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Avatar universal

Best Treatment for HBv

I am 53 years old last month I have went for preventive health check up and based on the report findings the followings noted; SGOT 83 IU/L ,SGPT 200 IU/L , Doctor recmended me to see the Gastro.consultant , the gastro.consultant advised me to go for others test the result are as follows: Anti-dsDNA 16.6 IU/ml. , HBsAg test value 9520(Reactive) ,HCV,IgG test value 0.12 ( non Reactive) ,Anti Nuclear Antibody ( ANA) 0.12 , Immunoglobulin IgA 279 mg/dl , Tissue Transglutaminase antibody IgA 0.40 U/mL , Anti Mitochondrial Antibody , Serum 0.26 UL/ml , ASMA 2.70 U/mL , LKM Antibody 0.02 U/ml , Hepatitis B envelope Antibody test value (Ab) 43.0 ( Reactive) , Hapatitis Be Antigen ( HBeAg) 0.15 ( Non reactive),AFP 4.38ng/ml  , HBV DNA Quantitative,Real Time PCR 5156250 IU/ml. Based on this the Doctor advised me for the treatment  Tab.Entavir 0.5 mg one daily. Here i went for second opinion with Lever specialist consultant and he advised me to go for Fibroscan which the result is 5.91 Kpa ( Negative for fibrosis).Now the lever specialist advised for Viraferon Peg 80 mg once in a week and monitor CBC & S creatin every 15 days.I have not started the treatment yet as I am going out of India for 1.5 months as Doctor told me that this treatment will be given under there supervision , please suggest which treatment is suitable under these report.Also with vaccine this problem will be solved and how long i have to take this treatment.
170 Responses
Avatar universal
Sorry my mistake it is not trivia but TIRAVIR 300 mg . (Tenofovir disoproxil fumarate tablet) Also I am taking  Vitamin D 3 5000 iu x 2 Nos. daily make swanson & Vitamin k2 mk-7 100mcg. daily make Now.

For prostate enlargement Doctor suggested me urimax 0.4 mg.daily.

I checked cretinine & urea last month & the result was at par with the limit.Test due next month also . Previously you suggested me to take soda lemen water which i am taking daily.
Thank you,
Avatar universal
soda lemen water

yes keep it, i also take it, it prevents kidneys damage and in a study it reversed kidneys damage so that most did not need dyalisis anymore
Avatar universal
Thanks Stef , you are a great help..
Avatar universal
Hi Stef

Need your suggestion , till now i was taking Teravir 300 mg make NATCO now this company stopped making the medicine or out of stock , I have purchased Tenvir 300 mg CIPLA make . Please suggest both are same salt.. Also I am taking this tablet daily at 10 PM , Is this the correct time.. Thank you,
Avatar universal
They are the same and cipla is a good brand.remember you have to take with food, anytime si ok with food
Avatar universal
Thank you Stef , Shall follow the instructions.
Avatar universal
Hi Stef
Todays I gone for Bone blood anylisis , followings are result:


Vitamin D,25 Hydroxy:
- on 8 Nov.2013 : Vitamin D , 25 - Hydroxy ,Serum ( CLIA ) 41.05 nmol/L.
- on 22 June 2014Vitd25oh :18.22 ng/ml.
- on 24/8/2014 : 51 ng/ml.
- on 8 Nov.2014 : 51.2 ng/ml.
- on 5 Feb.2015 : 157.55 nmol/L ( Sufficient range 75-250 nmol/L )
- on 7 march 2015 : 164.50 nmol/L (CLIA method) Range 75-250 sufficient)
- on 3 April 2015: 174.12 nmol/L ( CLIA method - Ref.renge 75-250 sufficient )
- on 1 May 2015 : 65.2 ng/ml

PTH ( Parathyroid Hormone) Intact, Serum :
- on 5 Feb.2015 : 73 pg/mL ( Ref.Interval 14 - 72 )
-on 7 March 2015: 86.60 pg/mL ( CLIA method Ref.range 14-72 )
-on 3 April 2015: 73.60 pg/mL.
- On 1 May 2015: 83.80 pg/mL.

Calcium, Serum:

- on 23 Feb.2015: 10.60 mg/dL ( Ref.range 8.8 - 10.60)
-on 7 March 2015: 10.50 mg/dL .
-on 3 April 2015: 10.50 mg/dL.
- on 1 may 2015: 11.20 mg/dL.

Phosphorus,Serum:
- on 23 Feb.2015: 2.00 mg/dL. ( Ref.Range 2.40-4.40)
- on 7 March 2015: 2.20 mg/dL.
- on 3 April 2015 : 2.40 mg/dL.
- On 1 may 2015: 2.30 mg/dL.

First time I did the test for Calcium , Ionized , Serum : 1.24 nmmol/L. ( Reference range is 1.16-1.32) don't know much of this test , please let me have your comments.

My question is the value of Calcium ,Serum is on out of reference range mean on high side and the PTH is also not coming down , the vitamin D,25  serum also almost same as one month before. Please let me have your comments on it.
Last one month I have severe pain on my upper back just behind chest. Don't understand the reason.

I met with Doctor Endocrinologist and he suggested to go for Parathyroid scan which i  am doing on 4 May 2015 , this test is slighlty expensive @USD 140/

I am still taking Vitamin D3 & Vitamin k2 mk7 , let me know should I continue Vitamin D3 or stop for some time.
I am taking 3 litres water with 0 calcium on it.

Looking forward your suggestion / comments.

Others test like qHbsag , HBV DNA and kidney test , LFT will be done next week as a routine six monthly.

Thank you,




Avatar universal
this pth level is so strange, if there are no troubles with Parathyroid scan i d suggest to supplement with vit d cofactors like magnesium chelate 400-600mg daily, vitamin A retinoids about 3000iu daily.maybe vit d is not workign because there are other deficiencies but the very strange thing is calcium is high and pth is out of range.

when calcium is high pth must go down if not so there is something in Parathyroids not working, some parathyroid glands disease

it is best to lower vit d for now, what did Endocrinologist suggest to lower calcium?
Avatar universal
Hi stef

Doctor suggested to give some break for Vit.D3 and continue with Vit.k2mk7.
After the parathyroid scan we will suggest further.
Avatar universal
Hi Stef

Hope you doing good , I have done serum & 24 hours urine test, & scan please find the report:
Serum: Test  Dated 10 May 2015
-S.calcium: 9.6 mg/dl.
- S.phosphorus : 4.9 mg/dl.
- s. creatinine : 1.4 mg/dl.
- Albumin : 3.45 gm%.

24 Hours urine : test date - 10 May 2015.

- Total urine volume 3500 ml.
- urine creatinine 1.36 g ( normal range Male 1.1 -3.0 mg/24 hrs.)
- urine calcium : 1335.0 mg ( normal range 25-300 mg/24hrs.)
- urine calcium :  1.33g  - (on average calcium intake 500-800 mg/24 hrs.)
- urine phophorus : 1.22 g ( normal range 0.3 - 1.3g/24/24hrs.

Beside these test I did Scan , X-ray ete.
Report date 4 May 2015: Examination performed: 10 min Iso time static image were acquired at 10 minutes and 2 hours following intravenous injection of 20 mCi of 99m Tc. Sets MIBI.
Findings: Initial images reveal physiological tracer accumulation in the third gland and submandibular salivary glands , normal washout of tracer is seen from the thyroid in delayed image acquired at 2 hours.
No other abnormal area of tracer accumulation is seen anywhere else in the neck or mediastinum.
Impression: No scan evidence of parathyroid adenoma seen .

X-rays: Both hands AP : No bone injury noted.
X-rays Skull lat: No bone noted.

This time I have changed the Lab. I noted the S.calcium level dropped, below are the previous test.
24 hours urine test did first time please give your opinion.
I met with two Doctor on different timing to 100% sure on the parathyroid result but as per this report there is no problem.
Both doctor asking to repeat test after 1 month as there is no medicine started .
Looking forward your comments,
Thank you,



Vitamin D,25 Hydroxy:
- on 8 Nov.2013 : Vitamin D , 25 - Hydroxy ,Serum ( CLIA ) 41.05 nmol/L.
- on 22 June 2014Vitd25oh :18.22 ng/ml.
- on 24/8/2014 : 51 ng/ml.
- on 8 Nov.2014 : 51.2 ng/ml.
- on 5 Feb.2015 : 157.55 nmol/L ( Sufficient range 75-250 nmol/L )
- on 7 march 2015 : 164.50 nmol/L (CLIA method) Range 75-250 sufficient)
- on 3 April 2015: 174.12 nmol/L ( CLIA method - Ref.renge 75-250 sufficient )
- on 1 May 2015 : 65.2 ng/ml

PTH ( Parathyroid Hormone) Intact, Serum :
- on 5 Feb.2015 : 73 pg/mL ( Ref.Interval 14 - 72 )
-on 7 March 2015: 86.60 pg/mL ( CLIA method Ref.range 14-72 )
-on 3 April 2015: 73.60 pg/mL.
- On 1 May 2015: 83.80 pg/mL.

