role of undetectable viral load in hbv patient

[varsa]

What is the role of undetactable viral load in chronic hbv patient.today i visit head of gastro in pearless hospital he told me if viral load in undetectable (taking entacavir 0.5 mg) then there is no chance of hcc. He just order for fibroscan. So dear community member please guide in this topic. Thanks

[stef2011]

everything fluctuates always, too many variables but when it goes down constantly on good numbers it is immune system only

I suppose only way nowdays to have a chance to lose HBsAg quickly (1year) is peginf ?

1 year is only on very few, pegintf keeps working for years after therapy it unlocks immune response which continues working after therapy

[sorte]

Is HBsAg fluctuating for example depending of current person's immunity during a season or it's rather stable or raises when no therapy ? Or maybe it's level depends on HBV DNA level ?

I suppose only way nowdays to have a chance to lose HBsAg quickly (1year) is peginf ?

[stef2011]

on hbeag pos hbsag is 16% at 3 years on tdf

hbsag is reduced to less than 1000iu/ml by 5 years of tdf on 50% and reduced to less than 100iu/ml on 20-30%.
we have nobody on tdf for more than 8-9years so we can only see hbsag decline on these years and see according to this decline what will happen and it is estimated an hbsag loss at 17years

[mike9111]

Also to add to what stef said etv have proven to cause lung cancer in mice although no human yet but i would be a bit careful if the doctor ask me to take it.

[sorte]

is it possible to rid off HBs just on tenofovir ? Or those are rather rare cases in compare to peginf ?

[stef2011]

So for such long time it may toxic to renal funtion and bone density loss.

that s a myth and not a scientific fact, people who had such problems had that already baseline, keeping high normal levels of vit d will prevent that anyway while we also discussed in the past the damage to our dna and our mitochondria after decades of antiviral use and entecavir makes more damage than tdf according to a researcher that posts here.i d suggest also checking with another doctor about tdf or etv and also possible peginterferon add on when hbsag reaches less than 1000iu/ml of hbsag

if your target is to get rid of hbv once and for all tdf is the best choice because the most potent on hbsag

[varsa]

Stef i told to my doctor that tdf have no resistance, please switch to me etv to tdf. But he replied me that for hbeag negative person there is no stoping point of nuc medicine. So for such long time it may toxic to renal funtion and bone density loss. He told that tdf is very good for those who want pregnency.now you dont want pregnancy.so it is better to u use entacavir.

[stef2011]

actually resistance is 0%, 1% cannot suppress hbvdna to und but the good thing of tdf is that you dont develop resistance even if hbvdna remains detectable while on others antivirals this is very dangerous

there was a study about the small percentages of hbvdna not und on tdf or etv mono, dont remember if they found the reason but it was not resistance variants

[mer971]

Another study showing that using tenof for 7 years with 99% no resistance. http://ow.ly/I7Gpu

[stef2011]

http://www.natap.org/2012/HBV/liv2805.pdf

this may be a good study to read now i have no time to read it but reveal study should have good data on hcc prevention

[stef2011]

no dont stop it, in any case the reason of taking antivirals can be prevention of any fibrosis and try sequential treatment to clear or lower hbsag very much

as to etv i do suggest to change to tdf because more potent and also able to lower hbsag less than 1000iu/ml by 5 years (30% less than 100iu/ml) according to one study, dont remember how many patients on this study, it is posted here in the forum

while we do know etv has little effect on hbsag on hbeag neg

[varsa]

Thanks a lot stef for your guidence.what i understood from this forum is that fibroscan is the best marker that one should start medicine or not. But my doc has already start the medicine before waching fibroscan. He just watch hbeag
Negative and when hbv dna >2000 he start the medicine of entehep o.5 mg daily, now stoping medicine will also harm.
Now i am waiting for fibroscan result
Should i stop medicine if fibroscan is in normal range? As per my knowledge it will harmful to stoping medicine

[stef2011]

as to the first question is making hbvdna und enough to prevent hcc?

there are many studies some finding less risk on cirrhotic but more risk on normal livers.some studies found less risk overall

i think the best we can do is follow all the steps to prevent:
most potent nuc (tdf), use pegintf add on after few years of nuc to lower hbsag less than 1000iu/ml.have a healthy diet, supplement vit d3 to make vitd25oh 100ng/ml, take a lot of coffee every day

[stef2011]

unfortunately no chance of HCC does not exist in real world even for those not infected by hep viruses, but the steps above will lower risk to very very low

according to a study just posted these days etv is the worst antiviral on hcc prevention

if you will use that same doctor try questions to understand if he is corrupt in use of entecavir, i am very curious if all these etv prescribers are paid to do so or just ignorant.

maybe a question to understand this...yes i ll take entecavir but only the teva generic version...

what do you think members, are there other questions to understand why there are so many etv prescribers around?

[stef2011]

What is the role of undetactable viral load in chronic hbv patient.today i visit head of gastro in pearless hospital he told me if viral load in undetectable (taking entacavir 0.5 mg) then there is no chance of hcc.

this is a lie or this doctor is another ignorant or a seller of drugs.
making hbvdna und is just one step and can only prevent liver damage if also all the rest of life style diet is healthy

first of all hbvdna is never undetectable in the liver and blood, just lowered to a low level which tests cannot detect (sensibility of tests have many limits of course) where damaged to the liver is balanced with repair

the second step is making hbsag less than 1000iu/ml on hbeag negative and hbvdna undetectable otherwise HCC risk remains elevated (on hbeag positive and high hbvdna  and high hbsag not clear yet, probably very low risk in this case of immune tollerance)

make fibroscan less than 7-8kpa by antivirals, antioxidants/heptech to reduce firbosis fast.only antiviral is very slow to reduce fibrosis and may take from 5 to 10 years from 9-10kpa to normal 5-6kpa