000iu/ml had much less hbsag loss

but many other studies on sequential with hbeag negative found hbsag loss 60% and very low hbsag (less than 100iu/ml) with probable clearance in the follow-up in 90%

the message from easl 2014 conference is sequential treatment is the only treatment to increase hbsag loss to more than 60% irrespective of hbeag and reaches 91% when baseline hbsag is less than 1000iu/ml.treatment with potent nucs like tenofovir or entecavir reduces hbsag to very low levels after 5 to 10 years of treatment so most patients will be able to reach these percentages
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Avatar_m_tn
anyway i presume they were hbeag neg because with such low hbsag on longterm nucs treatment to be hbeag positive is rare, but again it was not the reason for such high hbsag loss.the only reason was hbsag<1000iu/ml

since we have hbsag quantification we have found out that hbeag is of little utility.
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Avatar_m_tn
This paper is also rather interesting:
http://www.natap.org/2013/EASL/EASL_70.htm
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Avatar_m_tn
anyway i presume they were hbeag neg because with such low hbsag on longterm nucs treatment to be hbeag positive, but again it was not the reason for hbsag low so high.

UNFORTUNATELY THAT IS ABSOLUTELY TRUE!!
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Avatar_m_tn
In reading both studies it is obvious that NUCs have to be used for several years before INT add on, as Stef has been saying. Using both at treatments at the same time yields 30% success ( and unknown what nucs were used), while add on INT after TEN or ENT is 90% curative.
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Avatar_m_tn
One more study which is important.
http://www.natap.org/2012/APASL/APASL_26.htm

You can see that HBSag decrease is lower for non-Asian HBsAg negative patients when using longterm NUC therapy (cf. fig 2,3 and 4).
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Avatar_m_tn
please do not go off topic, that study is simple nucs mono, it has nothing to do with hbsag decline or sequential pegintf combo
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Avatar_m_tn
sorry correction:


You can see that the decreased HBSag level you reach is higher for non-Asian HBeAg negative patients when using longterm NUC therapy (cf. fig 2,3 and 4). This level is the same for HBeAg positive patients independently from genotype.
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Avatar_m_tn
totally off topic, that s simple nucs mono and useless

nucs must be followed for 5 to 10 years to see any real effect on hbsag decline, cd8 recovery, fibrosis regression and HCC risk.the hbsag decline drives everything but needs 5 to 10 years on antivirals mono
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Avatar_m_tn

Hi Stef,
Sequential therapy is starting with NUC mono. The question is when you can add interferon to your therapy. My HBsAg is very high, I am HBeAg negative, maybe I won't reach 3 log IU/ml HBsAG value in ten years with TDF mono.
Unfortunately the above paper to this question is informative.
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Avatar_m_tn
you ll see it at 7-8 years of therapy if not earlier, it cannot be predicted
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Avatar_m_tn
i mean these are useless questions on a single person, anybody goes lower by time on and off therapy
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Avatar_m_tn
I am absolutely sure that all the patients were HBeAG positive when the treatment started.

Please check the following link:

http://www.hivandhepatitis.com/hepatitis-b/hepatitis-b-topics/hbv-treatment/4625-easl-2014-adding-interferon-to-antivirals-increases-response-for-hepatitis-b-patients

If somebody (a HBV researcher) would like to make impressive results he /she can select HbeAg positive patients for experimenting. You can see that the story (the NUC phase, which is the starting phase of sequential therapy) is very different for HBeAg pos and neg patients:

http://www.natap.org/2012/APASL/APASL_26.htm

So for HBeAG negative treatment naiv patients the EASL 2014 results say nothing.

Naturally if your HbsAG is lower than 1500iu/ml (or using NAC for a long time and you reach this level) combination therapy is a good option for you. Independently from your HbeAG status!!!!!!
As you can see in this paper:
http://www.natap.org/2013/EASL/EASL_70.htm

If you are HbeAG negative with a HBsAg value higher than 15000iu/ml you need 6-10 or more years to reach the 1500iu/ml limit value.
From this paper (http://www.natap.org/2013/EASL/EASL_70.htm)
you can see that 3.2 log iu/ ml (1500 iu/ml) HbsAG value is a cut off value for patients having combination therapy (PEg + NUC) which is the second phase of sequential therapy.

