IFN course

[calebz]

Hi

Was sharing my status and though I should maybe share my current experience with IFN.
I'm currently 29. First diagnosed 2012 January. First HBV DNA June2012 was about 214000 IU.
I was HBeAg Negative then. For some reason at baseline I became HBeAg Positive.

My baseline
DNA ~170000 IU
qHBsAg 4500 IU
ASP/ALT 40/60
Fibroscan 6,6 Kpa

Week 4
DNA 67000 IU
qHBsAg 4700 IU
ASP/ALT 35/55

Week 8
DNA 6000 IU
qHBsAg 3900 IU
ASP/ALT 35/55

Week 12
DNA 3000 IU
qHBsAg 4700 IU
ASP/ALT 36/54


My ALT/ASP is generally unchanged, DNA keeps dropping but HBSaG is really scaring me. Doc says we need to wait for a pattern to take out any conclusions and consider stopping treatment.
One thing I can think of is before that Week 12 visit I went to a gym a few times and skiing where I got tired like crazy.

[calebz]

Hi

I'm currently on week 22 Pegasys.

For a few days I started having problems with constant ear noise, I have been having random noises from that ear all my life but they used to come at random and go away after a few hours.

Also I would like to know if milk is a good diet during treatment ? I have strange urges at night for sugar products and milk. I don't know if this is nerves or its related to interferon ?

[grmr]

hi all,

as you know i had 2 ifn course (6 months in 2008 stopped as non responder) and the last one ended 1 months ago (approx 16 months IFN and TDF for 12 months while on IFN).

I m still EAG+ adn ALT GGT sloghtly elevated.. i'll have a flare for sure as DNA is going up after tx end as usual..

As to sides I managed for both course to live a normal lifestyle  8/10 hs office job dailiy, studing and doing some sports (walking / cycyling) in the weekend. (used to have the Friday ifn shots)

I was ofetn hungry and I confirm my nervous was pretty strong..

[Rome70]

Skiing was not a problem for me. i am not on IFN but I went skiing and check hbsag before and after and it has even dropped a bit....

[calebz]

Hi.
Just had my 24week visit. My DNA is still detectable at week 16 result - about 2000IU.HBsAg results didn't arrive yet..

Should it be already undetectable on IFN or is it normal its still there ? Was starting at 171000IU and the drop was significant at start

[stef2011]

Should it be already undetectable on IFN or is it normal its still there ?

it is normal, intf doesn t act directly on hbvdna but acts on cccdna, hbsag and also on hbvdna in the end.
of course it d best having hbvdna und but your result at 2000iu/ml is good anyway, it is hbsag kinetics that counts now, be aware that max intf effect on immune system is reached at 48weeks and that you can keep intf even for 2 years if it has a constant hbsag decline so that you can make it totally und

the intf response at 2 years is much higher with same sides as in the first 48weeks

[calebz]

Just had my week 32 visit. They didn't receive all my results from week 16 and 24 but my hbsag was around 5400 for week 16 and ALT was 64.
Do you think I should consider stopping IFN ?

[stef2011]

stopping rules for pegintf are:
no hbsag decrease by week 12 hbeag+ or 24 hbeag-
hbvdna decrease less than 1-2logs

it is best to wait for the 24th weeks results because most have an increase of hbsag till week 24ths on hbeag - and the decrease happens between week 24th and 48th.this increase always happens on peg add on to nucs and can be a purging effect on infected cells especially if hbvdna keeps going down

if there is no decrease after 24 weeks of treatment it is best to stop and start tdf to try again peg add on aftter few years

some examples on hbsag kinetics
http://www.natap.org/2008/AASLD/AASLD_52.htm

[calebz]

Thanks stef,I guess the trial coordinator would terminate my treatment by now if there was no point. Thanks again for your knowledge, it is too bad there arent many hbsag kinetic trials on the net, hopefully after this trial they will publish more results over net.

[stef2011]

just make sure you have good vit d levels more than 50ng/ml for best peg response, let us know your 24th weeks or over hbsag results

[calebz]

Had 32W results over phone. DNA fluctuating at 4000IU and hbsag still at 5000IU levels. Seems like its time to give up ...
Doc said to keep it going and we will evaluate the case at 40Week as hes on holidays now.

[calebz]

Hello
Just had my 40week visit. DNA continues to rise from 2000 at week 18, through 4000 week 24 and 6000 (IU/ml) in week 32. HBsAg still standing at 5000 IU/nl levels.

