I am new: Interferon Treatment vs. Entecavir????

[ambiance3021]

I am 26 yrs old and contracted HBV vertically.  I am new to this site, but am due to start the pegylated interferon alfa-2a treatment (Pegasys) this Friday and am terrified of the side effects.  This treatment is usually used to treat HCV, but I have chosen it over the antiviral pills b/c of the lack of risk of viral tolerance and the dangers connected to skipping doses or quitting an antiviral pill treatment.

As I have read the forums related to HBV, I have not seen any posts regarding others who have chosen to go on this Pegasys treatment as I have.  I was wondering if any of you could please respond to my post in regards of whether or not you were ever offered Pegasys (interferon), and if you were offered, how you decided on the treatment option that you did.

I am a 3rd year full-time student doing a double major in Biology and Radiation Therapy.  Can anyone out there provide me with your personal experiences on Pegasys and whether or not you were able to continue with a busy schedule?  Am I being too optimistic to continue with even a 15 credit hr load?

[chiq7]

hi do u know how much interferon now a days? coz me and my husband got hepa b  pls help us too...

[saritahemanth]

anti hbe is positive ..hbsag positive(cov=0.152, od=1.740) and hbv dna 18iu/ml...asl=37 , alt=38...my doc he is insisting on interferon only ...he is saying see for  months doesn't work will give you tenofir....he is saying combination medi's are still under doubt...but he has left the decition with us whether interferon or medicine ....plij one last booster advice for me :-/  

[saritahemanth]

my tests results ..my  hbeag which was negative for 4 yrs then it turned positive and was positive for 8 months now its again negative??? why i n what is going on??? :-/  

[stef2011]

definitively entecavir plus tenofovir combination so that if any resistance mutant is arising it can easly be blocked now,

[saritahemanth]

now what shall i ask for still combination or interferon ???

[saritahemanth]

guess what ...my recent results --> hbvdna is 18 iu/ml...my dna was zero from last 3 yrs ..but 6months back my hbeag turned positive n now dna count is 18...does this mean virus has grown resistant to entacavir now???? :-(

[saritahemanth]

sure i am gonna talk to my doc ... :-)

[stef2011]

when you talk to the doctor be aware that most say:
"we wait for the resistance to make combination therapy if the test shows resistance we make combo"

of course this is totally bull**it nonsense, the combo must be used in order to prevent the resistance mutations once they happen there is no way back to the wild virus, so even if resitsance can be treated by combo it is best to prevent it

i suggest this so you know what to tell to the doctor, i too had to fhight to convince them on the combo......

[saritahemanth]

i am really thankful to you for guiding me ... :-) i am surely going to talk to my doc on all this ....sometimes i regret a lot for having this ... why me :-(  i donno how i got this where on this earth from??..but least what i can do is just to move on with this rest of my life ....

[stef2011]

what if i become resistant to tenofovir later??

there is no resistance to tenofovir only reduced response on one type of mutant from adefovir but even if reduced response most get hbvdna und

interferon doesn t work if hbsag is high it makes sense to use interferon only to clear hbv as add on to long time use of tenofovir or entecavir.tenofovir plus entecavir will rescue your immune system response in a few years use so that add on of intf may work

both hbeag and hbeab positive:
probably not a mutant, it can be a balance between hbeag and hbeab and even if it is the mutant it is not dangerous at all as long as hbvdna  is und and it is of course treatable

[saritahemanth]

check that hbeag becomes negative again on the combo.if both hbeag and hbeab remain positive this is another mutant, dont remember which one but it is not good for sure

means i will be at risk ?? if this is so then no treatment available??

it is best to take entecavir plus tenofovir and stop entecavir while you get pregnant (allow more than 6months on this combo).

what if i become resistant to tenofovir later?? and if i go to interferon after that and that to fails are there other options in medication ??

[stef2011]

it is best to take entecavir plus tenofovir and stop entecavir while you get pregnant (allow more than 6months on this combo).


my recent results were - hbeag positive ( which was negative for four yrs)
anti hbeag positive
check that hbeag becomes negative again on the combo.if both hbeag and hbeab remain positive this is another mutant, dont remember which one but it is not good for sure

hbsag 250 iu/ml
this is not hbeag quantity but the limit of abbott architect without diluition of your blood sample.the lab was so stupid and lazy to avoid the diluition and just tell you your hbsag is superior to 250iu/ml which is a totally useless information because if you have chronic hbv hbsag is in the thousands as 99,9% of hbv carriers
recheck hbsag with diluition

[saritahemanth]

one yr on adefovir
three yrs on entecavir (as virus got resistant to adefovir )

my recent results were - hbeag positive ( which was negative for four yrs)
anti hbeag positive
hbv dna < 20
hbsag 250 iu/ml