Consequence:
- for HBeAG negative patients (based on the two papers above and the EASL 2014 results)
first phase: 3-4 years NUC (1-3 log HbsAG decease)
second, finishing phase: NUC + PEG (further 1-3 log HBsAG  decrease)
(this is the way which was followed in the EASL 2014 study!)

- for HBeAG negative patients
first phase: 3-4 years NUC therapy (only 0.5 log decrease, see the APASL 2012 paper!)
if 0.5 log decrease is not enough to reach the 3.2 log iu/ml limit value you would better to continue first phase for a couple of years to reach the limit.
second phase: combination therapy (NUC + PEG) which can finish the project.

(Stef2011 follows this path. Good luck Stef.)

If you are a HBeAG negative patient with 4.5 log iu/ml HBsAg value or more  waiting for the next generation medications is a more realistic hope. It will come earlier than you reach the limit HbsAG value using NUCS.
You should start the first phase as soon as possible, the second phase more likely to be differ from NUC + PEG.



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Avatar_m_tn
Naturally this section is for the HBeAg positive patients:

- for HBeAG positive patients (based on the two papers above and the EASL 2014 results)
first phase: 3-4 years NUC (1-3 log HbsAG decease)
second, finishing phase: NUC + PEG (further 1-3 log HBsAG  decrease)
(this is the way which was followed in the EASL 2014 study!)
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Avatar_m_tn
there is no difference at all from hbeag os to hbeag neg when hbsag is less than 1000iu/ml, end of story.i am posting the results of these studies since 2-3 years!
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Avatar_m_tn
Yes, absolutely. But there are many patients here with higher HBsAg values who would like to interpret the EASL results.


In a presentation of Lampertico you can see all the important facts about the NUC phase:
http://www.aphc.info/pdf/2014/pleniere_14012014/1030/Pietro_LAMPERTICO.pdf

Please see also page 17.

So I don't want many patient here misinterpret the EASL results.
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Avatar_m_tn
what matters the most to clear hbv:
number of years on tdf or etv, min of 3 to 8 years.

baseline level of hbsag<1000iu/ml

but clearance has been observed even with hbsag around 8000-9000iu/ml baseline, hbeag neg and only 3 years on etv.

a good example is this study we posted sooooo many times from years:

http://www.aphc.info/pdf/2014/Luncheons_13012014/S-242A/Denis_OUZAN.pdf

so in the end anybody just needs tdf or etv for 3-8 yers to clear
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Avatar_m_tn
most studies are now checking for response after short nucs treatments and not always tdf or etv but also weaker antivirals....well in the end nothing to lose because pegintf can be retried some years ahead, but to be sure at least 4-5 years on potent nucs are needed

i also noticed tdf or etv mono look better than combos but spesific studies are needed to confirm this.on dr Ozan study, which is the only one with long term nucs 3-8 years, the only patients with slow response are on combos
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Avatar_m_tn
I have checked this paper. Dr Ozan's study is not a reliable one. 10 patients are not enough. In only one case initial HBsAg value was 6050 iu/ml. In all the other cases HbsAG was very very low.


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Avatar_m_tn
Hi Stef,
Maybe this is true, but we should wait for a more reliable and extended study.
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Avatar_m_tn
This paper http://www.natap.org/2012/APASL/APASL_26.htm
says that (based on 375 HbeAg negative patients) the treatment when using TDF for 4 years can decrease HbsAg with 0.5 log in average. That is an evidence.

just see your results, maybe you arrived from 10000iu/ml to 3000 iu/ml in 3-4 years with ETV and/or TDf, that is 0.5 log decrease approximately
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Avatar_m_tn
we dont have to wait anything these are the drugs we all use for hbv and we all must combine this way, end of story.
how can you say wait?and for what?
....stay off our drugs for the sake of investors?
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Avatar_m_tn
Hi Stef, I mean that waiting for reliable scientific statements is important. I didn't write any new pieces of information, only summarized the facts of two old important papers and an EASL 2014 news.

