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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
everything more than fine, also hbsag is responding to tenoffovir, just increase vit d to 10.000iu daily so that you reach 90-100ng/ml, once you reach 100ng/ml you can go back to 7000iu daily and see if that s enough to keep the levels
Avatar universal
hope hbsag decline keeps like this so when it reaches 1000-1500iu/ml you can go for pegintf add on

Avatar universal
Thank you so much for your kind advice & help time to time..
Avatar universal
Hi Stef

Please find my latest report:

I have gone through the blood test on 8 Nov.2015 , please review my reports & suggest.


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

9 August 2014: HBV DNA ( Quantitative) Method - Real time PCR , Instrument - Cobas Tagman 48 , Result  = 5.72x10^2 IU/ml.

8 Nov. 2014: 47.5 IU/ml.

HBsAg Quantitative:
Test Report on 28 Jan. 2014:
HBsAg ( Serum CMIA) quantitative : 7767.68 IU/mL.

Test Report on - 1 May 2014:
HBsAg Quantitative ( CMIA ) - 6812.40 IU/mL.


9 August 2014:
HBsAg Quantification by Chemilumiscence ,Result = 3585 IU/ml.

8 Nov.2014: HBsAg Quantification 4633 IU/ml



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

L.F.T.- complete:Report on 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.
Lipid Profile - Serum:
S.cholesterol ( Enzymatic) 139 mg/dl , S.Triglycerides ( Enzymatic) 101 mg/dL , HDL-Cholesterol ( Homogeneous) 25.7 mg/dL , LDL- Cholesterol ( Homogeneous) 92.5 mg/dL , VLDL - Cholesterol 20.80 mg/dL.

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.

Blood Urea Method Serum : 8 Nov.2014 22.2 mg/dl.

Creatinine Method Serum 1.06* High ( Normal Range 0.2 - 1)


Vitamin D , 25 - Hydroxy ,Serum ( CLIA ) 41.05 nmol/L.
Vitd25oh was 18.22 ng/ml  tested on 22 June 2014.
Vitd25oh on 24/8/2014 : 51 ng/ml.
Vitd25oh on 8 Nov.2014 : 51.2 ng/ml.

I have few concern like the Serum Alkaline Phosphatase has elevated to 136 and the normal range is 32-92 , S.Globulin has elevated to 3.70 and the normal range is 2-3.5 , A\G Ratio is 1.11 LOW and the normal range is 1.5- 2.5 ,

Also I am continues taking Vitamin D daily 5K to 10 K on weekdays and Satureday / sunday 60K. but the result is remain same as my previous report.

AST & ALT also elevated compare to previous report.

HBsAg also elevated compare to previous report.

Please suggest the best possible.

Looking forward to have your opinion ,

Thank you ,
  
Avatar universal
if you are taking vit d3 only results are extremely good, especially hbvdna and hbsag.vitd25oh is still very low so better results are possible

start a no dairy diet, no nuts (almonds and all similar nuts), no chocolate, drink 2.5L of water and increase vitd3 to 50.000iu daily or 60.000iu daily except sunday, on sundays no vit d

recheck vitd25oh by 4 weeks, parathormone and also check serum calcium, ionized calcium and urine calcium (requires 24hrs urine collection)

the target is:
vitd25oh 150ng/ml
parathormone 10-20pg/ml

by 6months on these stable values both hbsag and hbvdna might keep lowering

as to creatinine high level of normal drink baking soda 1 tea spoon with some lemon every day
Avatar universal
when hbsag stops decline, if it gets to less than 1500iu/ml you can try adding peginterferon to vit d or if you dont like to try peg just keep vitd25oh 150ng/ml with this regimen, since you achieved good lowering of both hbvdna and hbsag i think you may get even better results by vit d alone
Avatar universal
Thank you so much for your expert opinion , I will increase the vitamin d dose and check all test after 1 month.
I have started taking baking soda with lemon daily as i saw your previous comments  where u suggested the same to some one in the forum.
I am taking almonds nut & walnut since 1 month suggested by dietitian , now i will stop it.
Milk without cream ( double tone fat free) taking 50ML adding some turmeric as i read this is good for health . Should I continue this or stop ?
Any other abnormality you noted in the report like ALT  or AST elevation.
Thank you,
Avatar universal
the problem with kidneys is that hbv infects kidneys too and makes damage there too, if you can afford also use of goleic-gcmaf or fibroguard can restore kidneys

i know very well because i had same issue many years ago and was afraid i could not use tdf.at that time i used fibroguard and creatinine lowered immediately, later on gcaf even made my creatinine clearance higher than normal (kidneys that works better tha normal)...this is my personal experience.baking soda can be the cheapest option to try before more expensive firboguard or goleic-gcmaf

the good of goleic is that it may restore immunity against hbv combined high dose vit d and low hbvdna by antivirals or naturally
Avatar universal
Thank you so much , I will try Fibrogaurd or goleic-gcmaf. Shall up date you ..
Avatar universal
Hi Stef: I have done some test this week , followings are result.


