Is any treatmene needed? hbs+ hbe+ dna+

[grmr]

Hi everyone,

first of all I’d like to  introduce myself to this community: I’m 23 years old, male – Italian (so sorry for my poor English)!!!

I’ve been having HBV since my birth (my mother is a Hbsag+ carrier) but I’m very healthy and I’ve never had digestion problem or anything else. I’m used to have a bier (0.4) during the weekend twice a month and I’m not a smoker nor a drinker.

Here is my current situation:
Hbsag + / Hbeag + / HBVDNA >100.000.000

These values never changed from my birth. Transaminasis have been always in the range ALT sometimes during the last 2 years reached up to 74 (range 0-55), AST and GGT have been always ok.

I had a liver biopsy in 2007. Everything was good, they found F1 (Metavir) but doctors said there’s nothing to be worried about. I had also ultrasound test once a year and no liver damages were detected.

I saw my doctors in May and they forewarned they would treat the disease despite the values are not so high. The suggestible drug should be Peg-IFN (up to now I do not know if in mono or combo mode).

I was pushing on antiviral treatment but they told I’m so young and I should not take drugs which I may continue to take for my whole life.

Why was I pushing on AV? I’m really scared about IFN side effects, I move every month out of Europe for job and I’m not sure I’ll manage to do it again if I’ll take it!

What do you think? Am I in the immune-tolerance or immune clearance stage?
Should I be treated? May I seroconvert the eAG without drugs, I read it may take up to 3-4 decades? Should I wait some years again and then evaluate what to do?

When you convert the eag form positive to negative do the VL be low for the rest of the life or it can also flare up again?

In case I went for IFN and it didn’t work, would I have another possibility of cure? I’m also scared about disease flares during treatment..
What about if the same happened with Antiviral?

Is there anyone who can share experiences with IFN side effect and job activity? Is there a relation between my age and such effect (may I easily tolerate them?)

As you see I’ve a lot of question which are running around in my mind… I’d be very pleased if somebody answers me or cans share his experience…

Ciao ciao from Italy  

[stef2011]

e chi sviluppa mutazioni si trovera senza scampo
ovviamente questa mia affermazione abbastanza pesante si riferisce al trattamento a vita perche una volta che ce anche una sola resistenza questa preddispone a una resistenza anche con tutti gli altri antivirali nel giro di un paio d'anni.
al momento solo il tenofovir sembra non dare resistenza e solo la combinazione tenofovir+entecavir porta quasi a zero le possibilita di resistenza

oggi mentre facevo le analisi ho sentito di un conoscente di un amica che facendo antivirali da piu di 10anni ora ha il virus mutato e dna a bilioni resistente a tutto e fegato in cirrosi terminale, ed in questo caso neanche il trapianto (se glielo fanno) da soluzioni perche il nuovo fegato verrebbe distrutto in breve tempo dal virus, per nostra fortuna oggi sappiamo che con terapia combinata questo non succede e le giuste scelte di oggi ci potranno salvare la vita un domani

[stef2011]

ciao sono italiano come te, ho 40 anni ed anch io avevo l'hbv dalla nascita ed avevo una buona risposta immunitaria che teneva il dna negativo (il cosi detto erroneamente portatore sano).
consiglio di non fare nessun trattamento perche sei ancora nella fase immuno tollerante e non hai praticamente nessuna risposta immunitaria e anche se l'interferone la attiva questo significhera un inizio di danno al fegato elevato se il virus non viene sopresso totalmente (danno ora assente proprio perche non hai risposta immunitaria), per cui se il danno al fegato non è piu di f2 o fibroscan 9-10 non interverrei.Gli antivirali li escluderei assolutamente perche con un dna cosi alto solo il combo entecavir-tenofovir riesce a ridurlo e ce poi l incognita mutazioni dovendo fare il trattamento a vita.
io sto facendo l entecavir da un mese perche ormai avevo troppo danno al fegato e a 40anni il sistema immunitario ormai non bloccava piu il dna.
piuttosto qui in italia possiamo aiutarci nel senso di trovare qualche medico o centro ospedaliero che faccia la combinazione entecavir+tenofovir che è in sperimentazione con termine 2012 per cui la tendenza dei medici e di aspettare ad avere il quadro di questa sperimentazione pero la mutazione del virus è molto piu pericolosa perche gia si sa che i possibili danni ai reni sono solo nel 1% circa di chi ha solo hbv (senza hiv) e reversibili, mentre una mutazione virale mette a rischio la vita, segui anche i post di HR che è un ricercatore che ha sviluppato questi antivirali e che ha suggerito questa combinazione perche non ci sono nuovi antivirali in arrivo per molto molto tempo e chi sviluppa mutazioni si trovera senza scampo.
un altro consiglio è di fare il fibroscan ogni sei mesi perche io dal 2002 al 2009 ho sviluppato cirrosi con transaminasi quasi normali e basso dna perche il medico diceva che tanto ci volevano 5-10 anni per far danno, per cui meglio non fidarsi troppo ed esagerare coi controlli

[shan48]

hi i santosh lamani went for medical check up i found HCV postive any treatment

[grmr]

I hope to conert it since my mum didi the same in the past.. I'm happy to realize that many sx are riba's fault.. please keep me informed about your tfv experience...