Calcium, Serum:

- on 23 Feb.2015: 10.60 mg/dL ( Ref.range 8.8 - 10.60)
-on 7 March 2015: 10.50 mg/dL .
-on 3 April 2015: 10.50 mg/dL.
- on 1 may 2015: 11.20 mg/dL.

Phosphorus,Serum:
- on 23 Feb.2015: 2.00 mg/dL. ( Ref.Range 2.40-4.40)
- on 7 March 2015: 2.20 mg/dL.
- on 3 April 2015 : 2.40 mg/dL.
- On 1 may 2015: 2.30 mg/dL.

First time I did the test for Calcium , Ionized , Serum : 1.24 nmmol/L. ( Reference range is 1.16-1.32) don't know much of this test , please let me have your comments.

My question is the value of Calcium ,Serum is on out of reference range mean on high side and the PTH is also not coming down , the vitamin D,25  serum also almost same as one month before. Please let me have your comments on it.
Last one month I have severe pain on my upper back just behind chest. Don't understand the reason.

I met with Doctor Endocrinologist and he suggested to go for Parathyroid scan which i  am doing on 4 May 2015 , this test is slighlty expensive @USD 140/

I am still taking Vitamin D3 & Vitamin k2 mk7 , let me know should I continue Vitamin D3 or stop for some time.
I am taking 3 litres water with 0 calcium on it.

Looking forward your suggestion / comments.

Others test like qHbsag , HBV DNA and kidney test , LFT will be done next week as a routine six monthly.

Thank you,
Avatar universal
reduce vitamin d intake and lets see if calcium goes down in serum and urine, your situation is very unusual
Avatar universal
Thank you , Yes I have stopped taking Vit.D3 for 1 month , I will redo all the test after 1 month & then decide based on report.
Any suggestion related to 24 hours urine test report ?
Avatar universal
Hi Stef

I have done some test , please review & let me know your opinion:


Vitamin D,25 Hydroxy:
- on 8 Nov.2013 : Vitamin D , 25 - Hydroxy ,Serum ( CLIA ) 41.05 nmol/L.
- on 22 June 2014Vitd25oh :18.22 ng/ml.
- on 24/8/2014 : 51 ng/ml.
- on 8 Nov.2014 : 51.2 ng/ml.
- on 5 Feb.2015 : 157.55 nmol/L ( Sufficient range 75-250 nmol/L )
- on 7 march 2015 : 164.50 nmol/L (CLIA method) Range 75-250 sufficient)
- on 3 April 2015: 174.12 nmol/L ( CLIA method - Ref.renge 75-250 sufficient )
- on 1 May 2015 : 65.2 ng/ml
- On 13/6/2015: 41.1ng/ml

PTH ( Parathyroid Hormone) Intact, Serum :
- on 5 Feb.2015 : 73 pg/mL ( Ref.Interval 14 - 72 )
-on 7 March 2015: 86.60 pg/mL ( CLIA method Ref.range 14-72 )
-on 3 April 2015: 73.60 pg/mL.
- On 1 May 2015: 83.80 pg/mL.
-On 13/6/15: 63.45 pg/ml.

Calcium, Serum:

- on 23 Feb.2015: 10.60 mg/dL ( Ref.range 8.8 - 10.60)
-on 7 March 2015: 10.50 mg/dL .
-on 3 April 2015: 10.50 mg/dL.
- on 1 may 2015: 11.20 mg/dL.    
-On 10 may 2015: 9.6mg/dl.      
-On 13/6/2015 : 9.8 mg/dl.

Phosphorus,Serum:
- on 23 Feb.2015: 2.00 mg/dL. ( Ref.Range 2.40-4.40)
- on 7 March 2015: 2.20 mg/dL.
- on 3 April 2015 : 2.40 mg/dL.
- On 1 may 2015: 2.30 mg/dL.
On 10 may 2015: 4.9 mg/dl.
-On 13/6/2015: 2.4 mg/dl ( LOW)

S.Creatinine:
-On  10 May 2015: S.creatinine : 1.4 mg/dl.
-On 13/6/2015: S.creatinine : 1.09 mg/dl (HIGH)


24 Hours urine : test date - 10 May 2015.

- Total urine volume 3500 ml.
- urine creatinine 1.36 g ( normal range Male 1.1 -3.0 mg/24 hrs.)
- urine calcium : 1335.0 mg ( normal range 25-300 mg/24hrs.)
- urine calcium :  1.33g  - (on average calcium intake 500-800 mg/24 hrs.)
- urine phophorus : 1.22 g ( normal range 0.3 - 1.3g/24/24hrs.

On 15/6/2015: Calcium 24 hours Urine : 375 mg/day ( Ref.Range 100 - 300)
Phosphorus ,24 hours urine 825 mg/day ( Ref range 400 -1300)
Total urine volume 5000 ml/day ( Ref.range 800 - 1800)

HBsAg Quantitative:

- on 28 Jan. 2014:  : 7767.68 IU/mL.
- on - 1 May 2014:  6812.40 IU/m
- 9 August 2014: 3585 IU/ml.
8-  Nov.2014: 4633 IU/ml
- 20 Feb.2015 : 5174 IU/ml.
- 13/6/2015: 5431 IU/ml



L.F.T.-

- 28 Jan.2014
SGOT / AST 48 U/L.
SGPT / ALT - 106 U/L.
ALK . Phosphatase - 139 U/L.

L.F.T.-
-  27/4/2014-
SGOT / AST 40 U/L.
SGPT / ALT  65 U/L.
Alkaline Phosphatase ( ALP ) 143 U/L.

L.F.T :
9 August 2014:

Serum billrubin total ( Jendrassik- Grof) 0.8 mg/dl ,
Serum Billrubin direct ( Jendrassik - Grof) 0.1 mg/dl,
Serum Billirubin Indirect 0.70 mg/dl ,
AST/SGOT ( kinetic-Henry) 10 IU/L  ,
ALT / SGPT ( kinetic-Henry) 26 IU/L ,
Serum Alkaline Phosphatase ( Kinetic) 110 IU/L ,
GGT 22 IU/L , S.total Protein ( Bluret) 7.3g/dl ,
S.Albumin 4.1 g/dL ,
S.Globulin 3.20g/dL ,
A\G Ratio 1.28.

L.F.T
- on 8 Nov.2014:
Serum Biluirubin indirect 0.50 mg/dl ,
AST/SGPT ( kinetic - Henry) 24 IU/L. ,
ALT/SGPT ( Kinetic Henry) 34 IU/L. ,
Serum Alkaline Phosphatase ( Kinetic) 136 * High  IU/L. ,
GGT 17 IU/L. ,
S.total protein 7.8 g/dl. ,
S.Albumin 4.1 g/dl. ,
S.Globulin 3.70*High g/dl ,
A\G Ratio 1.11* Low.

LFT: On 25Jan.2015:
SGOT/AST:  12.8IU/L ( Ref.range 0.0 -37.0)
SGPT/ALT : 24.7 IU/L ( Ref.range 0-41 )

LFT : On 20 Fe.2015:
ALT : 26 IU/L ( Ref.Range 10-40)
Serum Alkaline Phosphatase 112* High IU/L ( Ref.Range 32-92)
GGT : 21 IU/L ( Ref.Range 7- 64)

LFT On 13/6/2015:
ALT 32 IU/L.
AST 19 IU/L.
Serum Alkaline Phosphatase 104 IU/L ( HIGH)
A|G ratio 1.34 (LOW)
GGT 17 IU/L.

FibroScan:
On 26 Dec.2014 : 4.7.
On 9 August 2014 : 4.9.
On 13/6/2015: 3.5 E ( kpa)
on 13/6/2015: CAP ( dbm) Median 270 , IQR 21.


Last 45 days i am not taking Vitamin D3 as Dr.Endocrinology have suggested to give break for D3 , now the Vitamin value is coming down as well as PTH also reduced with the previous one. So its mean when I stopped D3 both the values 25 hydroxy and PTH reduced .
I am planning to start Vitamin D3 , please suggest.