Anyway I am absolutely sure in that you will be HbsAg neg in a two years time period using TDF + PEG. For me, who is HBeAG neg with 17000 IU/ml HbsAG, more likely that next generation drug will extend my TDF therapy in 3-4 years.
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Avatar_m_tn
Hi! Kindly can you explain the means of LOG,, the equivalence with UI/ml, so for example you saying that you have 17000 iu/ml going down to 1000 iu obviously is easy math,what about log?how is converted? i am sorry but i don't have time to study this things,i already have enough other courses
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Avatar_m_tn
log - logarithm with base 10

10 x 10 = 100 = 2 log
10 x 10 x 10 = 1000 = 3 log
10 x 10 x 10 x  10 = 10000 = 4 log

You can use this calculator:

http://www.miniwebtool.com/log-base-10-calculator/

17000 iu/ml - 4.23 log iu/ml
10000 iu/ml - 4 log iu/ml
6000 iu/ml - 3.78 log iu/ml
1500 iu/ml - 3.18 log iu/ml

If your HbsAG value went from 6000 iu/ml to 1500 iu/ml that means a 3.78-3.18 = 0.6 log iu/ml decrase.

1 log decrease means that your value is decreased to 1/10 of the original value (one tenth)
2 log decrease means 1/100 of the original value
3 log decrease means 1/1000 of the original value

0.6 log decrease means 1/4 of the original value ( 10 ^ 0.6 = 3.98 which is 4 approximately)
Instead of superscript I can use the ^ character. 10^0.6 means 10 to the power of 0.6

0.5 log decrease means 1/3.16 of the original value ( 10 ^ 0.5 = 3.16 )
(e.g. from 10000 iu/ml to  3160 ml)

so decrease in the logarithmic scale means a division on the original scale
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Avatar_m_tn
another example:

let us assume that your HBSAG is 17000 iu/ml = 4.23 log iu/ml,
after applying 3-4 years NUC monotherapy your value for example will be 5000 iu/ml ( 3.69 log iu/ml),
after this phase your doc use PEG + NUC combined therapy and your HBSAG value will be 2000 iu/ml ( 3.3 log IU /ml)

From 4.23 to  3.69 means 0.54 log iu/ml decrease.
(10^0.54= 3.46)
(1/3.46 of the original value: 17000 / 3.46 = 5000)

From 3.69 to 3.3 means 0.39 log iu/ml decrease.

From 4.23 to 3.3 means 0.54 + 0.39 = 0.93 log decrease.

( So addition on the logarithmic scale means a multiplication on the original scale. Sorry in case if it is too technical. Just use the converter (see the link above).)


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Avatar_m_tn
I don't know yet my Hbsag, but I will keep it in my mind  thank you
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Avatar_m_tn
up first page
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Avatar_m_tn
Does anyone here know the percentages of seroconversion with just NUCS alone?
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Avatar_m_tn
we all know that: on hbeag neg 0%, on hbeag pos 5% more or less.since natural hbsag loss is about 3% hbsag loss on nucs is not relevant

tdf on hbeag pos reached 16% after 3-5 years on a trial but other trial have lower rates
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Avatar_m_tn
since natural hbsag loss is about 3% per year (cumulative is much higher) hbsag loss on nucs is not relevant
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Avatar_m_tn
Cheers Steff. I'm just trying to get an idea to put things into perspective for myself so once I start a course I know where I stand so to speak in terms of a cure rate. I'll be damned if I'm going to have this virus for the rest of my life :)
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Avatar_m_tn
When using TDF mono HBsAg decrease is much higher for HBeAg positive patients (or HBeAg negative patients who were positive when TDF and/or PEG treatment started years ago).

( see Figure 4. HBsAg Kinetics among Patients HBeAG+ at Baseline
http://www.natap.org/2012/APASL/APASL_26.htm )

When you reach 1000-1500 IU/ml HBsAG value by applying TDF, just adding PEGASYS you can clear HBV in 1-2 years with a very high probability.
This is true independently from your HbeAG status as Stef say.

If you are HBeAG negative, treatment naive patient with relatively high HBsAG value, HBsAG decrease is more time consuming (cf. Fig. 4.).



