should I start anti viral treatment?

I am a chronic HBV carrier for 20 yrs. Latest lab results.HbsAg 2.6 ,HbeAg  negative S.G.P.T   38  S.G.O.T   33  Other values normal.HBV DNA 700viral copies.Ultra sound scan result says slightly coarse echo texure with mild enlargement of left lobe. Doctor asked to take Lamuvir 100 for 3 months.I fear to start as this may become lifelong please advise.

[stef2011]

Doctor asked to take Lamuvir, absolutely do not take that drug, the only firstline drugs are tenofovir, entecavir, interferon.that drug will make hbv mutated and aggressive making all drugs useless r less active

change doctor because it told you a drug that makes damage, you have low virus so those drugs are not usefull for you, he didn t check your liver damage which is the most important thing to chosse if therapy is needed

make fibroscan or biopsy to know your liver damage, for this ultrasound is useless, if you find more than f2 or 7kpa damage you might try:
interferon+alinia (nitazoxanide)
entecavir+alinia
tenofovir+alinia
alinia only

i'd suggest to try alinia only snce your hbvdna is low, nizonide500 by lupin is the cheapest generic, alinia has very mild sides, makes no resistance or virus mutants, can be stooped with no danger

[stef2011]

Doctor asked to take Lamuvir, absolutely do not take that drug, the only firstline drugs are tenofovir, entecavir, interferon.that drug will make hbv mutated and aggressive making all drugs useless r less active

change doctor because it told you a drug that makes damage, you have low virus so those drugs are not usefull for you, he didn t check your liver damage which is the most important thing to chosse if therapy is needed

make fibroscan or biopsy to know your liver damage, for this ultrasound is useless, if you find more than f2 or 7kpa damage you might try:
interferon+alinia (nitazoxanide)
entecavir+alinia
tenofovir+alinia
alinia only

i'd suggest to try alinia only snce your hbvdna is low, nizonide500 by lupin is the cheapest generic, alinia has very mild sides, makes no resistance or virus mutants, can be stooped with no danger

[cajim]

You have HBeAg- HBV with normal liver function.  Some people choose to hold on starting antivirals.

Are you taking the conventional, Western-medicine route or some other route?

If the former, according to AASLD Hep-B Guideline 2009 Update,

If you are HBeAg+, HBV DNA (PCR) >20,000 IU/mL ALT 40 years, ALT persistently high normal-2x ULN, or with family history of HCC.  Consider treatment if HBV DNA >20,000 IU/mL and biopsy shows moderate/severe inflammation or significant fibrosis.

If you are HBeAg+, HBV DNA (PCR) >20,000 IU/mL ALT >2 x ULN, then, observe for 3-6 months and treat if no spontaneous HBeAg loss.  Consider liver biopsy prior to treatment if compensated.  Immediate treatment if icteric or clinical decompensation.  IFNa/pegIFNa, LAM, ADV, ETV, TDF or LdT may be used as initial therapy.  ADV not preferred due to weak antiviral activity and high rate of resistance after 1st year.  LAM and LdT not preferred due to high rate of drug resistance.  End-point of treatment – Seroconversion from HBeAg to anti-HBe.  Duration of therapy: IFN-a: 16 weeks;  PegIFN-a: 48 weeks;  LAM/ADV/ETV/LdT/TDF: minimum 1 year, continue for at least 6 months after HBeAg seroconversion; IFNa non-responders / contraindications to IFNa -> TDF/ETV.

If you are HBeAg-, HBV DNA (PCR) >20,000 IU/mL ALT >2 x ULN, then, IFN-a/peg IFN-a, LAM, ADV, ETV, TDF or LdT may be used as initial therapy.  LAM and LdT not preferred due to high rate of drug resistance  ADV not preferred due to weak antiviral activity and high risk of resistance after 1st year.  End-point of treatment – not defined.  Duration of therapy:  IFN-a/pegIFN-a: 1 year; LAM/ADV/ETV/LdT/TDF: >1 year; IFNa non-responders / contraindications to IFN-a -> TDF/ETV.

If you are HBeAg-, HBV DNA (PCR) >2,000 IU/mL ALT 1- >2 x ULN, then, consider liver biopsy and treat if liver biopsy shows moderate/severe necroinflammation or significant fibrosis.

