Highly reactive HBsAg

[Mars86]

Dears;

I'm 27 years male , Chronic HBV in immune Tolerant Phase and still Immune Tolerant since I got diagnosed last year in Jan...

I was treated with ETV .5 since exactly 12 month and added TDF in the last three months .. DNA is about 240 iu/ml but HBsAg is highly reactive 130 000 iu/ml ... what is the meaning of this high value ? why it keeps increasing while DNA is going to decrease ?

base line DNA was more than 170 * 10^6 iu/ml ... Normal ALT/AST ..

[stef2011]

i think we have to wait for you to reach hbvdna undetectable then follwoing years there should be immune cd8 recovery at some degree and pegintf might be considered to try clear hbsag

did you try way to boost immune response to make hbvdna und faster?like vitd25oh to 90-100ng/ml?nitazoxanide add on?ezetimibe add on?

[Mars86]

Thanks Stef

months of therapy on etv = 11 months
months of therapy on combo = 14 months

total months of treatment = 25 months
baseline of HBsAg =  not determined but it tested randomly and found 89000 Iu/ml and increased to 131000 iu/ml then added TDF and decreased to 67000 iu/ml now ...

Base line VL was greater than 170 * 10^6 .. now it is 240 Iu/ml

Thanks

[stef2011]

please sum up the following:

months of therapy on etv
baseline hbsag
baseline hbvdna

if hbvdna stops decline and remanins detactable after 6months i would go for etv+tdf combo

of course etv has no effect on hbsag for you like for most patients, on me it made hbsag increase and didn t work to make hbvdna fully und

[Mars86]

Dears;

Your inputs will be highly appreciated...

Thanks

[Mars86]

ok now HBsAg is around 67,000 IU/ml but DNA is still around 240 IU/ml ..

would I stop this treatment at all or what ? what are the consequences ?

Thanks

[stef2011]

the big mistake was to start treatment but now you are already on it and better continue until this combo of antivirals makes hbvdna undetactable, hopfully we may see an hbsag and hbeag decrease that allows pegintf to work, especially hbeag turning to negative

do you know your genotype?if not test before hbvdna und