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Avatar_m_tn
Cheers Bnd11 I'm pretty certain I'm HBEAG But I'll know for certain next  month.  5years max of this virus & then I'm good. I'll get the NUCS from my specialist next month
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Avatar_m_tn
Not all HBV carriers need treatment, just be sure for your status. Last week I made my MRI and elastography, no fibrous, no cirrous. Liver is healthy(thanks god) butI don't understand why i feel discomfort on the liver side.  My dna was 223 and now went 1021. No treatment, For now I begin to take only vit D3 because is low around 30, and Steff and researchers are saying that we all have defficiency of it as a result of hbv. For now i am waiting to do my HBsag test, and still i am not sure if my doctor will put me on treatment. Anyway, at least i feel relieved because I know that we have a future, a high rate of cure
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Avatar_m_tn
this post is about hbv infection cure, not treatment to manage the infection.

of course to manage the infection with drugs for life you need liver damage but to cure hbv you just need to be infected
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Avatar_m_tn
Isn't it a nice feeling knwoing we have a really good chance of slaying the Hep B  dragon with whats available all be it a very long process. I hope we all get cured :)
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Avatar_m_tn
HBSAG 780UI/ml (U/ml) (half a year ago it was 1200UI/ml)
cobas e411, ECLIA, Roche - Does someone know if this is a good machine?
HBV DNA - 4500 UI/ml
Vit d - 7
Liver tests all within normal limits.
The doctors do not want to start treatment and there is no insurance because liver tests are not elevated.
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Avatar_m_tn
please check this out : http://www.dzif.de/en/news_press/news_press_releases/view/detail/artikel/hepatitis_b_new_treatment_possibilities/
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Avatar_m_tn
Are you aware you are at highest risk of death of any cause being vitd25oh<10ng/ml and then when aids patients dye vitd25oh goes und or close to it?
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Avatar_m_tn
Steff after I will do this summer my hbsag, I will share with you,and we will discuss together. Thank You
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Avatar_m_tn
always first page
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Avatar_m_tn
vitd25oh less than 30ng/ml decreases response to all therapies peginterferon, antivirals and antibiotics both for hbv, hcv and all infections.it is best to avoid such suggestions that put health and life at risk
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Avatar_m_tn
...
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Avatar_m_tn
up
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Avatar_m_tn
Hi ,this is the post that Steff is talking about, and this is our cure
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up
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Avatar_m_tn
up
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Avatar_m_tn
up
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Avatar_m_tn
Up first page
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Avatar_m_tn
....
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Forza Italia!
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GO  Champions  USA and ITALY
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Avatar_m_tn
first page
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Avatar_m_tn
the only one
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7951432_tn?1400922437
hi
i dont want to disopointed all of you,but this treatement didn t work on all patients, and the rate of 91%of success is not true
my doc was in easl congress this spring and she told me tat add peg int after taking viread or years  is not the sollution to clear hbv maybe few patients responce because the results are not always good and hbv is  not always cleared
and the good news is that they manage fastly to find a real cure since they found one for hepatitis c
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Avatar_m_tn
the result is true for hbeag positive with very low hbsag

If someone's hbsag is not very high...he might lower it slowly with many years of entecavir/tenofovir...and then try interferon....and so reach the cure.


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Avatar_m_tn
There is a conference in Toronto on November 5th and 6th, it's about curing Hepatitis B & C. Sit tight all, I think something good may come out of this one for us (since the C cure is already out there!)
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Avatar_m_tn
I expect something big will happen within next 3-10 yeas regardin Hep B
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Avatar_m_tn
I don't know about your doc if he or she understand good english, There are some clearly proven results that shows clearing hbsag with sequential therapy when hbsag is less than 1000. This therapy takes some years, and if rep9ac or arc520 will come up soon,it means that this sequential would takes no years but weeks to clear hbv,as is happening with hepc carriers
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7951432_tn?1400922437
hhhhhh, she understand englsh very well
she told me that this treatement didn t work on  all patients
few ones only ,it  can tbe  considered it as a cure for all
here in France they applied this in hospital in paris 'Beaujon)as trial and she gave me  the numbers of cases wich success and those wich field  about 20% only respond ,;and each country did this trial;in the easl congress the results are not very good,few patients respond and you can ask your doc
also she asks me if i want to try after taking viread for 2 or 3 years and observe hbsag value during this time ,because now i have hbsag 3700iu/ml so high it will not work now  
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Avatar_m_tn
I do not think your doctor is right. Whether you are going to respond to interferon or not solely depends on your host virus relationship. Today science is not able to explain why some respond to intf and some don't.
There is no way to know for sure but try and no reason for doctor to claim that intf will not work on you.  
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Avatar_m_tn
I dont think your doctor is talking about patients with hbsag less than 1000iu/ml by use of antivirals for 5-6years because the results are clear, she was probably talking about higher hbsag and less years on antivirals because all trails on sequential found percentages for these years and for that hbsag found clearance from 60 to 90% and these have been shwon in easl, there are no other trials with these details but only the ones published here.