If you are HBeAg-, HBV DNA (PCR) <=2,000 IU/mL ALT 2,000 IU/mL—Treat, LAM/ADV/ETV/LdT/TDF may be used as initial therapy.  LAM and LdT not preferred due to high rate of drug resistance; ADV not preferred due to weak antiviral activity and high risk of resistance after 1st year.  HBV DNA6 months; 2. Serum HBV DNA >20,000 IU/mL (105copies/mL), lower values 2,000- 20,000 IU/mL (104-105 copies/mL) are often seen in HBeAg-negative chronic hepatitis B; 3. Persistent or intermittent elevation in ALT/AST levels; 4. Liver biopsy showing chronic hepatitis with moderate or severe necroinflammation.

Inactive HBsAg carrier state: 1. HBsAg-positive >6 months; 2. HBeAg-, anti-HBe+; 3. Serum HBV DNA 20,000 IU/mL after a 3-6 month period of elevated ALT levels between 1-2 ULN, or who remain HBeAg positive with HBV DNA levels >20,000 IU/mL and are >40 years old, should be considered for liver biopsy, and treatment should be considered if biopsy shows moderate/severe inflammation or significant fibrosis. Patients who remain HBeAg positive with HBVDNA levels>20,000 IU/mL after a 3-6 month period of elevated ALT levels >2  ULN should be considered for treatment.
HBeAg- patients:
● HBeAg-negative patients with normal ALT and HBV DNA <2,000 IU/mL should be tested for ALT every 3 months during the first year to verify that they are truly in the “inactive carrier state” and then every 6-12 months.
● Tests for HBV DNA and more frequent monitoring should be performed if ALT or AST increases above the normal limit.

Side effects:

IFN-a and PegIFN-a:  initial influenza-like illness: fever, chills, headache, malaise and myalgia. Other common side effects include fatigue, anorexia, weight loss and mild increase in hair loss. The most troublesome side effect of IFN-a is emotional lability: anxiety, irritability, depression and even suicidal tendency.

Lamivudine:  very well tolerated.

Adefovir Dipivoxil (bis-POM PMEA, Hepsera):  Nephrotoxicity has been reported in 3% of patients with compensated liver disease after 4-5 years of continued adefovir therapy.

Entecavir:  a similar safety profile as lamivudine in clinical trials.  Studies in rodents exposed to doses 3 to 40 times that in humans found an increased incidence of lung adenomas, brain gliomas and HCCs.

L-deoxythymidine (Telbivudine/LdT, Tyzeka):  well tolerated when used as monotherapy and has a safety profile comparable to lamivudine.   However, cases of myopathy and peripheral neuropathy have been reported.

Tenofovir:  has been reported to cause Fanconi syndrome, renal insufficiency as well as osteomalacia and decrease in bone density.

[josheeku]

I consulted another doc. prescribed tenefovir.doc. has not heard of alinia.I have started ten. 4days back.Nitazoxanide tab. is not available in this part of india. Ihave ordered for nizonide500 and hope to get it in aweek.Shall I take this without the knowledge of the doc. What should be the dose for 500mg tab. How long should i continue?pls advise.forgot to mention my age inthe last post. 44yrs male

[stef2011]

it is a very safe drug you can tell him you combo tnf with ntz

we have noticed in our group that if you start nitazoxanide first when you add antiviral the effect on hbvdna is very fast but you can also start them together, check if nitarid from cipla is available in your area but when consider that nizonide500 from lupin purity is a little better i have found a study where nitarid was used and purity was 99,45 vs lupin 99,65 (we checked lupin directly in our group)

What should be the dose for 500mg tab, the best dose as an antiviral is 4 pills per day every 6 hrs but since it can make mild diarrea (diarrhea) start with 3 pills per day every 7-9hr (take at least 2 pils at 7hrs interval).the drug stays in the blood 7hrs when taken with a meal/food.if you notice you have diarrea (diarrhea) problems that don t resolve take probiotics like lactobacillus reuteri or any probiotic that is usually taken with antibiotics.
the dose as antiparassite/antibacteria is 2 pills per day but we have seen almost no results on this dose

check creatinine while on tenofovir because it makes kidneys damage on less than 1% patients

How long should i continue?until hbsag negative and hbsab high titer, if hbsag quantification is available by abbott architect you should check if it decreases by 6 months, in case hbsag gets higher or stays the same after 6 months ntz+tnf it means ntz is not working for you so you should stop ntz.

[stef2011]

by the way do you know if entecavir generic is now available in india?

i guess ranbaxy is the most reliable since it looks quite a big internationl dug maker based in india, do you know this brand?

[josheeku]

ThanQ for the immediate response.I shall let you know about ent.generic