Start treatment or better to wait?

[macrold]

Thanks in advance for your input.
I was diagnosed in 1988 as being a chronic carrier and my ALT & AST at all the time and still is in the normal range. My Hep B DNA had been around 600copies/ml but Starting in 2011= 4600copies/ml  about 800 IU/ML and that is when I had liver Biopsy for the first time and the result is as follows:
September 2011 1st liver biopsy

"The sections show benign hepatic parenchyma with mild chronic inflammation of the portal spaces. No granulomas or piecemeal necrosis are seen. The hepatic lobules show spotty lobulitis consisting of small aggregates of lympoid cells and rare neutrophils with associated cellular damage. No steatosis is identified. Variation in nuclear size is also observed. The trichrome strain shows no significant fibrosis or cirrhosis. PAS stains with and without diastase reveal abundant hepatocyte glycogen with no abnormal diastase - resistant inclusions. No increased iron deposits are noted with the iron stain.
The findings are nonspecific but may be associated with hepatitis B virus infection.

2/06/11 HBVDNA   =4300 copies/ml       about 750 iu/ml         ALT= 30 IU/L       AST = 24IU/L

8/9/12   HBVDNA=   8900 COPIES/ML      about 1530 iu/ml       ALT= 21 IU/L     AST = 31 IU/L

2/15/13 HBVDNA= 7000 COPIES/ML       about 1206 iu/ml       ALT= 30 IU/L     AST = 20 IU/L

7/2013                  =   11000 COPIES/ML     about 1896 iu/ml      ALT= 30 IU/L     AST = 19 IU/L

I had normal tumor markers always last one was done on July, 2013 and:  hepbsag=+, hepbeag = - , hepbeab=+.
My 1st Fibro scan test at Mount Sinai Hospital in April 2013:  The result - Fibro scan score 5.7 stage 0 Fibrosis.
IN 2011 a test was done and Genotype “A” detected Part of the report also says as follows:
HBV drug resistance not detected. No mutations detected
3TC    (lamivudine, epvir) sensitive
ADV    (adefoir, Hesperia) sensitive
TEB     (Telbivudine, tyzeka) sensitive
ETV     (entecavir, baraclude) sensitive
TNF    (tenofovir, viread) sensitive

My HBV DNA is keep going up in the last 2 years; doctor suggested starting Entecavir 1 mg. But I think the best option for me is to be on Tenofovir for 3.5 years and add peg interferon to clear the virus. I had discussed with NIH and trying to register for the clinical trial they have if I can get accepted. Even if they do not accept me this is the route I want to go and clear the virus on my own. I like to see what you guys think about this approach. The only test I never done is Hepbsag quantification as I learned on this forum is an important indicator for combo therapy outcome. There is a talk that it will be approved seen here in the US. When I talk to the people at NIH I will discuss with them about that. In Any case I will not start treatment with out first knowing that level. The main reason why I want the treatment is to clear the virus if not to prevent damage to the liver, Stop this abdominal pain I have on the upper right quarter & occasional fatigue - joint pain I associate with being HepB +.

[macrold]

My recent Hepatic blood work shows the results below and it seems that
Alanine Aminotransferase (ALT) is slightly above the range and is that should worry me? Actually my  HBV DNA six months ago was about 1900 IU/ML and it looks like it is down by half this time. All my Hep b tests remain the same as posted previously. Hep E antigen - and hep B Genome type A. I tried to enroll in clinical trials but the doctors think I am healthy and do not need to be on medications. Any comments are appreciated.

Alkaline Phosphatase.  49 U/L 37-116
Alanine Aminotransferase.  42 U/L 6-41
Aspartate Aminotransferase.  16 U/L 9-34
Bilirubin, Total.  0.4 mg/dL 0.1-1.0
Bilirubin, Direct.  <0.1 mg/dL 0.0-0.2
HBV DNA- 732 IU/ML  

[stef2011]

only 7ng/ml in 3months taking 10.000iu d3 daily?it looks like a very low response, are you sure it was d3 and 10.000iu?

if so maybe you need to up to 20.000-30.000iu daily

[macrold]

Actually I been taking 10000iu/l vitamin d3 for the past 3 months and my vitamin d3 level went up from 30ng/ml to 37ng/ml is that probably the case of Dna drop. I will continue to take D3 until my level is 80-90ng/ml.

Thanks

[macrold]

Thanks Stef for the reply. I had fibro scan done last April and it was 5.7 kpa. I can only do it once a year, I had to travel to new York and pay out of pocket because insurance does not cover it. My dna was going up for the last 2 years and my last test 3 months ago was about 1900iu/ml this time it dropped to 732iu/l. My Alt for the first time crossed the upper limit by 1iu/l. What do you guys think is going on? I will try to contact the lab in Italy and ship the blood via fedex for hepbsag quantification. Any comment would be appreciated.

Thanks

[stef2011]

yes it is but hbvdna alone is of little use, hbsag quantitative is the most importqant and then fibroscan

[macrold]

I had a lot of lab works done to decide if I can get onto the clinical trial and see one of the test below which the protocol seems different than what I used too when I had it done at my doctors office. Can you explain to me if this is a typical DNA test?