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.

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



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.

Lipid Profile - Serum:
S.cholesterol ( Enzymatic) 139 mg/dl ,
S.Triglycerides ( Enzymatic) 101 mg/dL ,
HDL-Cholesterol ( Homogeneous) 25.7 mg/dL ,
LDL- Cholesterol ( Homogeneous) 92.5 mg/dL ,
VLDL - Cholesterol 20.80 mg/dL.

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 )

Blood Urea Method Serum :
-  8 Nov.2014 22.2 mg/dl.


Creatinine Method Serum 1.06* High ( Normal Range 0.2 - 1)

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 7 Feb.2015 : 157.55 nmol/L ( Sufficient range 75-250 nmol/L )

PTH ( Parathyroid Hormone) Intact, Serum :
- on 7 Feb.2015 : 73 pg/mL ( Ref.Interval 14 - 72 )

Kidney Function Test:
-on 5 Feb.2015:
Blood Urea: 21 mg% ( Normal Range 15-45)
Serum Creatinine 1.0mg% ( normal range 0.5 - 1.2 )
Serum Uric Acid : 5.7mg% ( normal range 3.4 - 7.0)
Calcium 10.5mg% ( normal range 8.2 - 10.3)
Phosphours 3.2mg% (normal range 2.5 -4.8)
Sodium 140mEq/L ( normal range 136-145)
Potassium 3.9 MEq/L ( normal range 3.5-5.1)

I have few concern like in KFT the calcium level is 10.5mg% which is high as per the normal range , please suggest how to reduce the calcium level back to normal range.
I am taking Vitamin D3 10000iu daily after breakfast and every Saturday Vitamin D3 :60000iu , sunday off. I drink more than 3 liter water daily.
Also taking Tenofovir 300 mg daily at 10PM .
I am taking Urimax 0.4mg daily as i have problem in prostate.

As a precautionary measure i am taking milk double toned with some amount of Turmeric powder & some garlic also.


Please suggest the best possible.

Looking forward to have your opinion ,
Avatar universal
First of all you must absolutely ban all dairies, even foods processed with dairies and check that the brand of water has calcium less than 10mg/l

just discovered a brand of water with calcium 87mg/l, that s very low quality water in general, it is absolutely not healthy

calcium will go down thanks to these changes, 10.5 is still good but it must go down because there are problems with your pth as well (like for most hbvers).pth is high because the body thinks there is not enough calcium so a high pth takes calcium from the bones...this will cause osteoporosis by time.a  chronic high pth also impairs immune system as a whole, not only hbv immune response.

a high pth confirms you are still very vit d deficient, vitd25oh is too poor to confirm vit d sufficiency in tissues and vit d receptors, only pth can confirm this and pth must be taken to lowest norm range which is 14pg/ml by increasing vit d dose but before taking more vit d we must correct calcium
Avatar universal
Also check all supplements or drugs you take to be calcium free, i found many suppl with calcium and had to change brand

also use always same lab especially for hbsag quant, pth, vitd25oh because different machines give very different numbers.vitd25oh in ng/ml chemilluminescenza (dont remember english for this now) are the best
Avatar universal
Hi Stef
Thanks for your advise , Yes I agreed with you that it can create osteoporosis and I have little symptom of neck pain where Doctor suggested me some exercise for the neck.
Also I have continuously pain on my right side shoulder joint and it still some time shifting up & down.This is because of high PTH & serum calcium. Please suggest should I continue D3 dose 1000 IU daily and 60000 IU on Saturday. Sunday no D3 dose.Water I am taking more than 3 Ltrs. & 3-4 times green tea. Dairy product reduced.
Suggest how to lower the PTH value.
Hbsag & HBV DNA test will be conducted next month. shall share the report with you.
Thanks once again for your help.
Avatar universal
you must eliminate all dairies, this is mandatory, they increase osteoporosis risk and add vitamin k mk7 to reduce calcium in blood and fix that into bones

i also had all those pains years ago and posted about it, all gone since vit d and low norm calcium in blood.the combo vit d plus vit k is mandatory for this

i have used this as vit k mk7 because most supplements are too low on this or if you like natto is full of vit k
https://www.bigvits.co.uk/product.asp?pid=953&cid=309&tid=&bid=
Avatar universal
Thank you so much Stef , I had Vitamin k earlier . I shall start it once again along with Vit d.
Avatar universal
Hi Stef: I have done some test this week , followings are result.


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.

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.