[saritahemanth]

i consider the use of tenofovir plus entecavir because you do have adefovir resistance which reduces response to tenofovir

but i was on entecavir for last three yrs is it ok if i continue entecavir plus tenofovoir from this point...as i need to plan for babies too...i heard its not safe to use tabs while u r pregnant :-(...doc was saying as u plan to have babies if interferon works that would be a plus point and that if after three months we find it not working we can immediately withdraw the interferon injections and will give me tenofir which is safe during pregnancy...i am a lot confused plij suggest what shall i ask my doc to do?...:-(

[stef2011]

it is also interesting to note:
me and my sister got infected from my mother who had wild type all life (hbeag reversion many times) while my hbv mutated to precore and bcp plus q215s very early

my sister has also precore or bcp because she turned immune tollerant again for few months when on alinia monotherapy but hbeag stayed negative without reversion

[stef2011]

hbeag is produced similar to hbsag, indipendently from virions (hbvdna).this in wild type and you can have hbeag pos, hbeag neg with hbeab pos and both negative if antibodies and antigenes are in balance
remember that you can be hbvdna und but no decrease of hbeag

with the precore bcp the hbeag is reduced or not produced so any hbeab is ble to hide hbeag in blood

the easiest thing is follow hbsag quantity when it reaches values less than 1000iu/ml for genotype d the hbv virus is really inactive and it is very difficult to have both hbvdna high again or hbeag reversion

[StephenCastlecrag]

In one Taiwan study, 283 patients were followed for a median period of 8.6 years after HBeAg seroconversion, 4.2% had HBsAg reversion. I have a feeling that these occurred in the immediate period after seroconversion. It is hard to understand HBeAg reversion in the setting of very low hbvdna.

[stef2011]

another important test is precore/bcp mutants test, adefovir, lamivudine and entecavir mutants test and genotype test

if you have no precore/bcp mutants your hbeag positive status will have 16% hbv clearance with the use of tenofovir plus entecavir, 24% tenofovir plus entecavir plus interferon.i consider the use of tenofovir plus entecavir because you do have adefovir resistance which reduces response to tenofovir

[stef2011]

your doctor is a killer, change it right away or sue him if possible:

using adefovir he made you resistant to both adefovir and reduced response to tenofovir

using entecavir monotherapy you risk resistance to entecavir low but possible, lamivudine, telbivudine

to be safe you should be on entecavir plus tenofovir, entecavir will be active on the adefovir mutation and the possible tenofovir resistance mutations while tenofovir will protect you from entecavir, lamivudine, telbivudine resistance mutations

interferon add on to entecavir plus tenofovir or entecavir plus interferon can be good only if your hbsag is low in the 1000iu/ml range, if hbsag is 1000 to 10.000iu/ml it is not sure to work on hbsag

[stef2011]

hbeag reversion is impossible with bcp and precore mutants but it is normal if you are wildtype
in the wildtype case the patient is hbeag negative because of antibodies hbeab but if immune system gets suppressed or the virus antigens get superior to the antibodies you get hbeag pos again

in my family:
one used to get hbeag pos again all the time when hbvdna detactable

i was hbeag neg and hbeab neg at 16-17yo but became hbeag pos at about 18-19 and then hbeag neg after 6 months of alt at 1500.hbv simply mutated to precore or bcp at that time

[StephenCastlecrag]

Thanks for the information. Reversion of HbeAg is not unheard of, but I can find very little information about its clinical significance. I wonder whether it is possible that the lab had made a mistake? In  November, did you test your hbvdna and ALT?

As for Interferon treatment, as it is finite course of treatment, with manageable side effects in most cases, I don't see any harm in trying it. But I always want to know what the treatment hopes to achieve. If available, I would suggest getting a quantitative assay of HBsAg, and a re-test of your hbvdna, ALT, and HBeAg status before starting Interferon.

I am not a doctor, these are just my opinions.

[saritahemanth]

actually when i was detected hbsag positive four yrs back i was found to be hbeag negative with high hbv dna count , so he started with adefovir n it worked well for a yr but after that dna levels started to increase again so he switched me to entecavir , it worked well my dna viral load constantly was zero for three yrs with hbeag negative and anti hbeag positive ... but recently n november when he was planning to stop the treatment my hbeag turned to be positive which he says is impossible when dna viral load is zero so decided to to go for interferon :-(

[StephenCastlecrag]

Can you tell us for how long have you been HBeAg? Did you become HBeAg negative whilst on treatment? Otherwise why were you on Entecavir?

I read of another case when a  hbver who became HBeAg negative at 12 is now HBeAg positive again at 27. This is all rather strange.

[stef2011]

some have but it is just the hair getting thinner, it is not exactly hair loss and
all the hair comes back

but recently i converted from hbeag negative to positive.....
maybe you converted hbeag negative, if you converted hbeag positive you have  wildtype virus and not mutans.
anyway hbeag pos or neg doesn t make much difference, pos is better

which he says is pretty impossible so decided to switch me from entecavir to interferon :-(
how stupid doctor combo is the only way to clear hbv, entecavir mono will never clear hbv (only 5%) and intf mono pretty much the same (7-10%) while combo can reach 50% of hbv clearance.if doctors says these are on study now ombo trials date back since 2004 and earlier