Results after 44 weeks of TDF+Peg+NTZ

[April9903]

In March 2012 (Before Treatment)
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HBV DNA --  450,897 copies/ml
HBsAg (Quantitative) --  3054.03 IU/ml (cut off= 0.05 IU/ml)
HbeAg  -- Neg
AntiHbe -- Pos
Fibroscan =  4.2 Kpa
Geno Type C
Precore BCP ( T 1762 / A 1764 ) Mu
PC codon 28 Mu


22-October 2012 (After 12 weeks of PEG + TDF + NTZ )
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HBV DNA --  186 copies/ml
HBsAg (Quantitative) --  2869.70 IU/ml (cut off= 0.05 IU/ml)
25-OH vit D3 --61.3 ug/l
ALT - 81 u/l
AST - 89 u/l
Platelet Count is low - 140


31-December 2012 (After 24 weeks of PEG + TDF + NTZ )
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HBV DNA --  UND
HBsAg (Quantitative) --  2606.72 IU/ml (cut off= 0.05 IU/ml)
25-OH vit D3 --   46.1 ug/l
ALT - 52 u/l
AST - 63 u/l
Platelet Count is normal - 150
Fibroscan =  6.1 Kpa

15-May 2013 (After 44 weeks of PEG + TDF + NTZ )
-------------------------------------------------------------------------

HBV DNA --  UND
HBsAg (Quantitative) --  2612.48 IU/ml (cut off= 0.05 IU/ml)
25-OH vit D3 --   54.8 ng/ml
ALT - 84 u/l
AST - 80 u/l
Platelet Count is normal - 177

Last week, I had the last shot of Peg. I am very disappointed with my HbsAg results. It's not going down anymore. Doc said the effect of Peg will stay on very long even after the last shot. I continue taking TDF but stopped NTZ now. My Alt and Ast is also still high. Very disappointed!

[Jeff912000]

Must be patient.  Can continue with serial treatment to prevent HCC and cirrhosis.  TNf is very good drug.  No resistance.  The next generation of drugs will be out in a few years.  

[stef2011]

we do know that pegintf non response is due to t-regs suppressing hbv specific immune responses and probably other parts of immune system too.use of antivirals lower t-regs and rescue specific hbv immune system response so i do suggest to keep tdf for about 2-3 years at least and when there is some hbsag lowering again add on pegintf again.
non response after use of thf or etv for more than 3 years is very rare, 10% but this was not even on tdf or etv but on lam+adv

it is also probable hbsag will lower a little after pegintf is finished, you may try some maitake too and see if it works.in vitro maitake improves pegintf response 9 folds and if you start it right now it is kind of an add on to the peg effect which will remain for about 1 year

[R_2012]

No need to be discouraged.  You gave it shot, but there are no guarantees in getting results.  Peg should continue to benefit you for years.  Did you do labs just prior to starting treatment (March to October >12 weeks)?  with regards to Peg, they have very clear stopping rules now as to whether you have a chance of SVR.  I have been researching because my doc wants me to go on Peg.  If >/10% HbsAg drop coupled with >/2 logs drop in HBVDNA at week 12/24 has high correlation with response.  Obviously in your case TDF obscures HBVDNA drop.  

If you don't mind me asking, what was your Doc's rational for prescribing both TDF and Peg?  I understand the studies from Add-On point of view after several year on TDF, but not sure starting them together.  Any research that you are aware that would increase SVR chances?  

Also your AST are constantly higher that ALT.  That is strange for someone with healthy liver.  That may be result of working out or something.      

[stef2011]

add on has about 50% clearance at 48weeks and hbsag lower than 300iu/ml on the rest of 40% patients, just one failure 10% but no using tdf or etv but adv+lam

pegintf plus tdf all at once is much much lower results, but it is possible to retry after few years on etv or tdf

[mustthinkpositive]

Who prescribe NTZ? Does the Dr know you take NTZ?

[calebz]

What's worrying is the Fibroscan result : you went from 4.1 to 6.1 within ~6 months of treatment that should help this result not worsen it from what Ive read.
You need to stay positive IFN will help despite the HBsAg result, there are studies that it lowers HCC risk a lot despite no SVR. I'm on IFN week 40 now and my HBsAg results behave similar to yours - it stays on same levels.

