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]

antivirals have no effect on hbsag and on hbv infected cells, they can only lower replication

since you are 27yo on immune tolleran tphase i do hope your doctor knows what he is doing because you can t take antivirals for life so it is best to try to clear hbv definitively and antivirals alone cannot do this

keep the combo etv+tdf which should have been used from the begining since such high hbvdna cannot be lowered by entecavir only, anyway just make sure hbvdna gets to undetactable by 6 months on the combo etv+tdf and keep monitoring hbsag

you have to consider add on of interferon to these antivirals to clear hbsag, this can be done after 1-3 years of antivirals monotherapy, as you can see from other patients on this combo of antivirals plus interferon hbsag gets cleared or lowered so much that antiviral can be stopped without disease activity

be aware that just taking the antivirals is useless and possibly dangerous because they cannot be used life long, so add on of intf in your case is a must.it is also unknown if these antivirals can develop resistance and severe sides on the long term because nobody used them for longer than 5-10years yet

[Mars86]

actually I left the old doctor who treated me in immune tolerant phase and go to a specialist one who advised with TDF add on ...

I think his next step is addiing intf.

but in your suggession , is it ok useful to add intf. while HBsAg is soo high ?

if yes

when I can add it on ? after UND DNA directly ?

what is the conclusion of this high value of HBsAg ?

Thanks

[stef2011]

too little data on immune tollerant treated patients because you should have not been treated

anyway the good point is clearance of hbv is easier when you will add intf

when I can add it on ? after UND DNA directly ?
follow your new liver specialist which sounds very updated

what is the conclusion of this high value of HBsAg ?
this is good on immune tollerant phase, that means you have no immune response yet and when it will be activated under these drugs hbv will be cleared fast

please update the community about your results it may be easily possible that treating while still immuen tollerant is good to clear hbv, no data about this but my personal view is that it is easier to clear

[Taj82]

what about your HBeAg?

[Mars86]

Sure stef , I visited my Dr. today , he advised to continue using combo ETV and TDF till next October then will add intf ... he also advised with Echinacea
this supports immune system ...

I'll keep all posted...

[Mars86]

it is positive :)

[stef2011]

very good doctor

[Mars86]

Stef ,

I examined HBsAg Quant. last month it decreased about 30000 iu/ml , it is now about 980000 iu/ml .. what do you suggest ?

[Mars86]

I forgot to say that ALT/AST are in normal range

[studyforhope]

When your baseline dna was determined to be higher than 170 million, was an effort made to determine your true baseline vl by retesting the sample with an appropriate dilution of 100fold?

You could be one of these patients with a vl of eg 40 billion. Then a primary treatment with entecavir alone is wrong. Hopefully the late add on of tenofovir will bring they vl to und.

A moderate reduction of hbsag quant under intense antiviral treatment is expected. But it will not go much further down and your chances of ifn add on to clear you are very small.

[Mars86]

Thanks

Next Month I'm going to retest DNA again , I'll inform the forum back .. BTW when I was first treated with ETV, after 2 weeks I retest DNA again and it was 870 000 iu/ml this only in 2 weeks ... the question is, does the baseline VL is an indicator of the treatment ?

[studyforhope]

After 2 weeks your vl reduction coming from very high is expected to be 100 to 1000 fold, so you had closer to a billion true vl at start.

It is harder to control a  virus that replicates uninhibited, producing hugh vl numbers.  But the full picture is more complicated.

[Mars86]

your input ?

[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

[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

[Mars86]

Dears;

Your inputs will be highly appreciated...

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]

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]

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?

[stef2011]

one good point of your status is that your virus should be wildtype, it has little opportunity to mutate with your low hbvdna so when immune system will be recovered hbsag shoudl be easier, at least theorically

anyway it is not good to have hbvdna detectable so if it does not go down to und by few months it is important to consider possible aid from ntz or ezetimibe

[Mars86]

thanks stef for your valuable advice :)

[Mars86]

I visited the Dr. today he advised with peg add on + etv and tdf ... what do u think ?  is it ok or not ?

[stef2011]

of course it is if hbvdna stopped decline, while if it is still going down you better wait before peg add on

[Mars86]

Thanks for precious advice :)