Strange thing is that I seroconverted .Why is this switching so often in my case ? I was Hbe- Jan'12 and turned + on baseline of TX around Oct'12. During TX i saw it tuned - for a while and now its back +.

I actually thought that they will stop my TX but they gave me the last 8 shots to finish 48weeks.

Combo results don't show any news in HBsAg drop. Do I benefit in any way from finishing 48w as a non responder?

[calebz]

Also my platelet count dropped but its around lower norm range. However I was wondering what might this comment mean:
PLATELET COMMENT : GIANT PLATEL +

[mustthinkpositive]

So sic....how about your ALT and neutrophils level.

Seems strange your HBV DNA rised up as well. You are on TDF/IFN combo?

[veteranB]

I hope Replicor people read this. Just look how a man has to suffer take intrferon with no surface antigen decline when YOU people have the cure.

Ps. Calebs I dont know what to tell you dude. But hang in there. I think stefan is right lets focus on the positive. At least your hbv dna went down. Try.to increase vitamin D3 and vitamin с intake.

Did they do immunograms on you . Maybe your wbc are low thus surface antigen stays elevated.

You can also ask them for tdf or etv add on. ETV will be gentler on you if your body is tired from taking peg. Maybe try to add nucs and see in a month what happens.

[calebz]

I knew the TX might be a failure from the beginning so I knew this could happen. Its just few % success rate after all. This is my first treatment attempt and its IFN mono.
I handled IFN pretty good until recently. I must admit I feel tired like hell since a few weeks.

ALT is around 60 all the time. Will check neutrophils level, but generally the rest was close to within norm, thats why I write only about platelets.
My hematology was all very good within norm until week 32. Its 7 injections to go, I will complete it for the sake of science.

[stef2011]

the max immune strength under peg is reached after 48weeks so this is the reason probably

you should start tenofovir as soon as possible and retry peg after 1-3years, this will rescue peg responsiveness with little chances of failure especially if we can reach hbsag levels around 1500iu/ml although few patients had response despite about 7000iu/ml of hbsag

[mustthinkpositive]

Yeah Calebz, just judging by your ALT level that IFN did not work on you. That's why I wonder how Paris2013 can reduce his HBSaG to near 0 with normal ALT. It's a science we can't figure out. Oh well, I hope the best for you in your future treatment.

Otan, AsianMale1985 all have elevated ALT while on IFN. Not sure about April9903 and Cyrus.

[calebz]

Hello just completed my 48 week Interferon mono therapy treatment. My week 40 results are :

My baseline
DNA ~170000 IU
qHBsAg 4500 IU
ASP/ALT 40/60
Fibroscan 6,6 Kpa

40 week
DNA 200 IU/ml
qHBsAg 6000 IU
ASP/ALT 50/99 (finally some ALT activity ?)

HBSaAg is disappointing. Got scared with the DNA raise in week 32 but it appears I end my treatment with a small light in the tunnel.
Its too bad I can't continue IFN more as it seems my ALT started to show some traces of response.

[stef2011]

total failure of treatment as expected, peginterferon doesn t work if hbsag and hbvdna are high, tenofovir should have been used first to lower at least hbvdna and allow some response despite the high hbsag

the best thing to do is start tenofovir right away and add on peginterferon after 3 years

[Bnd11]

My experience with interferon is similar. The positive part of the treatment is the following: a) interferon is an immune modulator and it has a longterm positive effect, b) I think your fibroscan value is improved (mine is from 6.8kpa -> 5.8kpa), c) HBV DNA decreased to a very low level.

Please keep your DNA level as low as possible, so "the best thing to do is start tenofovir right away". (I quote it from Stefano :)

[calebz]

Yeah I wish I could go NUC's too. I need to think about children now, that is also not without problems for me.

How did your DNA behave after stopping TX?

[Bnd11]

I am on a prolonged inf therapy (56th week).
Baseline: 34800 iu/ml, nowaday my HBV DNA fluctuates between 120 and 200 iu/ml.

[Bnd11]

Sorry, my baseline hbv dna was 12000 iu/ml. (34800 iu/ml was my baseline HbsAg level)

[stef2011]

I need to think about children now....

this has nothing to do with having children, tenofovir has no effect both on men and women and it must be used in pregnancy if the mother is infected.i think that high hbvdna is much worst onhaving children