[NashPred]

Maybe you can convert you "e" antigen by then and not have to worry about meds. Let's hope. I'll keep my fingers crossed for you.

BTW...I've been off of Ribavirin for 1 week now. Only on Pegasys mono-therapy and already feeling alot better. So it's starting to look like a lot of my sx were  from the HCV pills. Just wanted to let you know incase you consider Pegasys tx again in the future.

Best of luck and keep us posted as to your progress.

Take care of yourself and your liver.

[grmr]

met dcs yesterday.. since my liver is still in good condition i'll just have to keep monitoring my alt and have a biopsy in 4/5 years.. at that time we'll have also more data about etv or tfv resistance issues... let's hope.. thx all you guys

[stevenNYer]

Now keep in mind, since you ask, this is my lay opinion.

No, I won't treat now if I were you.  Especially if you don't want to do INF.  For antiviral, you may need years and perhaps lifetime of treatment.  And I have no experience with INF.  I had experience with ADV mono, ADV and ETV combo, and currently on TDF and ETV combo now.  I tolerated all antiviral treatment well.  Don't feel any sides.  I start treating at 31 with good evidence of the immunoclearance stage.  And in reviewing my labs, this phase could have started 7-8 years ago.  My doctor think I bordering close to the eSeroconversion, so it made sense to treat.  But I am still eAntigen + and eAntibody -   So it could take time.  And knowing what I know how, I wouldn't have let my doctor started me on ADV mono.  So if you do decide to treat, fight to get combo treatment.  For more info on why combo, see this thread:

http://www.medhelp.org/posts/show/632664?personal_page_id=7068

[grmr]

hi all.. had a phone chat this afternoon with dr...she was still pushing me on IFN or just monitoring for other 5/6 years... she did not suggest me AV (etv and tfv) at this stage.. I'm pretty young and I may develop resistance to them if i stay on AV for a long time...this is her opinion.

she stated that I may also naturally seroconvert (anti hbeag +) without any drugs..

She explained me also thath it's very difficuly to stop AV and to do it you have to shift to IFN for a few time before stopoing those drugs... what do you think about this statement?...

Steven.. please share with me your experince on ETV.. what about you eag status? how is it currently?

many thanks in advance to you all

[grmr]

would you treat righ now?
I'm a bit worried about the fatc that they'd put me on a trial combo tx etv+tfv.. and if I developed resistance (this may be likely due to my high hbvdna...right?) I would no longer go for this kind of antivirals for the rest of my life...In any case I'd prefer to avoid ifn.. do you have any experience on it??? especially about sx? are you still on av? thx in advance your help is highly appreciated

[stevenNYer]

I answered your other post earlier:

It the traditional sense, yes, you start off as eAg positive.  It's the wild-type (kind of like, the virus left alone in the wild to do its thing) strain that releases the eAntigen on viral replication.  And if you infected with the wild-type, then it usually takes its course, and for some they get the mutation (PC, BCP) at seroconversion.

It looks at your immune system is starting to recongize the virus and is in very early immuno-clearance phase.  This could take years and you could stay eAntigen + for years with high DNA, which puts you at a higher risk for developing antiviral resistance.  It's very important to drop the DNA quickly if you decide to treat.  

So my thought is still the same.  I would treat either with combo, TDF and ETV.  Or INF to reach a low DNA, then mono with TDF or ETV.  The goal is to lower DNA to UND as quickly as possible to minimize risk to antiviral resistance.  By doing this, you may speed up the seroconversion process (hopefully).  So talk to your doctor...good luck.  And come back and keep us informed.

[grmr]

.. my last "in range" ALT was detectec in September 2007 - 45 (0-55) and from thah date it' soncitnously increasing... I've been monitoring it evry months.this is the trend..
45 - 59 -62- 64- 68- 69- 71- 72- 73-84.... immunoclearance????

[grmr]

Is the e serocneversione a step which has to be done by all hbv carreirs? I mean: is everyoen starting eag+ and then becomes eag- eab+ with or without tx?

[stevenNYer]

So to recap:

You are 23 year old, chronic HepB, eAntigen +, and high DNA  in the hundred millions, normal ALT until recently with one or two snapshot in the 70s.