for higher hbsag and little years of antivirals everybody knows even here the numbers are just little higher than mono

also think like devil........ there are investments and this thread is not the favourite of companies looking for investors like replicor and all others and there are also some doctors tied to drug companies......they ll never talk well about sequential
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7951432_tn?1400922437
no stef
she talks about patients with less hbsag

i always talk with her about new treatement and she gives me what real happen and give me explinations about each trial the good side and the bad side
because she is doing researches about hep b ,she is not just a hépato but also a researcher
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Avatar_m_tn
My doctor is also a specialist of liver, chief of department of GI in NY, reseacher for a new drug on hep, but not all of them have been guiding this trial. To do a trial, It takes many years, and you can't come out with a decision or with just few patients. We believe in real facts, real numbers, real cases, real publications. All of us know that we have tenofovir and peginterferon to cure our disease but it  takes years. What we want is a fast cure. And this is going to happen only after 2-3 years when rep9ac or arc520 will be on market.
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Avatar_m_tn
There was user name Paris1982 or smth (also from France), well her hbsag was much higher then 1000 iu/ml she added peg and it worked well for her, she also developed antibodies to hbsag as well.  
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7951432_tn?1400922437
you know andry;what i remark here is each one react deferently towards treatement,and this what i am trying to say  and what my doc explains to me,but we cant generilise or agree that there is a sure cure  for hep b
when we see hep c ,yes there is a cure with label and efficient for 99%wich works similarly on all hep c patients
for us it is related to the chance and construction of the body of each one of us
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Please, if somebody has something new to say is welcome, we need real publications to spread out. My mom and my auntie has high blood pressure, and enalapril doesn't work to my mom's body.So Flyinsky, we know that each of us has unique chemistry, we are talking for general human being,and we are to finish and eredicate this virus. Sequential therapy works on 91% of people, period
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Sequential therapy certainly increases the rate of HBsAg seroconversion, but I am not sure that it has been clinically proven to be as high as 91%. I do agree with Flyinsky that the therapy may not work for everyone. Some researchers believe lowering the serum HBsAg, then add PegIFN may not be sufficient to lead to clearance for everyone. We are assuming that by lowering hbvdna and HBsAg, the HBV specific T cells immune functions can be restored, Interferon can further reduce HBsAg and also modulate the immune system, so the two combined may lead to HBsAg seroconversion. We are hopeful that these assumptions are true.

Reducing HBsAg (naturally or by using REP9AC' or ARC520) to restore the immune system is not the only approach. In cancer research, they are now using anti-PD1 and anti-PD-L1 monoclonal antibodies to remove these so called "checkpoint" that is characteristic of T-cell exhaustion.

I also believe therapeutic vaccine can also boost the number of T cells if given at the right time so that they are not inhibited by viral antigens.
HBV is tricky, we need to throw everything at it to secure a cure.

These are just my personal opinions.
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hi stef,
             i am kru from india....i took my blood test 3 months ago .......both hbsag and hbeag  positive.......first i want to reduce my hbeag.because my company asking about only hbeag..........so tell me about interferon....is it suitable treatment for me...........please tell me..this is spoil my career...
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your company is very ignorant anyway making hbeag negative is easier than hbsag

go for tenofovir for 1 year if hbvdna is not already undetectable naturally then add on peginterferon for another 48 to 96 weeks to tenofovir, this makes the highest chances to make hbeag negative
if hbsag is very high this may not work
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first page up
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first page up
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back to first page for this cure, until the cure drug is approved/release :)
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It's not about me, but other member from  other forum.

He is hbv chronic
HbAge nagative.

