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regressison of cirrhosis 48weeks etv+alinia
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regressison of cirrhosis 48weeks etv+alinia

a wonderful update after 48weeks of my treatment with baraclude 0.5mg (entecavir) plus alinia (nitazoxanide) 1.5g daily
i also changed diet with antioxidants known to reduce fibrosis in anima studies:bluberries, melatonin,omega3,green tea

cirrhosis regressed (not reversed), fibroscan 9kpa about f2 to f3 borderline, i started with a baseline value of 15.9 november 2009, 16.3 in march 2010, 13.9 in july 2010.
(cutoff values for F0 4.0kpa, F1 about 6.5, F2 about 7.1, F3 9.1 and F4 12.5)
this confirms baraclude as the most fast antiviral in cirrhosis regression while viread is better on less fibrosis stages

to talk about cirrhosis reversal (which takes years of hbvdna und)
in december we will check deeply by ultrasound to see if nodules have been absorbed or are disapearing and if structure of the liver is slowly getting back to normal, it is also important to reach F0 at 4-5kpa, if all this happens we might talk about cirrhosis reversal and not only fibrosis regression, but anyway this is not important because even if the structure of the liver is not like before cirrhosis the liver can adapt and work perfectly if fibrosis is zero
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Avatar_m_tn

new strategies to get rid of hbv:
of course researcher said etv is useless for this and a try of combo with interferon is a must unless alinia is so potent that hbsag is very low now, in that case we just increase etv to 1mg and keep alinia at 1,5-2g daily

big problems of interferon:
it would be best to get interferon lambda which has no sides but since it is produced by bms, same producer of entecavir, they are not interested in hbv trials and use of interfferon lambda for hbv, so it is now available on trials for hcv ONLY!

if anybody knows how to get interferon lambda please post since it has no sides and it act only on infected liver cells without the huge damage of the other interferons
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Avatar_f_tn
fibroscan 9kpa about f2 to f3 borderline, i started with a baseline value of 15.9

stefano170669, that's very good news. Сongratulations!
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Avatar_m_tn
Happy for you!
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1292648_tn?1303161853
Very good! Happy for you
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Avatar_m_tn
I am so happy to hear your good news, you work hard in helping others and i am glad you are doing better.
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Avatar_m_tn
of course the result is due to a combo of reasons from the capacity of own liver regeneration to the combo of drugs+antioxidants but i do suggest all those with fibrosis to start from a healthy life style which is the first most important rule for us and add daily bluberries, omega3 and melatonin to the diet, we cannot say anything certain about them but they will sure make no harm
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Avatar_m_tn
Glad to hear your good news!

Could you specify how much of each antioxidant do you take?

blueberry:

omega 3:

melatonin:

green tea:

BTW, do you take coconut oil too?
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Avatar_m_tn

first thing hbvdna must be und and alt normal by immune system or etv or tnf, after this any healthy life style is needed for hbv carriers and correct diet and antioxidant help improve it:

bluberries, 155-160gr daily.the research said that lower quantities than 152gr had no effect
omega3, about 1g daily
melatonin, 5-10mg
green tea, not every day but i drink it often

it must be also said that researcher said that on etv this result is ususal and he was disapointed i was still at 9kpa, they see even faster and lower decreaes of fibrosis during etv therapy and compensated cirrhosis
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Avatar_m_tn
Great! Congratulations!
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Avatar_m_tn
This is great news. It tell us that disease management and catching up with the most recent research are so important. Every hbver should actively participate discussions in this forum and communicate his/her experiences, because we are not professional and cannot research everything. A combination of experiences and knowledge from a number of patients will create valuable information for us to use to dynamically manage our disease. Stefano's experiences will definitely help other hbvers with similar fibrosis stage. People don't have to wait for a massive research since they don't have time to wait if the condition is progressing.
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Avatar_n_tn
Congratulations, Stefano.  Best wishes to you.
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Avatar_m_tn
Good effort,wonderful result,best of luck and congratulation

@cam4930, you got a point here
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Avatar_m_tn

i have found a study as a comparison of mean decrease of fibrosis by etv therapy
http://onlinelibrary.wiley.com/doi/10.1111/j.1872-034X.2010.00687.x/full

etv therapy mean decrease of fibrosis by 12months is only 3.4kpa

i decreased 7.3kpa already in 10months and a half (biggest decrease since hbvdna und of 4.9kpa), so those antioxidants i used might make a very big difference, although i stress that 100% proof is not possible from my experience only, i hope others can confirm this by their experience
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Avatar_m_tn
Hi,

Re your;
"combo of drugs+antioxidants"

bluberries, omega3, melatonin and green tea are rich of antioxidants.  Why we need all of them?  OR we take each of them by rotation.

I can't find much info re antioxidants and chronic hbv.