Result for HBV DNA is awaited will share once the report comes.
Looking forward your expert advice..
Avatar universal
there is only a disease that i know of making so much calcium despite low vitd3 levels and this also justify pth kinetics so different to others.your kidneys were eliminating so much calcium despite normal vit d levels and high pth

please check here about this disease
https://en.wikipedia.org/wiki/Sarcoidosis

if there is sarcoidosis it is not possible to take vit d supplements, i am not expert about this disease at all so you should check with your endo

with low vit d now and high pth you are still well above normal calcium in urine.this is not normal and not possible, i think we have sarcoidosis here of some degree
On 15/6/2015: Calcium 24 hours Urine : 375 mg/day ( Ref.Range 100 - 300)
Avatar universal
Thanks Stef , I will consult Doctor and update you .
Avatar universal
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160567/

check out this article, your excess dysregulation maybe due to extremely high 1.25oh too or sarcoidosis.we can get some clues from this article too
Avatar universal
Hi Stef
Hope you are doing good ,
I met with my Doctor and he suggested to change TIRAVIR 300mg with SEBIVO 600mg due to Creatinine report but asked me to do one more blood test for KFT and based on the report he will confirm for change of medicine.
The creatinine latest report is 1.09 mg/dl ( High )
Please suggest ,
The other report is as under:

HBV DNA Quantitative , Real time PCR : Plasma
- on 28 Jan.2014- 5156250 IU/mL.
- 1 May 2014:  - 33181 IU/mL.

- 9 August 2014: = 5.72x10^2 IU/ml.

- 8 Nov. 2014: 47.5 IU/ml.
- 20 Feb.2015 : 6.04 IU/mi.
- 13/6/2016: HBV DNA NOT DETECTED.

HBsAg Quantitative:

- on 28 Jan. 2014:  : 7767.68 IU/mL.

- on - 1 May 2014:  6812.40 IU/m

- 9 August 2014: 3585 IU/ml.

8-  Nov.2014: 4633 IU/ml

- 20 Feb.2015 : 5174 IU/ml.
- 13/6/2015: 5431 IU/ml

FibroScan:
On 26 Dec.2014 : 4.7.
On 9 August 2014 : 4.9.
on 13/6/2015: CAP ( dbm) Median 270 , IQR 21. , E(kpa) Median 3.5 , IQR 0.5 , IQR/med 14%.

I also met with Endocrologist related to my serum calcium & 24 hours urine ca. both are high so for he has given medicine for 1 month and thereafter the test to be repeated , till such time i am not taking vitamin D3 .
Please suggest me on this new medicine stated above and also your comments on the progress based on my report.

Thank you,



Avatar universal
telbivudine alone is not ok, it is too weak and high resistance.making a combo of tdf plus telbivudine has shown a repair effect on kidneys so no need to take telbivudine monotherapy

as to calcium what are blood test results on calcium and urine tests?

creatinine 1.09 is usaully not high, most tests are normal till 1.3

it is good to stay off vit d and take a drug to lower calcium.did they confirm you have sarcoidosis?
Avatar universal
Hi stef

Thanks for your revert ,
Please find the Ca. result:
Calcium, Serum:

- on 23 Feb.2015: 10.60 mg/dL ( Ref.range 8.8 - 10.60)
-on 7 March 2015: 10.50 mg/dL .
-on 3 April 2015: 10.50 mg/dL.
- on 1 may 2015: 11.20 mg/dL.    
-On 10 may 2015: 9.6mg/dl.      
-On 13/6/2015 : 9.8 mg/dl.

24 hours urine test result:
- 13/6/2015 : 300mg

Doctor advised me to redo the test on 1st week of august as he had given me medicine tablet 1 daily , so once this 1 month over then test to be repeated for both 24 hours urine and serum calcium.

No they have not told me any thing on sarcoidosis, I will check with him on my next visit.

How you rated my progress on my latest result on HBV.on my previous mail.

Looking forward your opinion.

Thank you,
Avatar universal
Sorry some correction in 24 hours urine test , the values is 375 not 300mg.
Looking forward your revert.

Thank you,
Avatar universal
http://www.sanihelp.it/esami/118/calciuria.html

tests are not bad, all normal, only urine calcium is high, check that page and try to translate from italian, there are many diseases making high calcium and your doctor should have checked them all because one thing we know for sure there is something wrong with pth, calcium and vit d

Avatar universal
Thank you so much ,
Avatar universal
I was looking for clues on vit d toxicity and found this info about people supersensitive to vit d despite low levels, from their hypothesis/experience it is an unbalance with vit A fro cod liver oil.carlson is a brand with vit a from cod liver oil at doses of 10.000iu or 25.000iu.it is good with bottles with monthly pill supply, the big supply bottle has soy that can be gmo so avoid it

http://www.westonaprice.org/blogs/cmasterjohn/is-vitamin-d-safe-still-depends-on-vitamins-a-and-k-testimonials-and-a-human-study/

Try and let us know if vit a makes calcium normal by fe weeks
Avatar universal
Hello Stef Sir...
Last year during blood donation in dec 2014 i found out dat i am hbsag +ve.
I went to the drs in delhi but hvnt got satisfactory answers.Right now i feel normal but i am worried about my future.
M not married and i have left alcohol an year back.
my reports are...

1.HBV DNA -            not detected , initially in dec 2014 - 40 Iu/ml

2.Hbsag QUANT.-     now 8126, initially in dec 2014 - 14070 Iu/ml

3.fibroscan-              5.4 kpa

4.alpha feto protein-  2.79 ng/ml

5.ALT-                     44 now

6.HbeAg -                -ve

7.anti Hbe -             +ve

8.Ultrasound -          Normal

9.Total protein -         8.1

10.Mean normal prothrombin time - 11.10

11.Prothrombin ratio - 1.11

12.Anti HAV -           +VE

MY QUESTIONS ARE-

1. If i was infected recently or since childhood.My brother is Hbsag -ve.

2. I am 24 years old now.Can you please tell how many years approximately I will live.

3. I am non alcoholic.I smoke 1-2 ciggs max.

4. what food shuld i eat,any specific kind or anything with less fat and hygenic.

5. In wat interval i need to go for the tests.
6.Do i need to worry much.I mean can i live d way i was before.

Please help sir.
Since i have came to knw this I am not able to live fully.I have became anxious,depressive and not happy at all.
Ur valuable suggestions can help me.
PLEASE HAVE AN EYE OVER THE ISSUE SIR.
Avatar universal
Dont worry you are perfectly healthy, you can wait for hbsag to becone lower on its own and use peginterfero  to clear hbsag when it reaches less than 1000iu ml

check hbvdna, liver function, fibroscan every year.if hbvdna becomes elevated or fibroscan start tenofovir
ulrasound evry 6 months
hbsag quantevery year

eat fresh and organic, no smoke, take vit d3 supplements 5000 to 10.000u daily
Avatar universal
Hi Stef
Hope you are doing good ,
As I discussed earlier post that my Dr.Endocrinology recommended to stop Vit.D3 supplement for some time due to elevated level of Serum Clcium and 24 hors urine - calcium & Phosphorus. Today I did the test and the result are as follows:Calcium, Serum:

Date 8 .8. 2015: Calcium serum: 10.40 mg/dL

- on 23 Feb.2015: 10.60 mg/dL ( Ref.range 8.8 - 10.60)
-on 7 March 2015: 10.50 mg/dL .
-on 3 April 2015: 10.50 mg/dL.
- on 1 may 2015: 11.20 mg/dL.    
-On 10 may 2015: 9.6mg/dl.      
-On 13/6/2015 : 9.8 mg/dl.

24 hours urine test result:
Date 8.8.2015: 303mg/day ( Ref.range 100-300 )
- 156/6/2015 : 375 mg/day.

Phosphorus,24-Hour Urine :
Date 8.8.2105 : 737.3 mg/day ( Ref.range 400-1300)
- 15.6.2015 : 825 mg/day.


