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New GI: Do you want Tenofovir or Peginterferon

New GI: Do you want Tenofovir or Peginterferon? My new GI said she will try to switch me from Entecavir and either put me on Tenofovir or Peginterferon. I ask for a combo and she told me that Tenofovir and Peginterferon does the same thing. Is that even true?
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Avatar universal
with food

Parathyroid Hormone, (pth) intact?

yes it is

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Okay my insurance approved Tenofovir. Is it best to take it with or without food?
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I don't have a regular doctor anymore but how do I check for intact pth? Is that the same as Parathyroid Hormone, (pth) intact? I sometimes use www.privatemdlabs.com to get lab work but I only see vitd 1,25 and vitd 25 test.
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So do I need to increase my vit d intake to 20,000 iu? I do take metamucil several times a day. I used to take bentyl but I stop taking it.
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you can t measure vit d sufficiency by vitd25oh, only intact pth can confirm it.by vitd25oh alone you can confirm deficiency only

it has been found also on statins that cpk rise and pains are due to vit d deficiency
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Avatar universal
The last time I got it checked it was around 68. I'm sure it's much higher know because I'm talking around 15,000iu per day. I doubt it is vitamin d because it all started from taking Entecavir. When my vit d levels where around 28, I didn't have these problems. I know exercise raises cpk but the muscle pains are unbearable. I never checked intact pth.
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high cpk is vitamin d deficiency, not the antivirals, what is your vitd25oh and intact pth?
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Do you have a direct link to the website? I see several other different prices.
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My cpk has been really high from taking Entecavir with has resulted in muscle pain. I can't workout until it comes down. I would take fish oil but I always get a jittery feeling from it. Black seed oil I'm taking ain't doing anything. Just gives me more headache.
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indian generic brands are the cheapest
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What is the cheapest place that sells tenofovir? The lowest price  I could find is 63.00 per 30 pills
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Thanks for explanation, it's interesting approach to start and stop and restart. I wonder if someone will do clinical trials with it, but I suppose it would take very long, depends how long each period.
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it is just the effect of stopping quiet immune system, antivirals have double effect they also keep immune system quiet, when you stop it you start the killing of infected cells as hbvdna rises
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Not sure if I understood well:

"A very small percentage of patients may clear HBsAg, most will have viralogical (hbvdna) and biological (ALT) rebounds. Among these, some will have a decrease in qHBsAg."

So some of them have hbv dna and alt going up but hbsag goes down ? It's strange.
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Avatar universal
Thanks Stef foe the info.
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Avatar universal
also double check if sides are from etv or by nutritional deficiencies

i d switch to tdf and think about combo after 3-5 years on tdf if hbsag goes down
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Thanks for the information Stephen.
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Dr Lampertico is one of the authorities on treatments for HBeAg negative patients. You can read his slide presentation at the 2015 Paris Conference
http://www.aphc.info/wp-content/uploads/2014/09/Pietro_LAMPERTICO1.pdf

On the issue of combination treatment (Peg + IFN), his conclusion is that it is NOT READY FOR CLINICAL PRACTICE YET. However, in the hand of a experienced practitioner, a higher percentage of HBsAg clearance can be achieved by careful selection of patients based on:
1. HBsAg level;
2. IP10
3. HBV genotype
4. Age, etc
these predictive and stopping rules can guide combo treatment.

There is also a study that involved stopping Tenofovir treatment after a prolonged period. A very small percentage of patients may clear HBsAg, most will have viralogical (hbvdna) and biological (ALT) rebounds. Among these, some will have a decrease in qHBsAg. This leads to speculation whether a sequence of start-stop-restart of NUC may be a way to reduce qHBsAg. As you can see, this requires experience and bold experimentation by the specialists, especially whether and when to re-start NUC treatment.
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Avatar universal
Hi Stepen,

Thanks for the info. Do you have any info or study where pegylated interferon gave goodrsults for HBeAg negative patients with undetected viral load and HBsAg count is around 4400?
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Hi Stepen,

Thanks for the info. Do you have any info or study where pegylated interferon gave goodrsults for HBeAg negative patients with undetected viral load and HBsAg count is around 4400?
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Avatar universal
Ok. There is a well known study involving switching from Entecavir to PegIFN:
Switch to Pegylated Interferon

In the second study, described in the June 7 advance edition of the Journal of Hepatology, Qin Ning fromHuazhong University of Science and Technology in Wuhan, China, and fellow investigators with the OSST Trial looked at outcomes among hepatitis B patients who switched from entecavir to pegylated interferon.

This study included 197 people with HBeAg positive chronic hepatitis B who had taken entecavir for 9 to 36 months and had HBV viral load <1000 copies/mL. They were randomly assigned to switch to weekly injections of pegylated interferon alfa-2a or to continue on 0.5 mg/day entecavir for 48 weeks.

Results

    Participants who switched to pegylated interferon were significantly more likely to experience HBeAg seroconversion at 48 weeks compared with those who continued taking entecavir (15% vs 6%) in a modified intent-to-treat analysis.
    Only patients receiving pegylated interferon achieved HBsAg loss, though this occurred in only 9%.
    Among pegylated interferon recipients with HBeAg loss and HBsAg <1500 IU/mL at randomization, 33% achieved HBeAg seroconversion and 22% had HBsAg loss.
    The decline in HBsAg during early treatment predicted response at week 48, with the best responses seen among patients with HBsAg <200 IU/mL at week 12 (67% HBeAg seroconversion and 78% HBsAg loss).

"For patients who achieve virological suppression with entecavir, switching to a finite course of [pegylated interferon] alfa-2a significantly increases rates of HBeAg seroconversion and HBsAg loss," the researchers concluded. "A response-guided approach may identify patients with the greatest chance of success."
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Avatar universal
I've been on Entecavir for only 15 months. The reason I want to change is because of side effects but I don't think my insurance will cover tenofovir or Peginterferon. Yes I'm Hbeag positive.
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Avatar universal
Why do you need the switch? Are you still HbeAg positive after several years on Entecavir?

Your GI is obviously not a Hepatitis B specialist - PegIFN is a finite course treatment and Tenofovir/Enetecavir are longer term medication.
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Avatar universal
That's what I said but she said combos is only for the worst cases or non responders
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