I found follows on Internet:-
Liver Disease Information
http://www.larklands.net/liver.htm

Investigation of oxidative stress and some antioxidants in patients with acute and chronic viral hepatitis B and the effect of interferon-α treatment
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TDD-4HM7S4B-1&_user=10&_coverDate=12%2F31%2F2005&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1512445412&_rerunOrigin=google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=bda01cbf4fbdeca638da9ec7db89c045&searchtype=a

Increased oxidative stress associated with the severity of the liver disease in various forms of hepatitis B virus infection
http://www.biomedcentral.com/1471-2334/5/95/

Any further you can find on Internet?  TIA

B.R.
satimis
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Avatar_m_tn
Congratulation.
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Avatar_m_tn

you should check liver fibrosis regression or similar on pubmed, i actually based antioxidants i used part on HR posts and part on a research about fibrosis regression on animal studies about blueberries and melatonin

i avoided only the antioxidants posted by HR that have an antiinflammatory effect because they might interfere with antiviral and used those who are known for a immune boosting effect
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Avatar_m_tn
http://www.sciencedaily.com/releases/2010/06/100617102706.htm

this is one on bluberries
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Avatar_m_tn
melatonin, acetylcisteine, green tea,
http://www.wjgnet.com/1007-9327/15/1452.asp
http://www.sciencedaily.com/releases/2009/11/091118101359.htm

also part of my diet are daily soia, cofee, often bitter cocao, often back rise with cucurmin

i didn t use:
emodin
sylibin
ppc
and others suggested in HR post
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Avatar_m_tn
Hi

Thanks for your links and advice.

> i used part on HR posts and part on a research about
> fibrosis regression on animal studies about blueberries
> and melatonin

Please advise where is the link?  Thanks


I found following thread;

The Impact of Diabetes Mellitus on Fibrosis Progression in Patients Transplanted for Hepatitis C
http://onlinelibrary.wiley.com/doi/10.1111/j.1600-6143.2006.01408.x/full


B.R.
satimis
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Avatar_m_tn
Hi,

Re your "new strategies to get rid of hbv:"

Whether it includes complete eradication of cccDNA?

TIA

B.R.
satimis
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Avatar_m_tn
I thought Melatonin induced us to sleep only and I don't know it is an antioxident.
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Avatar_m_tn
Whether it includes complete eradication of cccDNA?

this is an impossible end point for both acute hbv and cronic (chronic) hbv, hbv can only complitely control by immune system by hbsab antibody which blocks virus entrance in liver cells.

Once hbsag become negative hbsab will appear, in this condition cccdna is very low and not detactable by our assays even on biopsy but it will be present for decades anyway, complete eradication of cccdna might be achieved by 10-20 years of suppressed hbv maybe

anyway it doesn t matter complete eradication of cccdna, but hbsag neg and hbsag pos for immune control

strategies are:
if hbsag continue to decrease, keep etv+ntz and increase etv
if hbsag slow down decrease or doesn t decrease interferon+etv+ntz, if interferon lambda will be on the market by about 1 year i will wait for it because i don t like sides of normal interferon
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Avatar_m_tn
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Avatar_m_tn
Hi,

Thanks for your advice and links

>> Whether it includes complete eradication of cccDNA?

> this is an impossible end point for both acute hbv and cronic (chronic) hbv,
> hbv can only complitely control by immune system by hbsab
> antibody which blocks virus entrance in liver cells.

cccDNA is the source of hbv.  Suppressing it from being active only slows down hbv replication.  It'll become active again, similar to keeping a bomb in a drawer.  When the bomb will explode?

I read some articles on Eastern medicine claiming able to eradicate cccDNA.  But there is no lab nor clinical proof.  The medicine which slow down cccDNA replication is only a temporary control or temporary solution.  It is NOT a cure.  However it is better than NONE.

satimis
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Avatar_m_tn
Hi,

Following article states how "cccDNA" comes.

Intrahepatic HBV cccDNA Pool
http://www.medscape.com/viewarticle/581590_6

During HBV infection, cccDNA accumulates in cell nuclei and persists as a stable episome and acts as a template for the transcription of viral genes ......


Following article states how "hepadnavirus is replicated" - by an unknown mechanism

Mechanism for CCC DNA Synthesis in Hepadnaviruses
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0008093

Hepadnavirus replication requires the synthesis of a covalently closed circular (CCC) DNA from the relaxed circular (RC) viral genome by an unknown mechanism.


