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Avatar universal

Looking for advice

Hi,
I am looking for input from this community. I have hep B from vertical transmission, and I have been watching my numbers for about 7 years, I am a 50 yo female.

These are my latest numbers (9/15):
HBV DNA 3140 IU
AST 32
ALT 30

I am HBe Ag negative.

HBV DNA has been as high as 70000 IU and as low as around 2100 IU. AST and ALT have been as high as 40's also. Lately the HBV numbers have been staying around the 3000 IU (I think some dietary things help), but the 70000 IU was from just last year as well.

I went to China last year and had my HbsAg checked, it was 417.6 IU/mL. Fibroscan came back 10.1 kPA. I had liver biopsy back in the United States that was read as completely normal. US elastography done at Stanford due to discrepant results came back similar but maybe a little lower (they never sent me the results like they were supposed to). So, recommendation from my local doctor and Stanford doctor is to start anti-virals with either entacavir or tenofovir. I had renal function checked (24 hour creatinine clearance) and it is normal. Sounds like tenofovir would be the preferred drug?

I am a little worried about starting treatment. I'm not a very high energy person, will it make me feel tired all the time? Also, how precisely does it need to be taken each day -- within a couple hours of the same time, or really exact? I worry about traveling and remember to take it at different time zones.

Neither doctor mentioned anything about Pegasys, is this something worth considering down the road if a cure is not forthcoming? Of course living in the US, we don't have HBsAg readily available, but I would be willing to travel if need be to check it. Is it something I should have monitored regularly after I start treatment anyways?

Any thoughts/feedback would be appreciated before I start treatment. Thanks.
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Avatar universal
It is very frustrating to have such vastly different results from your Fibroscan and liver biopsy. But at age 50, with a viral load greater than 2,000 iu/ml, I think it is prudent to start treatment even though your HBsAg is below 1,000 iu/ml.  Based on Fibroscan score of 10 kpa, you should definitely start treatment. Entecavir is fine over Tenofovir. Talk to your doctor.
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Avatar universal
Thanks for the replies. I think I am genotype B (because that's my sibling's genotype, mine was not tested). The liver biopsy was done within two months of the original fibroscan. I'm going to request the results again from Stanford so I can compare the kPa.

I have tried a number of different things over the years to see if they would affect my HBV DNA numbers, and the only thing that seemed to help was dairy (milk). Then, my numbers started going up again, and I started taking high quality whey protein (I also was exercising a lot more). That's when my numbers started going down again to where it is now, though I know they're still not truly low (but better than 70000 IU). I think whey also has precursors to glutathione, which I understand is poorly absorbed orally. Either way I need meds given fibroscan and US elastography results. I will try adding vitamin D and some of the other recommendations that were made. Would anyone recommend entecavir over tenofovir?

I just want to add, though I have not previously posted on this board, I have certainly read it from time to time over the years and am very appreciative, especially of the frequent posters who have made my understanding of this disease process a lot clearer. I will update hbsag numbers when I am able to get them.
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Avatar universal
please update on hbsag numbers when so low antivirals are able to slowly clear hbsag
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Avatar universal
with hbsag only 417iu/ml i d go for sequential or directly with peg, pegintf can be used with fibroscan 10kpa and compensated liver function, sequential add on is anyway the safest option so you reverse your fibrosis

also consider making high normal vitamin d this is needed to reverse fibrosis first, make normal alt faster and general health.if you go for tdf it is also needed to prevent tdf sides like bone loss
add also antifibrotics like fibroguard, liposomal curcumin, resveratrol, glutathione this should allow making fibroscan below 5kpa very fast, taking antivirals only may take from 5 to 10 years to lower fibroscan to less than 5kpa.taking nucs only will lower fibroscan anyway but slower if it is tryu fibrosis and not liver inflammation or fatty liver
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Avatar universal
What is the time gap between your liver biopsy and Fibroscan? 10 Kpa is severe Fibrosis and treatment should be taken. Either Entecavir or Tenofovir will be fine. PegIFN is generally not recommended for severe fibrosis, it can be considered later on.
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Avatar universal
Hi I use TAF (trial form of tenifivir)

After taking TAF  my energy went through the roof.

Do you know your hbsag quantitive numbers?
What geno type you are?
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