After 16 week with Interferron + Simvastatin

[Otan]

Took 1st dose on 21 Oct 2011 and on 11 Jan 2012 HBV DNA not detected.  
Below is the lab history,                          

Date            13/9  20/10  21/10  11/11  16/11  9/12  15/12  6/1/12  11//1/12
                                   1st dose                                   12th dose
SGOT                    35*                          49*             63*                  67*
SGPT                    63*                          78*             89*                  90*
HBsAg     366.44  255.68                                                              176.4*
HBV DNA2.54x10^5                                                                   no detect

Result on week# 16

SGOT  86
SGPT  130
HBsAg  10.49

When HBsAg became zero, then what to do? Is that time to stimulate Anti-HBs?

[stef2011]

wow, i'll link your history to pisa researchers hbsag clearance before 24 weeks is rare, even if you start from very low hbsag the lowering is slow

even if hbsag becomes zero you must keep doing interferon absolutely because hbvdna and hbsag are in the serum while inside the liver it will take little longer to have them to zero

i suggest keep doing interferon until:
hbsag und
hbvdna und
alt less than 19

and check monthly for hbsab titer and wait until it is high, at least higher than 200miu/ml
if there is no hbsab development then you need to make hbv vaccine monthly and wait for response

what is hbsab now?did you check it?it may be already detactable

do look for vit d3 too

[stef2011]

by the way hbsag 10iu/ml is 100% clearance

it was already because hbvdna undetactable by 24 weeks of nterferon is clearance for sure by 5 years, i do think simvastatin boosted interferon response very much but of course other should try this to confirm

once hbsag is cleared, nd i think it will take less than 24 weeks, we can open a new thread with interferon+simvastatin experience for you and for others to follow, i will try this for sure too

[Otan]

"what is hbsab now?did you check it?it may be already detactable

do look for vit d3 too ."

No, I did not check it. I am in remote place now, will check it in town soon.
I will try to find this.

[stef2011]

hbsab is anti-hbs, they become detactable in some when hbsag gets less than 100iu/ml

[Otan]

on 13 Feb 2012 I made a check for
anti-Hbs-- negative
HBsAg-- 0.02 iu/mL

Should I wait for sometime to HBsAb to develope or do vaccination?

[stef2011]

yes wait and keep interferon and simvastatin until hbsab>200miu/ml

recheck hbsab at 24 weeks

please repost hbsag and alt results according to week of treatment.which week is hbsag 0.02iu/ml?

results of your interferon+simvastatin are increadible, hbsag clearance by 24 weeks is so rare, we always talk about years for hbsag clearance not weeks

[stef2011]

when you reach 24 weeks of treatment we will check all studies with use of vaccine to boost hbsab, also remember to get vitd3, anyway i am sure you will develop hbsab soon

[Bob0620]

1. If Otan develops HBsAB, does it mean he is cured ?

2. If HBsAg is low, does vaccination effective to increase HBsAB ?

3. Is Simvastatin approved for HBV ? I've read they are still under trial.

[stef2011]

1. If Otan develops HBsAB, does it mean he is cured ?

he is cured even with no hbsab because most patients don t get hbsag or hbvdna back again bt it is easy to get hbsab by vaccine so it is better to try it at 24-48weeks of interferon therapy

2. If HBsAg is low, does vaccination effective to increase HBsAB ?

no hbsag must be 0iu/ml or less than 1iu/ml

3. Is Simvastatin approved for HBV ? I've read they are still under trial.

no it is not approved and it will never get approved because it is too cheap and off patent now but simvastatin is now proved to prevent liver cancer and fibrosis so all hbvers are suggested to use it with ast/alt monitoring

do not wait for an approval or a trial noone will pay for it because there is no payback sim is too cheap.the trial is blocked since 2009 i think and it will neer start

[lema2210]

May I ask what status you were in before treatment? Were you on antivirals before, your hbseg status, etc? Thanks.

[grmr]

i join lema2210 question.. pls inform about your status prior to tx.

were you hbv carrier since birth?
liver status?
eag status?
age?

are you experiencing side effects on iterferon?

[stef2011]

it can also be important if there was use of anticholesterol drugs/statins before interferon and how long

gmr:
she has reported mild sides in another post but i d not consider them sides because those are signs of immune activation

[grmr]

so what mild sides?

[stef2011]

http://www.medhelp.org/posts/Hepatitis-B/HBV-almost-cleared-12-weeks-with-interferonsimvastatin/show/1676186

[Otan]

Sorry to reply late, I was at remote location internet access limited.

May I ask what status you were in before treatment? Were you on antivirals before, your hbseg status, etc? Thanks.
Before interferron treatment I did nothing at all since I felt healthy. I do the treatment becoz I lost my overseas job.

Before treatment
SGOT                    35*    
SGPT                    63*  
HBsAg                255.68  
HBV DNA         2.54x10^5    
HBeAg             non reactive
Anti HBe           reactive

Byopsi result
Chronic Heps B Metavir grade-1, stage 1.

[Otan]

i join lema2210 question.. pls inform about your status prior to tx.
pls see, i ve answer lema2210

were you hbv carrier since birth?
more probably, I have my brother has HBV. Mother never check but healthy now 78 years.

