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on viread no ALT normalization
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on viread no ALT normalization

Dear all, I'd like your opinion on my situation. I started taking viread in 10/2010 when I had for the first time higher than normal ALT (around 90), before that I always had very high HVB viral load (higher than 9 log). After three months of treatment, the viral load decreased to about 5 log. But ALT remained high at the same level. After one year and half treatment, now I have viral load of about 3log, with still high ALT level. Ultrasound is normal. Fibroscan is 3.9Kpa.  My doctor suggested to do biopsy, suspecting I might have early cirrhosis (He said there are surprises in HBV) evenif Fibroscan is normal.  Recently I did VitD test for the first time, and found that it is extremely low, so I started taking a dose every three months.  What can be the reason of low efficiency of Viread in reducing the viral load? Can it be because I had very high viral load in the start? or low VitD? Do I really need to do biopsy? Shall I go for combo (+enticavir)?  
8 Comments Post a Comment
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Avatar_m_tn
I am not a doctor, I will give you my opinion, hopefully others will also do so.
I slightly disagree with your doctor about the need for a biopsy. When your ALT is elevated, your Fibroscan score will tend to be higher. As for your elevated ALT, there may be other causes, such as fatty liver. Research indicates that combination of Viread + Entecavir is not superior to Viread or Entecavir alone.
Finally, why your viral load is not undetectable after 18 months of treatment with Viread, one factor may be you had previous treatment with another antiviral. The response figures for Viread are:
HBeAg positive, 76% has undetectable viral load after 1 year, 96% after 3 years of treatment
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Avatar_m_tn
Many thanks for your reply. I'm pretty slim, and I suppose fatty liver is more related with overweight, please correct me if I'm wrong.  I never drink alchohol.  I take Viread regularly. I did used Lamivudine about seven years ago for a couple of months irregularly and then stoped as I heard at that time it can induce virus mutation. What is best approach for me now? Continue with Viread, or switch to Enticavir if combo is not a better option?  I'm HBsAg positive and HBeAg positive.  
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Avatar_m_tn

you have to rule out the reason of eevated alt, hopefully it is due to a better immune system and hbsag will go down by 3-4 years faster

i do have this situation, we thought it was fatty liver or weak etv, noen of these, it was my good immune system, my alt are between 30-50.this has also no effect on liver damage and my cirrhosis regressed very fast, alt are not correlated to liver damage, they are very poor test for this.

a person with alt 10 may have no cirrhosis regression and continuous liver damage while i can have (and i did) cirrhosis regression and liver regeneration despite alt 50
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Avatar_m_tn
For want of a better suggestion, may be you should just repeat your tests in 3 months time and see.
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Avatar_m_tn
How do you test for liver regeneration ?
I think I should start my Viread treatment right away as my viral load is now over 1,500,000 copies/ml..

What can I expect from this?  Will I have side effects?  What other supplments should I take to help out my viral load situation or help out the effect of Viread?
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Avatar_m_tn
How do you test for liver regeneration ?

fibroscan, 6kpa or less is normal liver with no damage

I think I should start my Viread treatment right away as my viral load is now over 1,500,000 copies/ml..

viral load has little meaning what it matters is liver damage, hbsag quantity and hbeag pos or neg

What can I expect from this?  

to clear hbsag and hbeag by 3 years or add peg after 3 years to clear hbsag

Will I have side effects?  
no, very rare

What other supplments should I take to help out my viral load situation or help out the effect of Viread?

hbvdna will get und in a few months but this means nothing as hbv infection clearance, it just confirms tdf is working, it is hbsag quantity to matter as clearance of hbv infection, you have to monitor hbsag quantity in iu/ml and see if it lowers on therapy and if it does not by 3 years of use you have to add on pegintf

check your vitd (serum vitd25oh) and be sure to have it optimal levels around 80ng/ml, all hbv infected are deficent and good levels are 50-100ng/ml

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Avatar_m_tn
Hello, my ALT was 4 x times what it should have been, then I started taking 2 milk thistle capsules every morning (viread at my evening meal).  Germans and other Europeans are standardly given milk thistle for liver treatments, along with meds.  Apparently milk thistle helps protect the liver.  Any way within 3 months my ALT + AST levels were back to normal.  The capsules are available on the internet or at most big retailers.  Google it - it worked well for me.  Good Luck!
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Avatar_m_tn
milk thistle is already in heptech supplements which i and other members take since years.....it does have an antinflammatory/antioxidant effect which helps reduce liver damage but it has no effect whatsoever on hbv
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