[veteranB]

yaksss, I feel for you sorry..

Guys, you know we need to all go to Canada and sit in front or Replicor building, have them read all these stories...

That is what what we should do...

[R_2012]

I understand the add-on to nucs, but according to Lampertico presentation in January 2013, de novo therapy with nucs and peg does not increase SVR.  As far as I can tell, he is one of the biggest proponents of using Peg initially on patients, and he does not recommend combo.  

[mustthinkpositive]

Hi, what's your number in HBSag? Maybe IFN is good for preventing HCC because it's an immune booster. Boosting immune system naturally should have good result also but it's different for everyone. Always want to add new antioxidant to the regimen.

I feel for April.

[Jeff912000]

I agree combo treatment does not increase SVR but does  not hurt.  

[R_2012]

You do realize that you'll still need to use Peg with Replicor right?  Provided that the drug is ever approved in current state.  

[calebz]

You are wrong, there may be some nephrotoxic sides if you add painkillers people use to cope with IFN side effects. Remember not everybody handles IFN the easy way.. some have strong fevers/flu effect.  It would be perfect of you link a study result to what you say about combo results. I think that most options on combo treatments here are based more on theory rather than actual med trials. Gilead is currently running a combo trial of IFN/TDF and results will be available around 2015. Its too bad they don't have a sequential arm just combo combinations. I think that what stef does has more sense than a combo: keeping TNF for a few years and then starting IFN.

[Jeff912000]

Everybody should have one try with interferon just in case they are lucky reponders. I remember Steff also said this before.   I did not recommend April to do the combo.  I also think she should do serial treatment.  But just giving her support.  It is kind of her to share her treatment experience.  I do not think April needs any painkiller for her PEg.  

[Jeff912000]

Sorry.  I have to take back the last sentence about not needing any painkillers.   I am not sure whether she took more medication than panadol for the side effects.  

[April9903]

Thank you all very much for your support . I am feeling a bit down at the moment. Throughout the tx I lost a lot of hair and had flu like symptoms and tiredness, wired headaches, sometimes more, sometimes less. I used paracetamol when I cannot stand it anymore but I tried not to use it often.

@celebz..I am very encouraged to know that "IFN will help despite the HBsAg result, there are studies that it lowers HCC risk a lot despite no SVR."

[calebz]

April recheck that Fibroscan result.

[stef2011]

lampertico is doing many studies and the add on study after longterm nucs is his too

peg+nuc immediately work well on hbe+ but much less on hbe-, the add on sequantial treatment is the way to go

[stef2011]

Throughout the tx I lost a lot of hair and had flu like symptoms and tiredness, wired headaches, sometimes more, sometimes less

dont worry the hair will come back 3-4 months after you stop, i also had all that by imiquimod and i think pegintf was a good try anyway you will benefit a little while on tdf mono anyway
the paracetamol taken while on peg is no problem if doses are low and correct for liver disease

your fibroscan is not much different, 6kpa is still healthy rage and that is probably just a little inflammation by the immune response made by peg, this will go down in few months too

[stef2011]

http://www.mvlabyzh.fudan.edu.cn/admin/pic/uploadfile/2013052357155265.pdf

extremely interesting, especially the part of hbvdna intf alpha suppression, this is probably one of the reasons sequantial therapy works and pegintf mono doesnt

[April9903]

@calebz..I'll again check with fibroscan in September.

@stef2011..Thanks for the link. I saw in other thread that you are taking Mitake muchroom supplement. Do you know about Lingzhi muchroom?

[stef2011]

i havent seen enough studies on this i prefer maitake only for now which is the most studied in vivo

[andrey19]

There are studies saying that prolonged 96 weeks is safe and has response rate of almost 30% against 7% comparing to 48 week of interferon. I think if you can bear sides and high cost of pegasys just give yourself a chance and continue interferon.

[stef2011]

no it is best to stop and restart it later on, she won t lose the effect of this 48weeks treatment if she restarts in 1-2years

[R_2012]

Here is another paper on how add-on therapy is supposed to work.  Very informative.  Nucs rescue CD8 and interferon does the rest.  Not sure if it has been posted here before.  

http://www.sciencedirect.com/science/article/pii/S0168827812008719