Vitamin D,25 Hydroxy:
- on 8 Nov.2013 : Vitamin D , 25 - Hydroxy ,Serum ( CLIA ) 41.05 nmol/L.
- on 22 June 2014Vitd25oh :18.22 ng/ml.
- on 24/8/2014 : 51 ng/ml.
- on 8 Nov.2014 : 51.2 ng/ml.
- on 5 Feb.2015 : 157.55 nmol/L ( Sufficient range 75-250 nmol/L )
- on 7 march 2015 : 164.50 nmol/L (CLIA method) Range 75-250 sufficient)
- on 3 April 2015: 174.12 nmol/L ( CLIA method - Ref.renge 75-250 sufficient )
- on 1 May 2015 : 65.2 ng/ml
- On 13/6/2015: 41.1ng/ml
- On 8/8/2015: 26.01 ng/ml ( Insufficient range)

PTH ( Parathyroid Hormone) Intact, Serum :
- on 5 Feb.2015 : 73 pg/mL ( Ref.Interval 14 - 72 )
-on 7 March 2015: 86.60 pg/mL ( CLIA method Ref.range 14-72 )
-on 3 April 2015: 73.60 pg/mL.
- On 1 May 2015: 83.80 pg/mL.
-On 13/6/15: 63.45 pg/ml.
-On 8/8/2015: 95.40 pg/mL. ( HIGH)

S.Creatinine:
-On  10 May 2015: S.creatinine : 1.4 mg/dl.
-On 13/6/2015: S.creatinine : 1.09 mg/dl (HIGH)
-On 8/8/2015: 1.00 mg/dL

L.F.T.-

- 28 Jan.2014
SGOT / AST 48 U/L.
SGPT / ALT - 106 U/L.
ALK . Phosphatase - 139 U/L.

L.F.T.-
-  27/4/2014-
SGOT / AST 40 U/L.
SGPT / ALT  65 U/L.
Alkaline Phosphatase ( ALP ) 143 U/L.

L.F.T :
9 August 2014:

Serum billrubin total ( Jendrassik- Grof) 0.8 mg/dl ,
Serum Billrubin direct ( Jendrassik - Grof) 0.1 mg/dl,
Serum Billirubin Indirect 0.70 mg/dl ,
AST/SGOT ( kinetic-Henry) 10 IU/L  ,
ALT / SGPT ( kinetic-Henry) 26 IU/L ,
Serum Alkaline Phosphatase ( Kinetic) 110 IU/L ,
GGT 22 IU/L , S.total Protein ( Bluret) 7.3g/dl ,
S.Albumin 4.1 g/dL ,
S.Globulin 3.20g/dL ,
A\G Ratio 1.28.

L.F.T
- on 8 Nov.2014:
Serum Biluirubin indirect 0.50 mg/dl ,
AST/SGPT ( kinetic - Henry) 24 IU/L. ,
ALT/SGPT ( Kinetic Henry) 34 IU/L. ,
Serum Alkaline Phosphatase ( Kinetic) 136 * High  IU/L. ,
GGT 17 IU/L. ,
S.total protein 7.8 g/dl. ,
S.Albumin 4.1 g/dl. ,
S.Globulin 3.70*High g/dl ,
A\G Ratio 1.11* Low.

LFT: On 25Jan.2015:
SGOT/AST:  12.8IU/L ( Ref.range 0.0 -37.0)
SGPT/ALT : 24.7 IU/L ( Ref.range 0-41 )

LFT : On 20 Fe.2015:
ALT : 26 IU/L ( Ref.Range 10-40)
Serum Alkaline Phosphatase 112* High IU/L ( Ref.Range 32-92)
GGT : 21 IU/L ( Ref.Range 7- 64)

LFT On 13/6/2015:
ALT 32 IU/L.
AST 19 IU/L.
Serum Alkaline Phosphatase 104 IU/L ( HIGH)
A|G ratio 1.34 (LOW)
GGT 17 IU/L.

LFT on 8/8/2015:
AST: 22 U/L.
ALT: 30 U/L.
GGTP: 22 U/L.
Alkaline Phosphatase ( ALP): 143 U/L.
Phosphorus: 2.00 mg/dL.

On todays report I noticed that my Vit D3 declining and PTH increasing , also I noted that my ALP always on high side and Phosphorus on LOW side.
I have not taken vit D3 supplement almost 6 weeks now, i will consult Doctor soon and ask him about the Vit D3 as well as PTH.
Looks like my calcium both on serum and 24 hours urine in line with the reference range.
Please look into all these test report and suggest ,

Thank you,
Avatar universal
TrY the combo of vit A from cod liver oil 10.000iu daily and vit k2 mk7 200mcg daily and see  if calcium declines even more, stay at least 3-6months away from vit d and ifthis combo works protecting you may restart vit d to keep at least min sufficiency
Avatar universal
Thank you Stef for your revert,
I was looking in the website and you also suggested some time back milk thistle now it is available ULTRA THISTLE 360 mg. what is your say on it?
As suggested by you i will go for vit A from cod liver oil , i am already taking vit k2 mk7 100mcg last 6 month. which is the best time to take this combo.
I was thinking to bring back the Vit D3 to sufficient level , if i take 60K vitmin D3 weekly it helps need your clarification.As you may have noted my PTH is very high beyond the range in this way i can bring down the PTH as well.
Looking fowar your suggestion as always,

Thank you,  
Avatar universal
what is your say on it?

i know it helps with liver fibrosis, dont know if it has ny effect on kidneys


which is the best time to take this combo.

now to see if calcium goes down fast


I was thinking to bring back the Vit D3 to sufficient level

not now, bring calcium down fisrt
Avatar universal
Thanks Stef ,
Shall try to bring down the calcium first and then planned for Vit.D3 and Ultra Thistle.
Avatar universal
You are about to complete 2yrs of tdf treatment. U can try IFN now. Is it sure that hbsag will go down to 1500iu after 2-3yrs of tdf. IFN must be tried in young age and works different in different individuals.
Avatar universal
I will be going 3 years with teravir then may be plan for IFN, aagin depends upon the result & Doctor opinion.
Avatar universal

Hi Stef
Its long time , hope this note will find you in good health ,
I have gone through some test , please find the report along with the previous one , some of the result had increased a lot , please give your expert opinion .


Vitamin D,25 Hydroxy:

- on 10/10/2015 : 44.6 ng/ml.
- on 8 Nov.2013 : Vitamin D , 25 - Hydroxy ,Serum ( CLIA ) 41.05 nmol/L.
- on 22 June 2014Vitd25oh :18.22 ng/ml.
- on 24/8/2014 : 51 ng/ml.
- on 8 Nov.2014 : 51.2 ng/ml.
- on 5 Feb.2015 : 157.55 nmol/L ( Sufficient range 75-250 nmol/L )
- on 7 march 2015 : 164.50 nmol/L (CLIA method) Range 75-250 sufficient)
- on 3 April 2015: 174.12 nmol/L ( CLIA method - Ref.renge 75-250 sufficient )
- on 1 May 2015 : 65.2 ng/ml
- On 13/6/2015: 41.1ng/ml
- On 8/8/2015: 26.01 ng/ml ( Insufficient range)

PTH ( Parathyroid Hormone) Intact, Serum :

- on 10/10/2015 : 89.5* H pg/ml.
- on 5 Feb.2015 : 73 pg/mL ( Ref.Interval 14 - 72 )
-on 7 March 2015: 86.60 pg/mL ( CLIA method Ref.range 14-72 )
-on 3 April 2015: 73.60 pg/mL.
- On 1 May 2015: 83.80 pg/mL.
-On 13/6/15: 63.45 pg/ml.
-On 8/8/2015: 95.40 pg/mL. ( HIGH)

S.Creatinine:

- On 10/10/2015 : 0.90 mg/dl.
-On  10 May 2015: S.creatinine : 1.4 mg/dl.
-On 13/6/2015: S.creatinine : 1.09 mg/dl (HIGH)
-On 8/8/2015: 1.00 mg/dL

L.F.T.-

- On 10/10/2015:

AST/SGOT: 29 IU/L.
ALT/SGPT : 43* H IU/L.
Serum Alkaline Phosphatase: 115* H IU/L.
GGT: 19 IU/L
A\G Ratio: 1.46* L

- 28 Jan.2014
SGOT / AST 48 U/L.
SGPT / ALT - 106 U/L.
ALK . Phosphatase - 139 U/L.

L.F.T.-
-  27/4/2014-
SGOT / AST 40 U/L.
SGPT / ALT  65 U/L.
Alkaline Phosphatase ( ALP ) 143 U/L.