He wrote:
"After 12 weeks take baraclude hbs antigen quantitatively decreased for me with 19000 el/ ml to 54 el/ml. "
So he didn't need years to decrease hbsAg from 19000 thousand to 54 pieces.
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yes he is among the very little minority of 5% hbeag pos who clears on antivirals.also a member here cleared but it is an extreme minority, 5% is nobody
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he now has to check if decrease will slow, sometimes even if hbsag is 10-20iu/ml it takes 5 to 10 years to clear it, in this case pegintf might fasten decrease by 48 to 96 weeks to clear
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Stef, but he was hbaAg negative when he started take baraclude, not hbeAg positive,
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in this case the percentage is even lower than 5%, dont remember if they have any on hbeag neg, most studies report 0% on both etv and tdf
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You wrote:

''none, hbeag pos responds better than hbeag neg

but this study was on hbeag neg"

So people with hbaAg negative responds too for antiviral. therfore there is nothing strange that he manager to decrease from 19000 to 54 hbsAg.
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Almost nobody clears hbsag on antivirals alone whatever hbeag pos or neg, 91% clear when adding pegintf on an hbsag less than 1000iu/ml

the topic is peg add on hbsag less than 1000iu/ml, so please you are off topic, post on another thread about antiviral mono
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Steff,

He decreased from 19000 to 54, no to 0 (Zero).
54 is less than 1000 iu/ml.

Thats it.
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Stefan. All this is known about combo therapy. But it is hard to find a doctor that is willing to do Peg now. They are all writing nucs prescriptions.
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Bump!!
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This is not the cure, most doctors will not agree to this. There is no cure as of yet. May i ask how many members here have cleared hbsag using this strategy? 1 or 2 maybe. Until all doctors prescribe this and more members clear hbsag this post is toilet paper
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stop spamming, you are nobody to judge a clinical trial

if you dont find doctors thats your problem, not the drugs not curing.in many countries it is available both in europe or asia by doctors and free on trials

as to the members in the forum all on the combo cleared or reached such low levels that will clear

just to update you even tenofovir cure hbv and will clear hbsag by about 10-17years, peginterferon add on just cut the time
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the numbers of memebers clearing on pegintf or pegintf combo is reaching 5 to 10 members, just browse older posts there is a post made on those clearing hbsag to update with about 3 more members
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and of course we are talking about sequential only, pegintf plus antiviral all at once is superior but does not clear hbsag
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And not all members here are on treatment(as I am not), and researchers that announced this clinical trial have their numbers of patients, browse this trial and  you have answer.,
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Out of curiosity how long it will take in time to clear hbsag on peginterfron only if hbsag <1000? And is it 91% clearance for all?
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91% clearance and 100% response in lowering hbsag was in sequential treatment with hbsag less than 1000iu/ml

no data about peginterferon mono, we only know response is highest.

there was a study on hbvdna und inactive carriers long time ago at a easl conference, they did not check hbsag quantity at that time but it was probably less than 1000iu/ml.response for 48weeks was 30%, i dont remember if 30% clearance was within 48weeks or 5years follow up
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Yeah but I think the 91% was for eag positive isn't ? Also with my low hbsag And Hbv DNA around 40000 iu from your opinion how long will it take me to clear hbsag on mono therapy such as peginterfron as I never took any medicine in the past. My appointment is this Wednesday I'm just preparing my questions to the doctor just in case she ask me to take viread only
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Does interferon or Viread contaiin strawberry extract?
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hbvdna is not so low so i d try pegintf mono for 24 weeks if no big hbsag and hbvdna decline i d go for tdf and then pegintf add on in 1 year.i think that with peg you have to try and see then correct according hbsag levels

ask the doctor for the personalized hbv treatment according hbsag levels that most expert researchers/liver specialists are applying in italy
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So within this 24 weeks of peginterfron is there a high or low chance to get hbv DNA undetectable and possible high drop of hbsag given the fact I'm genotype D?
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there are rules for stopping peg for non response, for genotype D it is best to wait until 24 weeks instead of 12 weeks.

if no hbsag decline by 24 weeks switch to tdf, hbvdna is of little to no help because you can have rise of hbsag and hbvdna und, i am not sure but less than 2log drop of hbvdna is no response
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Stef, is Genotype D the most difficult Genotype to "cure" with this combination?
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i posted this already in this same thread, genotypes have no influence in sequential, sequential restore immune system t-cells and so the hbv is gone whatever it is the genotype
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t cell recovery and possible clearance by immune therapies is all thanks to nucs use for 5 to 10 years.so use of nucs is the base of hbv cure
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ok great lets all take nucs for 10 years and hope our hbsag level is below 1000iu/ml then hope peg can clear our hbsag..... great stef2011....   tell me if this is so great then why have you not put it into use? post your results of this cure you speak of and we can all believe........

this is spam...... if this worked we would all be on it.....

false hope.............. stef2011 also posted alinia was the cure....... did that work for anybody? cure to make hbsag positive to negative was your words..... stop misleading people with your theories
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nucs do not reduce hbsag in the majoritory and many people are above 1000 iu/ml so how can this work?

if nucs could reduce hbsag so much then why the peg add on?

