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Immune tolerant or break immune tolerant phase?
Hi everyone
I am a chronic hepatitis b carrier, probably type B or C, since born. I am 25 years old right now. My recent check shows HBsAG and HBeAg are positive with high HBV DNA count. My ALT is normal as defined by my family doctor (i didnt check the exact number). Not sure of AST. My doctor said I am still in immune tolerant state. I am wondering of following questions
1. its is possible to stay in immune tolerant state for lifetime? (from research paper i read, most of ppl enter immune clearing phase in 30 to 40s, so my guess is not?? i need confirmations)
2. Is it better to stay in immune tolerant phase or to break immune tolerant state? ( for this question, i cant rationalize a good answer. Since in immune tolerant phase, there is minimal liver damage, but high viral replication and high viral load (high HBV DNA). Minimal liver damage is always a good thing I guess. IN THE OTHER HAND, breaking of immune tolerant state means high degree of liver inflammation for a period of time with HBeAg seroconversion and low HBV DNA. After immune tolerant most of people enters inactive (HBeAg negative) carrier stage (low HBV DNA, normal ALT) and maintains that way. So low HBV DNA is also a good sign. Then which one is favoured???)
3. If breaking immune tolerant state is favourable,
a) how to break it (increase in immune system? taking drug?)
b) how to mimic liver damage during immune clearing phase (that is my major concern here)
4. Does entering immune clearing phase define as a Hepatitis B patient instead of carrier then? ( or the term carrier does not really mean anything)
Hopefully someone can give me advises to those question while i look deeper into individual research paper.
Thank you in advance.
I am a chronic hepatitis b carrier, probably type B or C, since born. I am 25 years old right now. My recent check shows HBsAG and HBeAg are positive with high HBV DNA count. My ALT is normal as defined by my family doctor (i didnt check the exact number). Not sure of AST. My doctor said I am still in immune tolerant state. I am wondering of following questions
1. its is possible to stay in immune tolerant state for lifetime? (from research paper i read, most of ppl enter immune clearing phase in 30 to 40s, so my guess is not?? i need confirmations)
2. Is it better to stay in immune tolerant phase or to break immune tolerant state? ( for this question, i cant rationalize a good answer. Since in immune tolerant phase, there is minimal liver damage, but high viral replication and high viral load (high HBV DNA). Minimal liver damage is always a good thing I guess. IN THE OTHER HAND, breaking of immune tolerant state means high degree of liver inflammation for a period of time with HBeAg seroconversion and low HBV DNA. After immune tolerant most of people enters inactive (HBeAg negative) carrier stage (low HBV DNA, normal ALT) and maintains that way. So low HBV DNA is also a good sign. Then which one is favoured???)
3. If breaking immune tolerant state is favourable,
a) how to break it (increase in immune system? taking drug?)
b) how to mimic liver damage during immune clearing phase (that is my major concern here)
4. Does entering immune clearing phase define as a Hepatitis B patient instead of carrier then? ( or the term carrier does not really mean anything)
Hopefully someone can give me advises to those question while i look deeper into individual research paper.
Thank you in advance.
not only researchers this is routine in italy since nucs mono is useless most doctors are making combo just like for hcv.
we are probably very different because all hbv drugs are free of charge so less problems as regards costs/health insurance which doesn t pratically exsist in italy
Probably we don't have the resistance test but i will ask.
HBsAg quantification is i guess available here, the doctor mentioned about it and told me to do it, it is available here in one laboratory. but i'll confirm it if it is abbott architect.
HBsAg quantification is i guess available here, the doctor mentioned about it and told me to do it, it is available here in one laboratory. but i'll confirm it if it is abbott architect.
With high ALT, your liver is inflamed, Fibroscan cannot give you a reliable indication of your fibrosis stage. An experienced liver doctor may be able to, but as the report clearly said - it is a grey area. So you have to wait until your ALT is normal to do another Fibroscan, or you do a biopsy.
But if there is really no choice, can i take the etv? just to lower down my ALT and HBVDNA? Probably my concern right now is to minimize the liver damage and getting into cirrhosis.
And after a while, if i can get a prescription on tdf, i'll just switch from etv to tdf? Is this just ok?
And after a while, if i can get a prescription on tdf, i'll just switch from etv to tdf? Is this just ok?
Mmm, I disagree. It is true that transition from Immune Tolerance to Immune Clearance phase is most likely to be caused by accumulated genetic changes related to the e-antigen. Some research indicates a rise in the percentage of precore mutants before seroconversion. This was a troubling thought as it implies all natural seroconversions will lead inevitably to chronic HBeAg negative hepatitis. However, I read a latest research by Timonthy Block of HBF that the percentage of precore mutants decreases after seroconversion. All these are based on my own understanding, so it can be totally wrong. I think we still need more research.
However, there are numerous papers that indicate natural seroconversion is more durable and many patients do remain in the Inactive phase for a long long time.
As for Tenofovir first and then Interferon, this treatment will take at least several years - at least few years of Tenofovir to reduce viral load to undetectable then at least 48 weeks of Interferon. I know your local researchers are very confident about this treatment, I would still like to see the results from a large group of patients, their baseline characteristics, especially genotypes, to be sure.
However, there are numerous papers that indicate natural seroconversion is more durable and many patients do remain in the Inactive phase for a long long time.
As for Tenofovir first and then Interferon, this treatment will take at least several years - at least few years of Tenofovir to reduce viral load to undetectable then at least 48 weeks of Interferon. I know your local researchers are very confident about this treatment, I would still like to see the results from a large group of patients, their baseline characteristics, especially genotypes, to be sure.
it is also indicated in the comment:
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A liver stiffness value of 11.9kPa falls within the gray zone. While this may be indicative of intermediate fibrosis (Metavir F2-F3), liver fibrosis assessment is less realiable within the gray zone. Correlation with other clinical parameters including a liver biopsy should be considered.
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so is this normal with high ALT?
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A liver stiffness value of 11.9kPa falls within the gray zone. While this may be indicative of intermediate fibrosis (Metavir F2-F3), liver fibrosis assessment is less realiable within the gray zone. Correlation with other clinical parameters including a liver biopsy should be considered.
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so is this normal with high ALT?
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