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)


Blood Urea Method Serum :
-  8 Nov.2014 22.2 mg/dl.
- 25 Jan.2015 : Blood Urea : 21.2 mg/dl.
- 25 Jan.2015 : Blood Urea Nitrogen ( BUN) : 9.91 mg/dl


Creatinine Method Serum 1.06* High ( Normal Range 0.2 - 1)
Serum Creatinine on 25Jan.2015: 1.2 mg/dl ( Ref.Range 0.7 - 1.2)
Urea/Creatinine Ratio on 25Jan.2015 : 17.67 * LOW mg/dl ( Ref.Range 20-35)


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 7 Feb.2015 : 157.55 nmol/L ( Sufficient range 75-250 nmol/L )

PTH ( Parathyroid Hormone) Intact, Serum :
- on 7 Feb.2015 : 73 pg/mL ( Ref.Interval 14 - 72 )

Kidney Function Test:
-on 5 Feb.2015:
Blood Urea: 21 mg% ( Normal Range 15-45)
Serum Creatinine 1.0mg% ( normal range 0.5 - 1.2 )
Serum Uric Acid : 5.7mg% ( normal range 3.4 - 7.0)
Calcium 10.5mg% ( normal range 8.2 - 10.3)
Phosphours 3.2mg% (normal range 2.5 -4.8)
Sodium 140mEq/L ( normal range 136-145)
Potassium 3.9 MEq/L ( normal range 3.5-5.1)

KFT on 20Feb.2015:
- Blood Urea : 21.8 mg/dl.
- Serum Creatinine : 1.02 * HIGH mg/dl.
- Rest of the test on KFT are normal range.

FibroScan:
On 26 Dec.2014 : 4.7.
On 9 August 2014 : 4.9.

My liver Doc.suggested me to meet with ENDOCRINOLOGIST as my PTH had increased as stated above. I met with this DOc. and he checked and suggested some blood test which are as follows:
On 23 Feb.2015:
- Albumin Serum 4.46g/dL ( Ref Range 3.50- 5.20)
- Alkaline Phosphatase ( ALP) Serum 153 U/L ( Ref.Range 30-120)
- Calcium Serum 10.60 mg/dl ( Ref.Range 8.80-10.60)
- Phosphorus Serum 2.00mg/dl ( 2.40- 4.40)

Looking into these test 2 test are beyond Ref.range like ALP & Phosphorus .

I have started K2 MK7 along with D3.
Doctor Endocrinologist thought that we need to correct the dose of D3, based on these report he will priscribe the d3 dose. but so far I am taking 10000IU daily & 60K once in week ,Sunday off.
This doctor also verify the Hormone produced in thyroid / PTH.He also asked me to repeat these test after 10 days. along with 25 hydro. & PTH.
As mentioned earlier i have pain in my upper back near to the shoulder joints.
Also my HbSag increased and HBV DNA had reduced.
Looking forward your opinion as always.
Thank you,
Avatar universal
i see nothing different as regards pth/vitd correlation from me, my sister and many other hbv carriers

the only thing you have more is damage from low vit d to kidneys and some imbalance.
the first thing to do is try everything to lower calcium, like high dose vit k2 mk4 (45mg daily) and vit k2 mk7 200mcg daily.there is no toxicity from these types of vit k

vit d, it is best to use daily vit d at 20.000iu or higher depending to response, stop big doses once a week.studies shown daily dose is beneficial, weekly doses unknown, monthly doses worsen.maybe high calcium is from these big doses which makes up and down levels of vit d

keep the no dairies and 2.5l low ca water

if you feel bone pains you are rebuilding bones from osteoporosis or weak bones, this will go away by time
Avatar universal
also keep in mind that you are still very vit d deficient in the tissues and cells because your pth is very high.so you are having no effect from the vit d you have in blood

the difficult thing is your calcium, was it 10.6 before starting vit d?maybe the 60.000iu dose once a week is making damage

i d reconsider hbsag levels, hbvdna when pth falls at least 20-30pg/ml
Avatar universal
Thank you so much ,
I also have concerned on high level of Calcium although it is on the borderline but the Doctor Endocrinologist have doubt on PTH hormone malfunctioning. He suggested to give holiday for D3 for 1 week and redo all the test again .however he told to continue K2 MK7 , I will redo all the test next week and share the report with you. His thought may be related to tumor on thyroid gland but so far he has not highlighted any thing.He will observe all these test for 1 month.
Also Stef my hbsag levels increased compare to the previous one , any suggestion on it.
Thank you,
Avatar universal
if you stop vit d the pth will jump very high, i doubt this doctor has knowledge of pth in chronic diseases or in general, the only thing that suppress pth is vit d.i will only stop the big doses once a week and increase the daily dose

His thought may be related to tumor on thyroid gland

a simple ultrasound will tell you if this is the case, but it is more hbv than any issues with glands

Also Stef my hbsag levels increased compare to the previous one , any suggestion on it.

you have no vit d in your cells and tissues, it just goes around attaching no receptors, so the changes of hbsag and hbvdna are correlated with the high pth as all studies says and there is no vit d boosting on immune system

if you can afford go with very high vit k mk7 like 500 or 1000mcg daily
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