I'm interested to find the information re "study on cccDNA eradication".  I have been searching heavily on Internet without positive result.  I'll continue when time allows.
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Avatar_m_tn
cccDNA is the source of hbv.  Suppressing it from being active only slows down hbv replication.  It'll become active again, similar to keeping a bomb in a drawer.  When the bomb will explode?

hbsab blocks viral entrance so the infected cells with cccdna will slowly dye together with cccdna.the bomb will never explode unless you destroy your immune system

once your immune system has hbsab you dont need to care about the tiny amounts of cccdna left
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Avatar_m_tn
> once your immune system has hbsab you dont need to
> care about the tiny amounts of cccdna left

The point is how to keep hbsab postive permanently?  After stopping therapy cccdna will becomes active again.  The bomb is always there.  In such a circumstance the patients have to taking medical treatment for the rest of their life.
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Avatar_m_tn

once hbsag is negative your immune system will work again like for all other people who cleared hbv, hbsag is the main immune system suppressor

the ways to lower hbsag already available are:
interferons, boosting interferon effect by nitazoxanide and entecavir or tenofovir.the best way is start with ntz follwed by entecavir or tenofovir after 4-12 weeks because also hbvdna suppress immune system and some interferon non responders become responders after hbvdna is und by entecavir or tenofovir, so the combo of these drugs will make hbsag lowering (results from previous trials interferon+adefovir better results than all other therapies but still too weak, telbivudine+interferon sides)

very near future:
interferon lambda which is by far better than normal interferons with no sides will be the way of the future since combined with etv and tnf will have no issues

who knows when:
rep9ac from replicor
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Avatar_m_tn
Sorry I still haven't got the point.

HBsAg, which indicates current Hepatitis B infection, is the surface antigen of the Hepatitis-B-Virus (HBV). An antigen is a molecule recognized by the immune system

A "negative" HBsAg test result means that the person is NOT infected with the hepatitis B virus.

HBsAb is the hepatitis B surface antibody.  The antibody protects against Hepatitis-B-Virus (HBV) infection.

A "positive" HBsAb (or anti-HBs) test result indicates that the patient has recovered from hepatitis B infection. This result means that the patient is immune to hepatitis B infection.

What makes the patient achieving above results is the medical therapy which suppresses the active of cccDNA.  But if therapy halted cccDNA may be active again.  The root is still there.  It is the source of HBV.  This kind of therapy is only a temporary cure.
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Avatar_m_tn
greeting,
             is u have mention about the blueberry,melatonion,omega3,
             dear friend i am a patient from 2003 to hepatitis b upto 2009 i repeat every year the DNA test it was negative each year without any medication.but now in 2010 i tested positive for DNA i consult the doctor he advise me enticavir for 2 years.my liver ultasound show cirhosis impression.
my question is that can i used these three ingridients and also tell what HBeAg means.
thanks
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Avatar_m_tn
What makes the patient achieving above results is the medical therapy which suppresses the active of cccDNA.  But if therapy halted cccDNA may be active again.  The root is still there.  It is the source of HBV.  This kind of therapy is only a temporary cure.

hbv persists because it suppresses immune system mainly by hbsag, if you remove hbsag the underlaying antibody hbsab takes control of hbv and cccdna slowly decreases to und by our assays but it is not zero, it may persist all life.
do not rely on old studies because they use wrong words or are wrong, for many viruses and hbv family also, eradication doesn t exist they can only controlled to und by immune system but the template is hidden inside cells, herpes, papilloma virus, citomegalovirus and many others, they all have the residual template hidden but until immune system works you might say they are cured or und

This kind of therapy is only a temporary cure.
no if it is immune system to take control it is definitive.we have millions of viruses/bacteria inside us in a balance with immune system, if you like you can consider it hbv eradication because it makes no difference until you have an immune system.
as an example why aids patients get all kinf of viruses/bacteria/cancers once immune system is destroyed, the viruses were already inside the body and once immune system lose control they attack the body




at present there is no way to eradicate hbv cccdna, herpes virus, papilloma virus and many others, they stay hidden inside cells in a balance between immune system and virus.actually is a similar concept of health, health is a balance, perfect health doesn t exist


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Avatar_m_tn
if you see cirrhosis from ultrasound it is well advanced, you should have monitor by fibroscan and not blood tests, we now know all blood tests are useless in terms of fibrosis and liver damage

you must get immediately hbvdna<10iu/ml or und, alt<30, hbe negative, so that the virus can make no damage to you

follow through the posts the same antioxidants i used not only bluberries, when hbvdna is und, hbe negative and alt<30 you can add all the list posted here:
http://www.medhelp.org/posts/Hepatitis-C/Research-supported-antifibrotics---do-they-exist/show/346752
it is better to use all of them when antiviral has suppressed all virus to avoid interference

you can also get all these supplements from hepatitistechnologies, if you google it you will find it

entecavir is the best choice but it is necessary to make a resistance test before you start it because it doesn t work if LAM mutants are present, these mutants can be present naturally or after therapy with this drug

