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My feedback on Entecavir +Interferon combo
I live in France. End of 2004 (I was 37) I discovered that I had chronic hepatitis B when my doctor saw a suspect ALT flare and asked for an additional blood test.
These are the results I had in January 2005:
Transaminases: AST: 95 UI/l, ALT: 216 UI/l
HBsAg +, HBcAb +, HBsAb -, HBeAg +, HBeAb -
ADN VHB: > 35000000 IU/mL
Liver biopsy result: A1F1
In February 2005 I started taking Hepsera.
Transaminases lowered to normal values in July 2005. HBV DNA values also lowered.
Phosphorus went down due to Hepsera.
In December 2005 the HBV DNA started to raise again showing that Hepsera was no more useful. My doctor added Lamivudine (Zeffix) on top of Hepsera.
In June 2008 the HBV DNA became undetectable. My doctor decided to move to Entecavir (Baraclude) 1mg.
In September 2009 I had HBe seroconversion: HBeAb +, HBeAg -
In September 2011 HBsAg was 4087 UI/mL. HBV DNA was always undetectable.
In September 2012 my doctor convinced me to add interferon (Pegasys) on top of Entecavir (even if I was really afraid by the possible side effects). After three months (Week 12) of entecavir + interferon combo the HBsAg was around 700 UI/mL (I don't have here the precise figure). After six monts (Week 24) HBsAg was 39 UI/mL.
My next blood test will be end of May.
I have some side effects due to interferon and sometimes I feel very tired. Neutrophils are very low (once they went down to 600/mm3). But the results I had until now convinced me to continue my weekly injections (even if I don't like at all to do injections all alone).
These are the results I had in January 2005:
Transaminases: AST: 95 UI/l, ALT: 216 UI/l
HBsAg +, HBcAb +, HBsAb -, HBeAg +, HBeAb -
ADN VHB: > 35000000 IU/mL
Liver biopsy result: A1F1
In February 2005 I started taking Hepsera.
Transaminases lowered to normal values in July 2005. HBV DNA values also lowered.
Phosphorus went down due to Hepsera.
In December 2005 the HBV DNA started to raise again showing that Hepsera was no more useful. My doctor added Lamivudine (Zeffix) on top of Hepsera.
In June 2008 the HBV DNA became undetectable. My doctor decided to move to Entecavir (Baraclude) 1mg.
In September 2009 I had HBe seroconversion: HBeAb +, HBeAg -
In September 2011 HBsAg was 4087 UI/mL. HBV DNA was always undetectable.
In September 2012 my doctor convinced me to add interferon (Pegasys) on top of Entecavir (even if I was really afraid by the possible side effects). After three months (Week 12) of entecavir + interferon combo the HBsAg was around 700 UI/mL (I don't have here the precise figure). After six monts (Week 24) HBsAg was 39 UI/mL.
My next blood test will be end of May.
I have some side effects due to interferon and sometimes I feel very tired. Neutrophils are very low (once they went down to 600/mm3). But the results I had until now convinced me to continue my weekly injections (even if I don't like at all to do injections all alone).
Are you taking any supplements like Vit D3? What's your D level in your blood?
I really think your immune system must be tip top, pre, during and after IFN. D3 levels must be at least 50ng/ml pre-IFN treatment.
Even with the boost of IFN (which is integral), your own diet and vitamins intake (selenium, D3 and zinc) must be consistent.
However, having said that, you are a responder to IFN. Just need another oomps! to get that HBsAb up high. Vit D3 supplements might just be the ticket. I was lucky to have my HBsAb going up every month from 55 (when it first appeared) to over 200 and now over 300.
I really think your immune system must be tip top, pre, during and after IFN. D3 levels must be at least 50ng/ml pre-IFN treatment.
Even with the boost of IFN (which is integral), your own diet and vitamins intake (selenium, D3 and zinc) must be consistent.
However, having said that, you are a responder to IFN. Just need another oomps! to get that HBsAb up high. Vit D3 supplements might just be the ticket. I was lucky to have my HBsAb going up every month from 55 (when it first appeared) to over 200 and now over 300.
What a complicated head screwing disease we have. I just pray one day we can have a cure and not need to wrap our heads around what is trying to eat us from the inside outwards.
Your situation is unfortunately not untypical.
Restarting ifn now might bring you a more permanent control of HBV remnants in the end, possibly depending on the length of ifn therapy.
While the immunological reasons behind these different outcomes are basically known, it is currently impossible to analyze this in an individual patient. Availability of effective TCell epitopes combined with presence and proper activation of TCell clones is the true reason behind success or eventual failure of ifn mediated immune activation, a complex battle with numerous critical parameters.
In my opinion, the svr rates will increase once frequent vaccinations with an HBV core containing vaccine will be added in the phase of low virion presence (UND DNA LEVELS). This will add the missing stimulus to increase TCell recruitment in the periphery.
At this time such a core vaccine is in development in cooperation between Cuba and a french company, but availability is possibly far out.
Using available hbsag vaccines in the phase of low hbsag to boost hbsAB levels is likely only marginally effective. It must be understood, that even a high AB level is never completely protective against localized reinfection in close proximity of an infected liver cell. The core vaccine will hopefully trigger Tcells that attack the slowly growing clusters of reinfected cells in that situation, leading to a permanent control of the remnants.
Restarting ifn now might bring you a more permanent control of HBV remnants in the end, possibly depending on the length of ifn therapy.
While the immunological reasons behind these different outcomes are basically known, it is currently impossible to analyze this in an individual patient. Availability of effective TCell epitopes combined with presence and proper activation of TCell clones is the true reason behind success or eventual failure of ifn mediated immune activation, a complex battle with numerous critical parameters.
In my opinion, the svr rates will increase once frequent vaccinations with an HBV core containing vaccine will be added in the phase of low virion presence (UND DNA LEVELS). This will add the missing stimulus to increase TCell recruitment in the periphery.
At this time such a core vaccine is in development in cooperation between Cuba and a french company, but availability is possibly far out.
Using available hbsag vaccines in the phase of low hbsag to boost hbsAB levels is likely only marginally effective. It must be understood, that even a high AB level is never completely protective against localized reinfection in close proximity of an infected liver cell. The core vaccine will hopefully trigger Tcells that attack the slowly growing clusters of reinfected cells in that situation, leading to a permanent control of the remnants.
if no relevant sides go for it again or change doctor, the response when hbsag is so low are very very high
i understand that if sides are severe it is not possible to keep it for more than 48weeks but in your case the only side can be expense if peg is not free
dont worry about the rise if it is less than 500-1000iu/ml the virus has very little strength
i understand that if sides are severe it is not possible to keep it for more than 48weeks but in your case the only side can be expense if peg is not free
dont worry about the rise if it is less than 500-1000iu/ml the virus has very little strength
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