Immune tolerant or break immune tolerant phase?

[freewind2013]

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.

[StephenCastlecrag]

The exact reasons why our immune system suddenly begins to recognise and attempt to clear the virus are unknown - they have a few theories. Most likely it has to do with accumulated genetic changes in the virus over a period of time.

It is difficult to compare skin color - look at the white in your eyes - if they turn yellow then most likely you have jaundice. Jaundice only appears when your liver is not functioning properly. Most hbvers will not have jaundice.

[kinetix1208]

yes i also read about that, bilirubin started to elevate in a decompensated liver and jaundice occurs. is that correct? But why cases of the acute hbv has jaundice? does it mean the liver did not function properly for some period and started the function again during clearance of hbsag?

[StephenCastlecrag]

From Wikipedia:
Jaundice (also known as icterus;[1] attributive adjective: icteric) is a yellowish pigmentation of the skin, the conjunctival membranes over the sclerae (whites of the eyes), and other mucous membranes caused by hyperbilirubinemia (increased levels of bilirubin in the blood). This hyperbilirubinemia subsequently causes increased levels of bilirubin in the extracellular fluid. Concentration of bilirubin in blood plasma does not normally exceed 1 mg/dL (>17µmol/L). A concentration higher than 1.8 mg/dL (>30µmol/L) leads to jaundice.[2] The term jaundice comes from the French word jaune, meaning yellow.

Jaundice is often seen in liver disease such as hepatitis or liver cancer. It may also indicate obstruction of the biliary tract, for example by gallstones or pancreatic cancer, or less commonly be congenital in origin.

Yellow discoloration of the skin, especially on the palms and the soles, but not of the sclera and mucous membranes (i.e. oral cavity) is due to carotenemia - a harmless condition[3] important to differentiate from jaundice.

[stef2011]

if your alt are 800 you have now an immune response to virus (although weak because also hbvdna is so much), this is the best time to try to attack the virus before it mutates to escape your immune response nd before hbeag becomes negtive

the best therapy is the same as grm is doing tenofovir and when hbvdna very low/und peginterferon add on, making vit d25oh>50ng/ml will increase svr and response to interferon

[kinetix1208]

I'll try to ask the doctor if she can prescribe me with tenofovir even it is not available here. In the Philippines, baraclude is often prescribed by most of the doctors. But aside from high cost of baraclude (entecavir), i'am also hesistant to take it since as you have said it may fail due to very high hbvdna, that's why i'm really aiming in taking tenofovir because it has no resistance, but it is not available here in the Philippines. This is really the sad part. what if the doctor don't prescribe it to me. That's why i'm really trying hard to find a generic tenofovir online without prescription of the doctor.

I'am also calling out doctors in the Philippines who would prescribe me with tenofovir, please pm me. I'll visit your clinic/hospital.

[stef2011]

you ll find it everywhere out of philippines, it is the first hiv antiviral approved in 2000 it is almost out of patent.in sia you will be able to order it from almost all pharmacies

this proves the corruption in the philippines, they approved banned useless drugs like clevudine which has stopped even development worldwide and dont approve the cheapest and most potent hbv drug available since decades