POST YOUR RESULTS FOR PROOF UNTIL THEN STOP SPAMMING

chronic hep b is currently uncurable, sorry folks.

some people may be lucky and clear on peg/nucs but most will not.

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In patients with baseline HBsAg< 1000 IU/ml, 100% patients achieved complete response and 91% patients achieved HBsAg loss

IN THOSE PATIENTS

how many had hbsag less than 1000? what was hbsag before starting nucs?

what is your hbsag level? how long have you been on nucs?

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I am in no position to speak about the treatment of hepatitis but have in mind that at least in my country until last year they treated hepatitis b just to achieve undetectable  hbvdna, they just started to watch hbsag quant .if nucs can lower hbsag, in a few years it is logic that this can be possible after many years to achieve seroconversion. I didnt seen official trials on this but speaking of this, stef, do you have some links on this ? Let's hope that replicor  will manage to get to the market their arc vaccine in the next years
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Me, you and Steff are not scientists, nor researchers. This is said because of study done by researchers.

Professor Cihan Yurdaydin from the Department of Gastroenterology, University of Ankara, Turkey, have conducted this study and had presented on liver conference 2014
192 patients who had received at least two years treatment with NUCs without achieving HBeAg loss or seroconversion were treated with 48-week combination therapy with additional Peg-IFN to on-going NUCs or NUCs monotherapy.

Out of this population, 83 patients were treated with combination therapy and 109 patients were treated with NUCs monotherapy. All patients were followed for a further 24 weeks and the HBsAg level was measured both during treatment and post-treatment.
http://virtualpressoffice.easl.eu/three-new-studies-help-clarify-optimal-use-of-combination-therapy-in-chronic-hepatitis-b-patients/

Where is your prof that mostly do not reduce hbsag on nucs? I think that Steff is not misleading anybody, but thanks to him we know much more about hep B. Personally I would thank him,for taking his time to response to everybody,advising them for what he has done through his experience,bringing latest news from pisa's researchers and what is reading from internet. If you have prof for your saying you are very welcome as well.
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We are adults here and have brains so nobody will force us to do something we don't want to do. Either way if Stef was right or Wrong we do appreciate taking his time to responde like mer971 said
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I have been following this forum for a long time, I am one of the so many here who benefited from stef2011's contributions. Many thanks are due to you stef and others who provide helpful info
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thanks.

my main point is discussion that helps patients now with the cures we have available now, with such high cure rates reported we need to focus on these sequential therapies and also look in to possible improvement of response from 91 to 99%

we just need to apply this and confirm in our daily clinical experiences
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i am a mom, i am new in your community..my son supposed to be in ksa now but due to his finding that he has a mild fibrosis and doctor told him to take entegard 5mg daily...i don't know more of this virus. please help educate especially the treatment, its a very great help for me to read your reply.

worried mom...
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please open a new post because this is of topic here with all tests hbsag quantitative in iu/ml, hbvdna, hbeag, hbv genotype, liver function and fibroscan

without those tests the infection status is not known, anyway entegard which i guess is generic entecavir is ok if there is liver damage and active infection
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Hi! doctor gave prescription of entecavir 0.5mg/tab

What do you mean by mild fibrosis?

manerissa

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My son is still working with 4 shifting is it ok for him to work. Not a call center but trouble shooting and networking at the same time...
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Mild fibrosis mean little damage in the liver. And yes he can work and he should have no issue with that. Like Stef said open a new post and you will have all your answers there.
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anyway studies are Peer-reviewed so these are the results end of story and our members are showing similar results with all nucs users over 5 years clearing or so low hbsag to clear soon

if he wants to say they are different he has to set up sequential combo studies and show they are different...
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