L.F.T :
9 August 2014:

Serum billrubin total ( Jendrassik- Grof) 0.8 mg/dl ,
Serum Billrubin direct ( Jendrassik - Grof) 0.1 mg/dl,
Serum Billirubin Indirect 0.70 mg/dl ,
AST/SGOT ( kinetic-Henry) 10 IU/L  ,
ALT / SGPT ( kinetic-Henry) 26 IU/L ,
Serum Alkaline Phosphatase ( Kinetic) 110 IU/L ,
GGT 22 IU/L , S.total Protein ( Bluret) 7.3g/dl ,
S.Albumin 4.1 g/dL ,
S.Globulin 3.20g/dL ,
A\G Ratio 1.28.

L.F.T
- on 8 Nov.2014:
Serum Biluirubin indirect 0.50 mg/dl ,
AST/SGPT ( kinetic - Henry) 24 IU/L. ,
ALT/SGPT ( Kinetic Henry) 34 IU/L. ,
Serum Alkaline Phosphatase ( Kinetic) 136 * High  IU/L. ,
GGT 17 IU/L. ,
S.total protein 7.8 g/dl. ,
S.Albumin 4.1 g/dl. ,
S.Globulin 3.70*High g/dl ,
A\G Ratio 1.11* Low.

LFT: On 25Jan.2015:
SGOT/AST:  12.8IU/L ( Ref.range 0.0 -37.0)
SGPT/ALT : 24.7 IU/L ( Ref.range 0-41 )

LFT : On 20 Fe.2015:
ALT : 26 IU/L ( Ref.Range 10-40)
Serum Alkaline Phosphatase 112* High IU/L ( Ref.Range 32-92)
GGT : 21 IU/L ( Ref.Range 7- 64)

LFT On 13/6/2015:
ALT 32 IU/L.
AST 19 IU/L.
Serum Alkaline Phosphatase 104 IU/L ( HIGH)
A|G ratio 1.34 (LOW)
GGT 17 IU/L.

LFT on 8/8/2015:
AST: 22 U/L.
ALT: 30 U/L.
GGTP: 22 U/L.
Alkaline Phosphatase ( ALP): 143 U/L.
Phosphorus: 2.00 mg/dL.

HBV DNA Quantitative , Real time PCR : Plasma
- on 28 Jan.2014- 5156250 IU/mL.
- 1 May 2014:  - 33181 IU/mL.

- 9 August 2014: = 5.72x10^2 IU/ml.

- 8 Nov. 2014: 47.5 IU/ml.
- 20 Feb.2015 : 6.04 IU/mi.
- 13/6/2016: HBV DNA NOT DETECTED.

HBsAg Quantitative:

- On 10/10/2015: 6858 IU/ml.

- on 28 Jan. 2014:  : 7767.68 IU/mL.

- on - 1 May 2014:  6812.40 IU/m

- 9 August 2014: 3585 IU/ml.

8-  Nov.2014: 4633 IU/ml

- 20 Feb.2015 : 5174 IU/ml.
- 13/6/2015: 5431 IU/ml

FibroScan:

- On 10/10/2015: 3.8 (E kpa) , CAP ( dB/m) 272.
On 26 Dec.2014 : 4.7.
On 9 August 2014 : 4.9.
on 13/6/2015: CAP ( dbm) Median 270 , IQR 21. , E(kpa) Median 3.5 , IQR 0.5 , IQR/med 14%

I noted that the ALT  , PTH & HBsAg result had fluctuated a lot from the previous report , please let me know the reasons.

24 hrs urine & serum test is due for next week , i will share with you the result latter.

Thank you,
1 Comments
You have fantastic results, except ALT being raised and your liver seems to be fatty (CAP score). You need to take care of your diet and eating habits, and probably also exercise more to lose the fatty liver.
Avatar universal
i think alt and hbsag are not so important now we need to understand why you have problems with vitamin d pathways (severe vit d deficiency confirmed by abnormally high pth which is usually named secondary hyperparathiroidism but this has to do with vit d deficiency or some kidneys issues).what did the doctor say about this?any clue about the disease?

did you try vitamin A supplements the natural type from fish oil?carlson, nordic naturals are very good brands but also nowfoods although they dont have ifos certification
Avatar universal
another thing doctors should consider is possible kidneys damage from hbv but this is very hard to see from the tests only by using antivirals you may see improvements in creatinine clearance and serum creatinine after 1 year therapy
Avatar universal
Thanks Stef ,

I have stopped taking Vit.3 supplement as my calcium level both in serum & 24 hours urine was high so the vit D3 was stopped almost 3 months , now i have started weekly 60K as per doctor advice , and it showed increase in the result but PTH way high ,
24 /10/15 I am going for calcium check both in serum & urine then will see the result and increase the Vit D3 dose.
I also checked the Parathyroid and found no tumor its normal report.
If my calcium level within normal range i will increase the Vit D3. What you suggest how much Vit D3 should take.
Stef one more question i noticed upper back ach gone through the MRI found all normal but some time the pain is quite severe , it could be related to Vit D diffiency also .
I also lost 10 Kg.weight within 12 months, is it normal or related to HBV .I am concerned on it, please suggest as i am taking overseas job effective 25 Dec.2015 , in Maldives if health permit me i will join there.
My last meeting with Doctor advised me to eat healthy food as normal diet no restriction to any food product.
I am meeting with Doctor next week .
Avatar universal
Thank you Aduiski ,
Yes I am eating healthy diet and takes green tea 2 times on daily basis. I treatment 1 tab.of Tiravir daily after dinner and it has been started since Jan.2014 so almost 2 years now, Doctor advised to continue it further.
I am meeting Doctor next week and share the outcomes.
Avatar universal
Hi Stef

I have not tried Vitamin A supplements as yet but will find out & start taking it as well, what should be the dose.

Doctor suggested me multi vitamin named : Lycopene,vitamin,methylcobalamin,folic acid,chromium & sodium soft gelatin capsules( Make Medoscha gold) he asked me to take for 2 months. I noticed this is quite useful i feel more energetic now , last 1 month i am taking 1 capsule daily. Whats your opinion ..
Avatar universal
you know my concern is that there is something not working like high calcium with vitamin d within ranges and at the same time high pth with high calcium

before starting all that vit d i would go with low dose daily like 2000iu and take all vitamins correlated with vit d pathways to see if this gets solved.magnesium, vit A, vit k2 all work together with vit d and if there are deficiencies of these vits increasing vit d may not be good

gcmaf is the vitamin d transporter to receptors and nagalase made by hbv blocks gcmaf...i d be curious to see what your nagalase is but this is a research test and too difficult to get this in asia
Avatar universal
Hi Stef
Hope you are doing good , it has been long time we haven't communicate. i have done some test in-between ,i will attach these along with the previous one.
Vitamin D,25 Hydroxy:

- On 9 Dec.2015 : 71.69 nmol/L.
- on 10/10/2015 : 44.6 ng/ml.
- on 8 Nov.2013 : Vitamin D , 25 - Hydroxy ,Serum ( CLIA ) 41.05 nmol/L.
- on 22 June 2014Vitd25oh :18.22 ng/ml.
- on 24/8/2014 : 51 ng/ml.
- on 8 Nov.2014 : 51.2 ng/ml.
- on 5 Feb.2015 : 157.55 nmol/L ( Sufficient range 75-250 nmol/L )
- on 7 march 2015 : 164.50 nmol/L (CLIA method) Range 75-250 sufficient)
- on 3 April 2015: 174.12 nmol/L ( CLIA method - Ref.renge 75-250 sufficient )
- on 1 May 2015 : 65.2 ng/ml
- On 13/6/2015: 41.1ng/ml
- On 8/8/2015: 26.01 ng/ml ( Insufficient range)

PTH ( Parathyroid Hormone) Intact, Serum :

- On 12 Dec.2015: 77.3 pg/ml.
- on 10/10/2015 : 89.5* H pg/ml.
- on 5 Feb.2015 : 73 pg/mL ( Ref.Interval 14 - 72 )
-on 7 March 2015: 86.60 pg/mL ( CLIA method Ref.range 14-72 )
-on 3 April 2015: 73.60 pg/mL.
- On 1 May 2015: 83.80 pg/mL.
-On 13/6/15: 63.45 pg/ml.
-On 8/8/2015: 95.40 pg/mL. ( HIGH)

S.Creatinine:

- On 12 Dec.2015 : 1.11mg/dl.
- On 10/10/2015 : 0.90 mg/dl.
-On  10 May 2015: S.creatinine : 1.4 mg/dl.
-On 13/6/2015: S.creatinine : 1.09 mg/dl (HIGH)
-On 8/8/2015: 1.00 mg/dL

L.F.T.-

-On 12 Dec.2015:
ALT : 39 IU/L. , Serum Alkaline Phosphatase :135 IU/L , GGT: 20 IU/L , S.Total Protein: 7.2g/dl. , S.Albumin: 4.2g/dl. , S.Globulin:3 g/dl., A\G:1.40.