HBV DNA Quantitative.  4260 Copies/mL -
HBV DNA-IU Samples collected as of 04/18/2011 will be tested utilizing the COBAS Ampliprep/COBAS Taqman HBV v2.0 Test which is an FDA approved assay intended for use as an aid in the management of patients with chronic HBV infection undergoing antiviral therapy. It is not intended for use as a screening test for the presence of HBV in blood or blood products or as a diagnostic test to confirm the presence of HBV infection. 732 IU/ML -

[stef2011]

the most poten thing against calcium deposits are:
vitamin k2
glutathione IV or liposomal only (in mices plaques clear/regress by few months already)
vitamin c IV or liposomal

while doing this it is easy to check the calcium on vessels, i remember there is a specific tomography to do this

[macrold]

Do not you guys think that treatment will prevent any liver damage and improve the symptoms I mentioned above, I have been checked with every possible lab tests and ruled out any other cause for the symptoms other than the hep B. I do not know why the doctor said 1 mg Entecavir but in any case I do not want to take that. If I start treatment I will go with the NIH study and try to see if I can get rid of the virus. One correction I need to make is that one of the NIH clinical trials is that with 6 months of combo therapy at the beginning of a 4 year treatment not as I mentioned only PEginteferon for the 1st 6 month. One interesting thing Stef mentioned is about 2 cases for blood pressure, Years back my daughter was born with congential heart defect which was corrected by surgery and I had an echo-cardiogram to check my heart. Everything being normal I remember the report mentioning a minor calcium deposit some where. Perhaps my blood pressure is related to the calcium deposit and I need to look a way to control that. In any case will let you know how the NIH thing going on if I get in.

Thanks

[Jeff912000]

You seem pretty well read.  Your DNA is not high and your LFT is normal.  Like stephencastlecrag mention you do not need treatment yet.   If your quest is to clear the virus then it is imperative to do HBSAg quantification.  Both Peg and TNF can reduce HBV DNA to 0 or very minimal. When you stop therapy, the DNA will come up again.

it is easy for FDA to approve a test, i guess they just do not know what to do because there is no   proven effective treatment against hbsag yet.  

[StephenCastlecrag]

I am surprised that your doctor recommends treatment and at the double dosage of Entecavir (1mg). Both the AASLD and American guidelines recommend no treatment if hbvdna < 2,000 iu/ml and normal ALT. You also have very little or no fibrosis.
What is unusual is of course you are HBeAg negative, your hbvdna is elevated, yet your ALT is persistently normal. In the Chinese forum, there is a case, quite similar to you, except the patient's viral load has increased to log 5 iu/ml. My opinion there was to wait and observe.
I too would like to hear what the doctors at. NIH have to say.

[macrold]

Thank you,  I will take seriously your suggestion and will let you know how it goes.

[stef2011]

hbeag neg not big difference on etv or tdf at 3 years, it is hbeag + to have 16% chances to clear hbsag by 3 years on tdf

anyway tdf is way superior to etv so no reason to chose etv, i dont think it has any effect on blood pressure too but those supplements should clear blood pressure issue

http://www.naturalnews.com/038567_blood_pressure_natural_remedies_foods.html
as to cocao i suggest rapunzel unsweeten cocao and organic oat milk, it is beneficial to liver too

http://articles.mercola.com/sites/articles/archive/2010/10/08/discover-the-secret-to-lowering-your-blood-pressure-in-15-minutes.aspx

[stef2011]

peg and then tdf is already proven not to work and the times are also too short and won t work.it is a perfect trial desgned to say add on dont work, they could think of it only for that purpose and being US you can be sure of that

Do I need to take vitamin k?
yes it is better and avoid diaries in case you plan to go over 100ng/ml.biolab d3 plus is perfect for this

blood pressure:
did you try to change diet and take liposomal vitamin c for it?i am not expert of natural ways to lower blood pressure but it should not be difficult

blood pressure is usually due to hardening of arteries due to calcium deposits and cholesterol, the calcium deposits is the worst:
liposomal vit c
liposomal glutathione
vitd25oh >50ng/ml
k2 400mcg or best 800mcg daily like in d3 plus pill
fish oil with dha+epa 2.7g daily

after 6 months on this there should be changes

[macrold]

Stef,

I am e antigen negative.

[macrold]

Thanks stef for your usual quick response. I learned so much from you and others on this forum. At NIH they have 2 trials going on: one is to take peginterfron for 6 month and add tdf for 3.5 years and the 2nd one is the one I mentioned above. Because of the possible side effects I am not prepared to start with the first one. My vitamin D level last month was about 30ng/ml and I start taking 5000 IU twice daily and I am going to check it every month - Do I need to take vitamin k? Which I am not sure but I read something on this forum. I think I have the info you put out about the Italian lab & I will try to contact them. Do you think the treatment will relief me of the symptoms I mentioned above? I have a controlled high blood pressure for the last 15 years and I do take one tablet a day of Enlapril - I think the dosage is 5-25 mg which I do not have it with me right now. Is any say about the blood pressure treatment and tdf reaction? My take on the doctors is the same as yours.

[stef2011]

i think it is best to start tdf as soon as possible if you are hbeag+ and later add on peg.pegintf patent should be gone soon so by the time you want the add on it will be much cheaper , roches in india where patent is not valid already sells for about 100usd per injection so this might be the future price

i find so increadible doctors give all the wrong suggestions to keep patients away from clearing hbsag and hbv, entecavir is absolutely a wrong suggestion for a genotype A and hbeag+, with tenofovir you can clear hbsag by 3 years of tdf without add on

so best you start with checking your d level, start d supplements and then when vitd25oh is 80-90ng/ml start tenofovir

you may also send your blood samples for hbsag quantification to labs in europe or india so you know your baseline values before u start therapy and so you ll see the improvment