My feedback on Entecavir +Interferon combo

[Paris2013]

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).

[andrey19]

is it right that you continued taking entecavir after stopping interferon on w48?

[StephenCastlecrag]

I don't think you should be too disappointed. The effect of PegIFN has a very long tail, so the benefit may come later.
Can you please check your message:"Now I suppose that HbsAb will raise up to my previous value when I started the itf+etv combo, i.e. 3000 iu/ml. "
Is there a typo?
I think the "no nuc" referred to observations by doctors that after prolonged treatment with NUC and achieving undetectable hbvdna, some patients who stopped NUC had a ALT flare and then managed to clear HBsAg. There is an on-going clinical trial to test this:
http://clinicaltrials.gov/show/NCT01320943

So I don't think it is a therapy that will work for everyone.

Thank you for letting us know the results of your trial. We await details that may identify which candidates (those with low baseline HBsAg?) can achieve a cure using PEG + NUC.

[andrey19]

I would like to help you with advice but frankly have no idea on what is best for you now.

Maybe studyforhope can join discussion and give some advice?

maybe starting interferon again would be best for her even doing it against her doctor?

[andrey19]

I would like to help you with advice but frankly have no idea on what is best for you now.

Maybe studyforhope can join discussion and give some advice?

maybe starting interferon would be best for her even doing it against her doctor?

[Paris2013]

At week 48 when I stopped interferon HbsAb was 40 miu/ml.
I did not boost it with vaccine.
According to my doctor entecavir alone will not be able to hold HbsAg as it is now (300 iu/ml), he thinks that it will go as high as it was before starting interferon.

[andrey19]

Very sad and disappointing news! But could you share what was your anti-hbs titer when you stopped interferon treatment? Did you boost it with vaccine?According to your doctor will entecavir be able to hold your hbsag around 300 iu/ml as it is now without further increase?