- On 10/10/2015:

AST/SGOT: 29 IU/L.
ALT/SGPT : 43* H IU/L.
Serum Alkaline Phosphatase: 115* H IU/L.
GGT: 19 IU/L
A\G Ratio: 1.46* L

- 28 Jan.2014
SGOT / AST 48 U/L.
SGPT / ALT - 106 U/L.
ALK . Phosphatase - 139 U/L.

L.F.T.-
-  27/4/2014-
SGOT / AST 40 U/L.
SGPT / ALT  65 U/L.
Alkaline Phosphatase ( ALP ) 143 U/L.

L.F.T :
9 August 2014:

Serum billrubin total ( Jendrassik- Grof) 0.8 mg/dl ,
Serum Billrubin direct ( Jendrassik - Grof) 0.1 mg/dl,
Serum Billirubin Indirect 0.70 mg/dl ,
AST/SGOT ( kinetic-Henry) 10 IU/L  ,
ALT / SGPT ( kinetic-Henry) 26 IU/L ,
Serum Alkaline Phosphatase ( Kinetic) 110 IU/L ,
GGT 22 IU/L , S.total Protein ( Bluret) 7.3g/dl ,
S.Albumin 4.1 g/dL ,
S.Globulin 3.20g/dL ,
A\G Ratio 1.28.

L.F.T
- on 8 Nov.2014:
Serum Biluirubin indirect 0.50 mg/dl ,
AST/SGPT ( kinetic - Henry) 24 IU/L. ,
ALT/SGPT ( Kinetic Henry) 34 IU/L. ,
Serum Alkaline Phosphatase ( Kinetic) 136 * High  IU/L. ,
GGT 17 IU/L. ,
S.total protein 7.8 g/dl. ,
S.Albumin 4.1 g/dl. ,
S.Globulin 3.70*High g/dl ,
A\G Ratio 1.11* Low.

LFT: On 25Jan.2015:
SGOT/AST:  12.8IU/L ( Ref.range 0.0 -37.0)
SGPT/ALT : 24.7 IU/L ( Ref.range 0-41 )

LFT : On 20 Fe.2015:
ALT : 26 IU/L ( Ref.Range 10-40)
Serum Alkaline Phosphatase 112* High IU/L ( Ref.Range 32-92)
GGT : 21 IU/L ( Ref.Range 7- 64)

LFT On 13/6/2015:
ALT 32 IU/L.
AST 19 IU/L.
Serum Alkaline Phosphatase 104 IU/L ( HIGH)
A|G ratio 1.34 (LOW)
GGT 17 IU/L.

LFT on 8/8/2015:
AST: 22 U/L.
ALT: 30 U/L.
GGTP: 22 U/L.
Alkaline Phosphatase ( ALP): 143 U/L.
Phosphorus: 2.00 mg/dL.

HBV DNA Quantitative , Real time PCR : Plasma
- on 28 Jan.2014- 5156250 IU/mL.
- 1 May 2014:  - 33181 IU/mL.

- 9 August 2014: = 5.72x10^2 IU/ml.

- 8 Nov. 2014: 47.5 IU/ml.
- 20 Feb.2015 : 6.04 IU/mi.
- 13/6/2016: HBV DNA NOT DETECTED.

HBsAg Quantitative:


- On 12 Dec.2015: 6485 IU/ml.
- On 10/10/2015: 6858 IU/ml.

- on 28 Jan. 2014:  : 7767.68 IU/mL.

- on - 1 May 2014:  6812.40 IU/m

- 9 August 2014: 3585 IU/ml.

8-  Nov.2014: 4633 IU/ml

- 20 Feb.2015 : 5174 IU/ml.
- 13/6/2015: 5431 IU/ml

FibroScan:

- On 10/10/2015: 3.8 (E kpa) , CAP ( dB/m) 272.
On 26 Dec.2014 : 4.7.
On 9 August 2014 : 4.9.
on 13/6/2015: CAP ( dbm) Median 270 , IQR 21. , E(kpa) Median 3.5 , IQR 0.5 , IQR/med 14%

Todays I showed all report to Doctor , he advised to change TIRAVIR 300mg with Sebivo 600 mg , his idea to change the medicine is to control the creatinine level. I checked the web site the salt is almost same in both the medicine . please suggest as per your experience.
Looking forward your reply.
Thank you,





Avatar universal
Hi stef

Looking foward your comments on Tiravir 300 mg vs Sebivo 600 mg. as doctor suggested , and also the reports stated in previous mail.

Thank you
Avatar universal
Hi stef

Looking foward your comments on Tiravir 300 mg vs Sebivo 600 mg. as doctor suggested , and also the reports stated in previous mail.

Thank you
Avatar universal
i'd try the combo tdf plus sebvivo, this combo showed to solve the kidneys problems issues

or much better why not use entecavir?
Avatar universal
sebvivo has a very weak profile for resistance
Avatar universal
Hi Stef

Thank you for your kind suggestion , in fact i would like to continue with Tiravir 300 mg. I agreed with you the Sebivo is very weak profile for resistance.
Actully i am travelling to Maldives and have to stay there for 6 months so i am carrying these medicines along with me.
If any issue comes up during my stay at maldives , i shall share with you.

Thank you once again.
Avatar universal
as long as creatinine and gfr are within limits it is ok to keep tdf

avoid use of drugs that make kidneys damage, in feb 2015 i had t use antibiotics for 2 weeks and gfr went less than normal and creatinine borderline high and i have not fully recovered to high gfr and very low creatinine like i was before, antibiotics are for sure kidneys killer when using other heavy drugs on kidneys
1 Comments
Hi Stef11 & all other expert in the forum:
Please find my last blood test & USG whole abdomen and Fibroscan:


Vitamin D,25 Hydroxy:
on 21 March 2016: 56.6 ng/ml.
- On 9 Dec.2015 : 71.69 nmol/L.
- on 10/10/2015 : 44.6 ng/ml.
- on 8 Nov.2013 : Vitamin D , 25 - Hydroxy ,Serum ( CLIA ) 41.05 nmol/L.
- on 22 June 2014Vitd25oh :18.22 ng/ml.
- on 24/8/2014 : 51 ng/ml.
- on 8 Nov.2014 : 51.2 ng/ml.
- on 5 Feb.2015 : 157.55 nmol/L ( Sufficient range 75-250 nmol/L )
- on 7 march 2015 : 164.50 nmol/L (CLIA method) Range 75-250 sufficient)
- on 3 April 2015: 174.12 nmol/L ( CLIA method - Ref.renge 75-250 sufficient )
- on 1 May 2015 : 65.2 ng/ml
- On 13/6/2015: 41.1ng/ml
- On 8/8/2015: 26.01 ng/ml ( Insufficient range)

PTH ( Parathyroid Hormone) Intact, Serum :
-on 21 march 2016:89.1*(High)pg/ml.
- On 12 Dec.2015: 77.3 pg/ml.
- on 10/10/2015 : 89.5* H pg/ml.
- on 5 Feb.2015 : 73 pg/mL ( Ref.Interval 14 - 72 )
-on 7 March 2015: 86.60 pg/mL ( CLIA method Ref.range 14-72 )
-on 3 April 2015: 73.60 pg/mL.
- On 1 May 2015: 83.80 pg/mL.
-On 13/6/15: 63.45 pg/ml.
-On 8/8/2015: 95.40 pg/mL. ( HIGH)

S.Creatinine:
-On 21 march 2016: 1.05*(High)mg/dl.
- On 12 Dec.2015 : 1.11mg/dl.
- On 10/10/2015 : 0.90 mg/dl.
-On  10 May 2015: S.creatinine : 1.4 mg/dl.
-On 13/6/2015: S.creatinine : 1.09 mg/dl (HIGH)
-On 8/8/2015: 1.00 mg/dL

L.F.T.-
-On 21 march 2016; ALT 23 IU/L ,AST 23 IU/L ,Serum Billrubin total 0.7mg/dl , serum billrubin direct 0.1 mg/dl ,serum billrubin indirect 0.60mg/dl ,Serum Alkaline Phosphatase 127*(H) IU/L ,GGT 14 IU/L , S.total protein 6.9 g/dL S.Albumin 4.1 g/dL , S.globulin 2.80 g/dL , A\G ratio 1.46* (L)
-On 12 Dec.2015:
ALT : 39 IU/L. , Serum Alkaline Phosphatase :135 IU/L , GGT: 20 IU/L , S.Total Protein: 7.2g/dl. , S.Albumin: 4.2g/dl. , S.Globulin:3 g/dl., A\G:1.40.