I am 47 now.


are you experiencing side effects on iterferon?

Below is my experience with Interferron teraphy,
At 1st injection, Doctor asked me to stay at hospital for 24 hrs to see the effect, but everything felt normal. Same thing happen with 2nd injection.
After 3rd injection, started feel flu symptons , dry mouth (thirsty), less taste for food (my portion still normal) but still feel strong
After 4th injection, feel headache, sleepy/weak, less taste for food  and itching. But I still can riding bicycle for exercise.
After 10th injection, sometime light headache, dry mouth,  itching , less taste for food  but feel little stronger.
But now itching is less.

[Otan]

it can also be important if there was use of anticholesterol drugs/statins before interferon and how long

No , interferron come together with simvastatin

[stef2011]

you ll sure get your job back now, hbsag is already negative at 0....iu/ml, we just have to wait for hbsab to rise

[stef2011]

i think this may easily apply also to hbv vaccine, vitd25oh>50ng/ml in serum are also needed for peginterferon therapy optimal response

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0016709

BCG Vaccination: A Role for Vitamin D?

Conclusions
Vitamin D may play an immuno-regulatory role following BCG vaccination. The increased vitamin D concentrations in BCG vaccinated infants could have important implications: vitamin D may play a role in immunity induced by BCG vaccination and may contribute to non-specific effects observed following BCG vaccination.

[stef2011]

i found article about hbv vaccine to make hbsab in those with no hbsab, i will pm email of researcher so if this happens to you after 48weeks of interferon you can contact with him

INDUCTION OF HBS ANTIBODY PRODUCTION AFTER
ELIMINATION OF HBS ANTIGEN IN PATIENTS TREATED
WITH NUCLEOSIDE(TIDE) ANALOGS AND AUGMENTED
IMMUNO-ENHANCEMENT THERAPY AS A PRELUDE TO CURE
University of British Columbia, Vancouver, BC, Canada

Background: Curremt treatment of Chronic hepatitis B aims
at clearance of circulating viral load reducing HBV DNA to
undetectable level. This is followed by more recent advances in
eliminating HBs antigen which is a reflection of the amount
of intracellular cccDNA. Elimination of HBS antigen is regarded
as an ideal end point of Hepatitis B treatment. However, HBS
antigen loss does not imply total eradication of cccDNA which
can still act as a template for viral replication. Only when
protective levels of HBS antibodies are produced in such patients
can we then safely declare them as under permanent hepatitis B
control.
Aim: To demonstrate the induction of Hepatitis B antibodies
production in Chronic hepatitis B patient cleared of HBS antigen
with Nuclotide(side) analog with or without immuno-enhancement
therapy with augmented doses of Recombinant HBV vaccine
together with immuno-vaccine enhancer.
Method: 8 patients: 7 male and 1 female, age 29–53, median age
38 who were successfully treated with entacavir or tenofovir with
or without interferon or thymosin achieved negative serological
detection of HBS antigen, They were given augmented doses of
Triple Recombinant Hepatitis B vaccine (Engerix B) IM toghether
with immuno-vaccine enhancer Thymalfasin 3.2 mg SC. on Day 0,
Day 30, and Day 180. Hepatitis B surface antibody were then
measured on each patient on Day 210.
Results: 6 of the 8 patients demonstrated positive response with
protective tires of HBS antibodies ranging from 50–600–mIU/ml.
One patient showed no response and one patient’s results are
pending.
Conclusion: Induction of antibody against HBS antigen is achievable
in patients with Chronic hepatitis B after HBS antigen elimination.
This is definitely a prelude to the permanent control of Chronic
hepatitis and probably a cure for this incurable disease of the
past

[Otan]

Hbv DNA become undetected, HBsAg - down to 0.02.
HBsAb - negative.
But why SGOT / SGPT still increasing? What does it tell? Is it normal?


6 feb 12
ast- 86
alt- 130
hbsag- 10.49

13 feb 12
hbsag- 0.02

22 feb 12
ast- 139
alt- 210
hbsab-- neg

[stef2011]

But why SGOT / SGPT still increasing? What does it tell? Is it normal?

absolutely normal and the higher the better, it means your immune system is killing infected cells and that s why hbsag and hbvdna have gone down because all infected cells producing hbsag and hbvdna are being killed

when ast/alt gets normal it means most of the infected cells are killed and hbsab will rise.hbsag and hbvdna tests in the serum are very poor sensibility so even if we see hbsag und and hbvdna und in serum they are still present in the liver.
the best situation with interferon is a alt rise to 1000-1500 like in acute hbv in this case hbsab is very fast like for acute hbv, with alt at 100-300 it may take longer

the slowest is seroconversion with normal ast/alt, this one takes years like 5-10 years usually, this is the worst situation both on interferon and antivirals.of course hbvdna must be und in serum otherwise it means rise of alt is due to virus winning over immune system and not the opposite

[stef2011]

also do not worry about alt levels they are not correlated with liver damage unless this alt rise goes on for 6months or longer

[stef2011]

alt flares over 1000 are dangerous only for cirrhosis patients, while less than 1000 are not dangerous even in case of cirrhosis if compensated