it is also very important to check liver by fibroscan every 3-6 months to see improvement in fibrosis

i also used alinia (nitazoxanide), at the moment it is better not to use it because it is off label and we don t have any proff it can also act as antifibrotic, but if you see no improvement by fibroscan after 6 months you should try to add alinia too.it has a stong effect on apoptosis of cells so theoretically it might have a little effect on fibrosis too but there is no proof so do not use it at first

also follow my posts about alinia and if you see i get hbsag negative or very very low you might add it too because a reduction of hbsag in vitro has shown to reverse HCC growth

i wish you can reverse cirrhosis as soon as possible, do post your fibroscan results and check for liver cancer every 6 months by ultrasound because you have the highest risk of liver cancer until fibroscan is more than 10kpa, any value of fibrosis lower than 10kpa is safer
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Avatar_m_tn

i forgot to tell you to add nac (acetylcisteine) too from start, this is a potent antioxidant/immune booster which helps liver and kidneys work better, the dose in heptech protocol is 2400mg daily and i am using this dose from 15 sept
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Avatar_m_tn
Hi,

> as an example why aids patients get all kinf of
> viruses/bacteria/cancers once immune system is
> destroyed, the viruses were already inside the
> body and once immune system lose control they
> attack the body

If I understand your advice correctly, the viruses are existing inside the body but dormant (or inactive).  It is because the immune system of the body being in sound condition putting them to that state but can't remove them.

Applying this principle on HBV, the virus, replicated by cccDNA, is inside the body but being non active when the immune system of the body is in sound condition putting them under control.  Once the situation changed due to an unsound condition of the immune system the HBV will become active again attacking the liver.

That is my point.  The source of the virus- cccDNA, taking the liver cell as the place of abode, continues replicating HBV even in slow production and waiting for a chance to retort.  We never know when the immune system, the body's defense, will become weakened.  In such circumstances the patient has to attend follow-up medical consultation at regular base for the rest of his/her life.  In parallel he/she may have to resume therapy against HBV when the situation changed.

B.R.
satimis
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Avatar_m_tn
your point is correct but once hbsab is present the entrance to other cells is blocked so there is no way hbv can rise again to make a lot of damage, hbsab must lower to less than 10miu/ml but for this to happen the immune system needs to be very very damaged, even people with aids have enough immune system to keep producing hbsab

in any case even after hbsag seroconversion it is good to check for hbvdna pcr below 10iu/ml because residual viremia is present in some and here you got the point perfectly, this condition is called occult hbv, but a perfect liver with no fibrosis has no problems with occult hbv or residual viremia

in the case of cirrhosis it is another story, hbsag seroconversion is not enough and antivirals must be kept until cirrhosis has complitely regressed to a very safe stage, this is because even very low viremia keep making remarkable damage to a cirrotic liver and liver cancer can develop even after hbsag seroconversion in cirrotic livers

in my case even if i achieve hbsag negative and hbsab positive i will keep making hbvdna checks every 3-6 months, ultrasound every 6 months and will keep entecavir+alinia until the liver is complitely recovered, i prefer to stay on the very safe side, this is also the point of view of the most expert researchers on cirrhosis
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Avatar_m_tn
Hi stefano,

Lot of thanks for your detail advice.

Scientists are now casting their eyes on cccDNA and its eradication.  That is ultimate therapy.  They are now heading on combined antiviral drugs and immune activator to clear cccDNA.

I have been searching heavily on Internet without much result.  Maybe it is just started.


I found:-
Hepatitis B Virus Replication Is Regulated by the Acetylation Status of Hepatitis B Virus cccDNA-Bound H3 and H4 Histones
http://www.gastrojournal.org/article/S0016-5085%2806%2900002-3/abstract


Siete italiano ?

I'm looking for the article:

Tallone d'Achille di epatite B
(Achilles heel of HBV)

written by Prof Massimo Levrero of Sapienza Università, Roma

English version preferable, if possible.

Parlo poco Italiano solo

Potete aiutarmi? Per favore

Grazie


B.R.
satimis
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Avatar_m_tn
Hi,

I found the article:-

Control of cccDNA function in hepatitis B virus infection
http://www.jhep-elsevier.com/article/PIIS0168827809003894/fulltext

Massimo Levrero
Teresa Pollicino
Jorg Petersen
Laura Belloni
Giovanni Raimondo
Maura Dandr


satimis
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Avatar_m_tn
If a carrier of chronic HBV having blood test result with Hbsag negative and Hbsab positive does he/she still possesses a potential risk spreading HBV to other?  If YES, in which most possible route?  Assuming no occult HBV is found on PCR test.  TIA
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Avatar_m_tn

thanks for the articles, they are very very interesting and get right to the point of hbv persistance (drug makers don t like these studies for sure), i will read them carefully tonight
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