- On 10/10/2015:

AST/SGOT: 29 IU/L.
ALT/SGPT : 43* H IU/L.
Serum Alkaline Phosphatase: 115* H IU/L.
GGT: 19 IU/L
A\G Ratio: 1.46* L

- 28 Jan.2014
SGOT / AST 48 U/L.
SGPT / ALT - 106 U/L.
ALK . Phosphatase - 139 U/L.

L.F.T.-
-  27/4/2014-
SGOT / AST 40 U/L.
SGPT / ALT  65 U/L.
Alkaline Phosphatase ( ALP ) 143 U/L.

L.F.T :
9 August 2014:

Serum billrubin total ( Jendrassik- Grof) 0.8 mg/dl ,
Serum Billrubin direct ( Jendrassik - Grof) 0.1 mg/dl,
Serum Billirubin Indirect 0.70 mg/dl ,
AST/SGOT ( kinetic-Henry) 10 IU/L  ,
ALT / SGPT ( kinetic-Henry) 26 IU/L ,
Serum Alkaline Phosphatase ( Kinetic) 110 IU/L ,
GGT 22 IU/L , S.total Protein ( Bluret) 7.3g/dl ,
S.Albumin 4.1 g/dL ,
S.Globulin 3.20g/dL ,
A\G Ratio 1.28.

L.F.T
- on 8 Nov.2014:
Serum Biluirubin indirect 0.50 mg/dl ,
AST/SGPT ( kinetic - Henry) 24 IU/L. ,
ALT/SGPT ( Kinetic Henry) 34 IU/L. ,
Serum Alkaline Phosphatase ( Kinetic) 136 * High  IU/L. ,
GGT 17 IU/L. ,
S.total protein 7.8 g/dl. ,
S.Albumin 4.1 g/dl. ,
S.Globulin 3.70*High g/dl ,
A\G Ratio 1.11* Low.

LFT: On 25Jan.2015:
SGOT/AST:  12.8IU/L ( Ref.range 0.0 -37.0)
SGPT/ALT : 24.7 IU/L ( Ref.range 0-41 )

LFT : On 20 Fe.2015:
ALT : 26 IU/L ( Ref.Range 10-40)
Serum Alkaline Phosphatase 112* High IU/L ( Ref.Range 32-92)
GGT : 21 IU/L ( Ref.Range 7- 64)

LFT On 13/6/2015:
ALT 32 IU/L.
AST 19 IU/L.
Serum Alkaline Phosphatase 104 IU/L ( HIGH)
A|G ratio 1.34 (LOW)
GGT 17 IU/L.

LFT on 8/8/2015:
AST: 22 U/L.
ALT: 30 U/L.
GGTP: 22 U/L.
Alkaline Phosphatase ( ALP): 143 U/L.
Phosphorus: 2.00 mg/dL.

HBV DNA Quantitative , Real time PCR : Plasma
- on 28 Jan.2014- 5156250 IU/mL.
- 1 May 2014:  - 33181 IU/mL.

- 9 August 2014: = 5.72x10^2 IU/ml.

- 8 Nov. 2014: 47.5 IU/ml.
- 20 Feb.2015 : 6.04 IU/mi.
- 13/6/2016: HBV DNA NOT DETECTED.

HBsAg Quantitative:

- On 21 march2016: 6384 IU/ml.
- On 12 Dec.2015: 6485 IU/ml.
- On 10/10/2015: 6858 IU/ml.

- on 28 Jan. 2014:  : 7767.68 IU/mL.

- on - 1 May 2014:  6812.40 IU/m

- 9 August 2014: 3585 IU/ml.

8-  Nov.2014: 4633 IU/ml

- 20 Feb.2015 : 5174 IU/ml.
- 13/6/2015: 5431 IU/ml

FibroScan:
- On 21 march 2016; Cap( db/m) median 268 , E(kpa) median 4.2.
- On 10/10/2015: 3.8 (E kpa) , CAP ( dB/m) 272.
On 26 Dec.2014 : 4.7.
On 9 August 2014 : 4.9.
on 13/6/2015: CAP ( dbm) Median 270 , IQR 21. , E(kpa) Median 3.5 , IQR 0.5 , IQR/med 14%

USG whole Abdomen:
-On 21 march 2016:
Liver is normal in size( cranio caudal span 12.9 cm) it shows diffuse increase in echogencity S/o fatty infiltration ( grade 1) Intraheptic billary radicles are not dilated.
portal vein is normal in calibre and shows normal color filling on application of color doppler.
Gall bladder is distened and shows normal lumen and wall thickness.Perichoecystic fat planes are unremarkable.CBD is normal in calibre.
Pancreas is normal in size,outlines and echo texture .No peripancreatic fluid collection is noted.No obvious intra-pancreatic ductal dilatation os noted.
Retroperitoneum is partially visualized and appears normal.
Spleen is normal in size,outlines and echo texture.No obvious focal lesion is noted.
Bilateral Kidney are normal in size, shape,position,outline and echo texture. Bilateral pelvicalyceal systems appear normal.No evidence of hydronephrosis is seen, bilateral mild increased echogenicity noted 16.6 mm mild pole calcus in mid pole.
Right kidney measure 12.3 cm in size and left kidney measures 12.2 cm in size.
Urinary bladder is distended and shows normal lumen and wall thickness. No free fluid is seen in the peritoneal cavity. Prostate measure 42 cc.
Impression:
Fatty liver grade 1.
Bilateral medical renal disease.
Moderate prostatomegaly.

My concern is still my HBSag is not coming down , however my Hbvdna not detected since six Oct.2015.
PTH on higher , I am taking daily Vit.D3 supplement 5000iu  one capsule daily and Mk-7 it.k-2 one capsule daily , I am taking both these supplement in the morning after breakfast and Teravir (TDF) 300 mg after dinner.
Please suggest the best option ,

Thank you,

Avatar universal
keep this therapy and recheck hbsag every year, usually tdf lowers hbsag on 50% of patients to 1000iu/ml by year 5, dont remember if this was hbeg os or neg
1 Comments
Hi Stef2011
Thank you so much,
My Hbeag is -ve and the treatment  started 1st Feb.2014 and till now with Tiravir 300 mg daily , I feel some time very weak and upper back having regular pain.
I am in the remote place maldives these days but keep visiting India almost 4-5 months so getting treatment is not a problem but due to weakness & tiring some time not deleiver 100% at work .
PTH is concern as its not getting down as I said in Maldives the sun is very bright and I almost out in the day time and cycling as well.I have a doubt like parathyroid gland so i will check with Doctor if required will do the scan once again.
My routine to take medicine after dinner ,Is it okay or required to change the schedule.
I sent you the details report how you find the result please let me know.
Avatar universal
maybe you have some genetic difference that makes use of vit d/pth different, where did you send the report?

you may try nicotinamide riboside for boosting energy, i take NR plus liposomal resveratrol and pterostilbene as antiage supplements and i got a very potent boost of energy like in my '30, i have no idea if this can work for anybody but definitely worths a try after reaching 35-40yo
1 Comments
Hi Stef2011
Thank you I will find out this energy booster supplement and try to take 1 daily , what is the best time to take this supplement.
I my previous post all the reports sent but i will send once again.
PTH - 89.1pg/ml.
Vitamin D3 - 25 hydoxy 56.6ng/ml.

I am planning to do the parathyroid scan as well. I have done it 6 month back and the report findings were okay but the doctor was not convinced with the report as serum Calcium was high 10.47 mg/dl , phosphorus serum always low 1.98 mg/dL , ALP high 164 U/L. , 24 hour Urine calcium 316.80 mg/day slightly high from the range 100-300 , calcium ionized serum 1.29 mnol/L. phosphorus 24 hour urine 825 mg/day
This time i am going with different lab. to double check.
Shall post you the findings.