You are very likely still in the immuno-tolerant stage, or very very early immuno-clearance stage.  I would chart the ALTs closely, like every 2-3 months (for about year) before treatment.  If ALTs (trend) goes back down to in range and stays that way, I would hold off on treatment.  If it goes back and forth from in range to the 70s or higher, I would treat.  I would treat either with combo, TDF and ETV.  Or INF to reach a low DNA, then mono with TDF or ETV.  The goal is to lower DNA to UND as quickly as possible to minimize risk to antiviral resistance.  Important since the eSeroconversion process could take years and for some they may need treatment for life.  I wish you good discussions with your doctor.  

[NashPred]

I really don’t know as much about when is the best time to start tx as others on this forum do. I have only known about my HBV for less than a year so I don’t really feel qualified to give much advice other than my own personal experiences.

As far as Peg IFN goes, there are no resistance issues with this drug so it will always be an option. Also, if you read the post by Peteshine titled “No Questions”, he says that he really didn’t feel many side effects from Peg IFN mono-therapy. You may not have any side effects either but unfortunately you can never be sure unless you try it because everyone reacts differently to Peg. (Zelly, what does your magic 8 ball say? Lol)

TDV and ETV both have excellent resistant profiles so far, so if you were to get into the trial study, you would be in good hands whether or not you got mono or combo therapy (unless there is a control arm of the study were both pills are placebos) However, as your Dr said, these drugs don’t have a long history either so there may be some resistance issues develop as the drugs get a longer history of use.

It sounds like you are in good health now, so if you were to continue to monitor, you may very well convert your “e” antigen on your own and/or better drugs may come along by the time you need to tx.

I wish I could help more with your decision to tx or not to tx. Others may be able to give you a better idea about that decision.

Best of luck and keep us posted.

[grmr]

Hi everyone,

i’ve just met doctors who had suggested me some months ago a pegIFN tx and this morning they was on that same opinion… I told them about sx which can be very difficult to match with my job.. and I also did ask for antivirals, especially entecavir and tenofovir.

They would not suggest antivirals tx at this time, i’m 23 years old,  due to resistance that may rise during thay period.. the only solutions they proposed are pegIFN or just keep on monitoring every 3 months for 5 years.. then have a biopsy and evaluate what to do afer it.
In this light I assume my liver does not need an immediate tx therefore I keep on wondering why they were hardly pushing on it..

Anyway they did propose me to take part to a sperimentation with the aim yo evaluate results in patients taking Entecavir monotx or combo tx ETV + TFV (tenofovir). I just have to put my sign on the docuemnts they gave me and then the trial should start and last 100 weeks approx…at that time I’ll know if I will be taking mono or combo tx..

Now I’m a bit concernded about this… what if antivirals did not work? Would I still have the chance to go for IFN? What may happen when I’ll stop taking them… would my HBV become stronegr than now?

I keep on hoping that I’ll gain the E seroconversion by myself…

I’m very confused…

Your comments are needed and greatly appreciated..

[stevenNYer]

PC = Precore
BCP = Core Promoter

These are the common (BCP are more common) HBV mutant strains that could escape during the seroconversion process and lead to eAntigen - disease.

[grmr]

PC? BCP? what do you mean by this?

[stevenNYer]

It the traditional sense, yes, you start off as eAg positive.  It's the wild-type (kind of like, the virus left alone in the wild to do its thing) strain that releases the eAntigen on viral replication.  And if you infected with the wild-type, then it usually takes its course, and for some they get the mutation (PC, BCP) at seroconversion.

But what's interesting is that there are newer and more variations to HBV now.  For example, those with PC, BCP, and antiviral resistance strains.  So let's say, someone with eAntigen - disease that turns out to have a PC mutation.  This person infects someone, that new infected person will be surface antigen positive but are they eAntigen - to begin with ?  They could be but we need a HR type person to confirm that.  So I think as they are more variations, it could get more confusing in the future.  

[NashPred]

I’m pretty sure everyone does start as eAg positive and it can take decades to convert to eAb. I think that certain medications can help you to reach eAg Neg and eAb Pos status faster than you would on your own.

I’m not sure if it is ALWAYS just a matter of time before you convert or not.
I could use some clarification on this myself.

[grmr]

I'll ask him for sure next month. I've been monitoring since 18 yo.. (5 years ago) and e -status has not changed yet..

Do all the hbv carriers start eag + and then it th e antibodies light up? .. I mean.. is it just a matter of time?

[cajim]

It could be just monitoring.  Ask doc.

[grmr]

I read the same too... so what should be the best route now?

[cajim]

From what I read, a good time to start IFN is elevated ALT and low DNA.

Not sure.  Better ask your doctor.

[grmr]

Got my laste labs made on August:
ALT: 84 (0-55)
HBVDNA: >100.000.000
despite this I'm felling very good.

What do you think about? Is now the right time to start IFN or may I am on immuno clearance phase and become eag - by myself?