Thank you,
Avatar universal
nicotinamide riboside works at 300 to 500mg daily, start 300mg and see the effect
take 200mg with breakfast and 100mg before bed
1 Comments
Hi Stef2011
My wife got blood tested for HbS Antibody ( Anti-HBs) and the result is 505.28 mIU/mL. and Vitamin D,25 Hydroxy serum - 40.70nmol/L
I know the Vitamin is extremely low and need to know on the test value  of Anti-HBs. please interpret the result.
Thank you,
Avatar universal
antihbs are ok, vit d too low

later today i ll post a study just published about centenarios it happens that they have good vdr or high vit d while others dying younger bad vdr and bad vit d levels
2 Comments
jcm60
Hi Stef11 & all other expert in the forum:
Please find my last blood test & USG whole abdomen and Fibroscan:


Vitamin D,25 Hydroxy:

Date 9 July 2016: 47.8 ng/mL.
on 21 March 2016: 56.6 ng/ml.
- On 9 Dec.2015 : 71.69 nmol/L.
- on 10/10/2015 : 44.6 ng/ml.
- on 8 Nov.2013 : Vitamin D , 25 - Hydroxy ,Serum ( CLIA ) 41.05 nmol/L.
- on 22 June 2014Vitd25oh :18.22 ng/ml.
- on 24/8/2014 : 51 ng/ml.
- on 8 Nov.2014 : 51.2 ng/ml.
- on 5 Feb.2015 : 157.55 nmol/L ( Sufficient range 75-250 nmol/L )
- on 7 march 2015 : 164.50 nmol/L (CLIA method) Range 75-250 sufficient)
- on 3 April 2015: 174.12 nmol/L ( CLIA method - Ref.renge 75-250 sufficient )
- on 1 May 2015 : 65.2 ng/ml
- On 13/6/2015: 41.1ng/ml
- On 8/8/2015: 26.01 ng/ml ( Insufficient range)

PTH ( Parathyroid Hormone) Intact, Serum :

Date: 9 July 2016: 87.72 pg/mL.
-on 21 march 2016:89.1*(High)pg/ml.
- On 12 Dec.2015: 77.3 pg/ml.
- on 10/10/2015 : 89.5* H pg/ml.
- on 5 Feb.2015 : 73 pg/mL ( Ref.Interval 14 - 72 )
-on 7 March 2015: 86.60 pg/mL ( CLIA method Ref.range 14-72 )
-on 3 April 2015: 73.60 pg/mL.
- On 1 May 2015: 83.80 pg/mL.
-On 13/6/15: 63.45 pg/ml.
-On 8/8/2015: 95.40 pg/mL. ( HIGH)

S.Creatinine:

Date 9 July 2016: 1.15 mg/dL.
-On 21 march 2016: 1.05*(High)mg/dl.
- On 12 Dec.2015 : 1.11mg/dl.
- On 10/10/2015 : 0.90 mg/dl.
-On  10 May 2015: S.creatinine : 1.4 mg/dl.
-On 13/6/2015: S.creatinine : 1.09 mg/dl (HIGH)
-On 8/8/2015: 1.00 mg/dL

L.F.T.-

Date 9 july 2016: ALT. 31 IU/L , AST - 24 IU/L. Serum Billrubin Total - 0.6 mg/dl , Serum Billrubin Direct 0.1 mg/dl. , Serum Billrubin Indirect 0.5 mg/dl.Serum Alkaline Phosphatase 165 IU/L. , GGT - 16 IU/L , S.Total Protein 6.8 g/dL , S.Albumin 4 g/dL , S.Globulin 2.8 g/dL , A\G Ratio 1.4

Date  21 march 2016; ALT 23 IU/L ,AST 23 IU/L ,Serum Billrubin total 0.7mg/dl , serum billrubin direct 0.1 mg/dl ,serum billrubin indirect 0.60mg/dl ,Serum Alkaline Phosphatase 127*(H) IU/L ,GGT 14 IU/L , S.total protein 6.9 g/dL S.Albumin 4.1 g/dL , S.globulin 2.80 g/dL , A\G ratio 1.46* (L)
-On 12 Dec.2015:
ALT : 39 IU/L. , Serum Alkaline Phosphatase :135 IU/L , GGT: 20 IU/L , S.Total Protein: 7.2g/dl. , S.Albumin: 4.2g/dl. , S.Globulin:3 g/dl., A\G:1.40.

Date 10/10/2015:

AST/SGOT: 29 IU/L.
ALT/SGPT : 43* H IU/L.
Serum Alkaline Phosphatase: 115* H IU/L.
GGT: 19 IU/L
A\G Ratio: 1.46* L

- 28 Jan.2014
SGOT / AST 48 U/L.
SGPT / ALT - 106 U/L.
ALK . Phosphatase - 139 U/L.

L.F.T.-
-  27/4/2014-
SGOT / AST 40 U/L.
SGPT / ALT  65 U/L.
Alkaline Phosphatase ( ALP ) 143 U/L.

L.F.T :
9 August 2014:

Serum billrubin total ( Jendrassik- Grof) 0.8 mg/dl ,
Serum Billrubin direct ( Jendrassik - Grof) 0.1 mg/dl,
Serum Billirubin Indirect 0.70 mg/dl ,
AST/SGOT ( kinetic-Henry) 10 IU/L  ,
ALT / SGPT ( kinetic-Henry) 26 IU/L ,
Serum Alkaline Phosphatase ( Kinetic) 110 IU/L ,
GGT 22 IU/L , S.total Protein ( Bluret) 7.3g/dl ,
S.Albumin 4.1 g/dL ,
S.Globulin 3.20g/dL ,
A\G Ratio 1.28.

L.F.T
- on 8 Nov.2014:
Serum Biluirubin indirect 0.50 mg/dl ,
AST/SGPT ( kinetic - Henry) 24 IU/L. ,
ALT/SGPT ( Kinetic Henry) 34 IU/L. ,
Serum Alkaline Phosphatase ( Kinetic) 136 * High  IU/L. ,
GGT 17 IU/L. ,
S.total protein 7.8 g/dl. ,
S.Albumin 4.1 g/dl. ,
S.Globulin 3.70*High g/dl ,
A\G Ratio 1.11* Low.

LFT: On 25Jan.2015:
SGOT/AST:  12.8IU/L ( Ref.range 0.0 -37.0)
SGPT/ALT : 24.7 IU/L ( Ref.range 0-41 )

LFT : On 20 Fe.2015:
ALT : 26 IU/L ( Ref.Range 10-40)
Serum Alkaline Phosphatase 112* High IU/L ( Ref.Range 32-92)
GGT : 21 IU/L ( Ref.Range 7- 64)

LFT On 13/6/2015:
ALT 32 IU/L.
AST 19 IU/L.
Serum Alkaline Phosphatase 104 IU/L ( HIGH)
A|G ratio 1.34 (LOW)
GGT 17 IU/L.



HBV DNA Quantitative , Real time PCR : Plasma
- on 28 Jan.2014- 5156250 IU/mL.
- 1 May 2014:  - 33181 IU/mL.

- 9 August 2014: = 5.72x10^2 IU/ml.

- 8 Nov. 2014: 47.5 IU/ml.
- 20 Feb.2015 : 6.04 IU/mi.
- 13/6/2015: HBV DNA NOT DETECTED.

HBsAg Quantitative:

Date 9 July 2016 - 5236 IU/ml.
- On 21 march2016: 6384 IU/ml.
- On 12 Dec.2015: 6485 IU/ml.
- On 10/10/2015: 6858 IU/ml.

- on 28 Jan. 2014:  : 7767.68 IU/mL.

- on - 1 May 2014:  6812.40 IU/m

- 9 August 2014: 3585 IU/ml.

8-  Nov.2014: 4633 IU/ml

- 20 Feb.2015 : 5174 IU/ml.
- 13/6/2015: 5431 IU/ml

FibroScan:
- On 21 march 2016; Cap( db/m) median 268 , E(kpa) median 4.2.
- On 10/10/2015: 3.8 (E kpa) , CAP ( dB/m) 272.
On 26 Dec.2014 : 4.7.
On 9 August 2014 : 4.9.
on 13/6/2015: CAP ( dbm) Median 270 , IQR 21. , E(kpa) Median 3.5 , IQR 0.5 , IQR/med 14%

Other test result are as follows:
Date 9 July 2016
Serum Calcium 10.5 mg/dl , S.Magnesium 2.18 mg/dl.

Date 21 March 2016:
Serum calcium 10.2 mg/dl.
S.Magnesium 2.18 mg/dl.

Based on these report Doctor suggested Tab Seviro 600 mg instead of Tenofovir 300 mg daily.
Please check the report and give your expert opinion .

Thank you,
Hi Stef2011 : Its long time i was not active in the forum , I have one question to you please let me know in Thailand Bangkok the HBV patient is allowed to get work permit. My HBV DNA is undeducted since 4 years but the HBsag is still exist. looking forward your kind response.
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