To understand what s going on start monitoring your hbsag in iu/ml. Any doctors suggestion without this test result will have no sense. Usually alt flare is a good sign as but as long as hbvdna und and hbsag decreasing.
resistance to etv so fast is extremely unlikly, hbvdna is also too low to be the virus to induce the flare
it is hbeag seroconversion and lowering of hbsag, only if you find hbvdna increase over many logs it can be considered a bad sign...many of us would like to have your little flare (not that much of a flare)
I have two doctors, one is a famous professor of virology in my country, the other one is assoc. professor of virology. Both of them are from different hospitals. Believe in me that, they are not knowledgeable as much as stef2011. The assoc professor is not even be aware of fibroscan and quantity test of hbsag.
Anyway. What I should understand from the ALT flare;
1. It is very low percentage of resistance in 5 months
2. My HBV DNA is too low to flare ALT
3. If my HBV DNA keeps the decrease, my ALT flare is good, right?
So, if my HBV DNA increase, what can the bad sign be?
Here is an article to give you a clue of your ALT flare level:
Hepatology. 2001 Nov;34(5):1021-6.
Serum alanine aminotransferase flares during interferon treatment of chronic hepatitis B: is sustained clearance of HBV DNA dependent on levels of pretreatment viremia?
Nair S1, Perrillo RP.
During interferon treatment of chronic hepatitis B, an alanine aminotransferase (ALT) flare may herald a sustained loss of viral replication, but the relationship between virologic response, the extent of a flare, and pretreatment hepatitis B virus (HBV) DNA level has not been defined. We retrospectively examined the impact of an ALT flare on sustained virologic response in 121 interferon-treated patients and 42 untreated controls with either low-level ( or =100 pg/mL) viremia. The degree of ALT flare was classified as mild (increase in ALT of 86-171 IU/L above baseline), moderate (increase of 172 to 343 IU/L above baseline), and severe (increase of > or =344 IU/L above baseline). Undetectable serum HBV DNA and hepatitis B e antigen (HBeAg) loss were significantly more likely at the end of follow-up in patients having a flare (P =.0001 and.001, respectively). In the high viremia group, a proportionate increase in virologic response was observed as the degree of flare increased. By multivariate analysis, high baseline HBV DNA, high pretreatment ALT, and both moderate and severe ALT flare were independently predictive of a virologic response with severe flare being the most powerful predictor for a sustained loss of serum HBV DNA (odds ratio, 5.3; P =.004). Severe flare was predictive of a virologic response in the high but not low viremia group. We conclude that a virologic response in patients with high-level viremia is dependent on the degree of ALT flare. Induction of a robust flare may enhance virologic response when high-level viremia is detected.
you are seroconverting hbeag and soon will have hbeab positive
the flare is low so it will probably take long for hbeab to become positive, the good thing is that hbsag goes very low usually, it would be good to have it tested too
just for you to compare, my natural hbeag seroconversion happened at about 18yo with 6 months of alt over 1500....to bad at that time there was only experimental use of peg and no hbsag quantitative even in research hospitals, add ing pegintf at that time (if my hbsag was low) would have cleared hbv for sure
1. "the good thing is that hbsag goes very low usually, it would be good to have it tested too" what do you exactly mean? I do not understand.
2. My ALT increased from 90 to 347. my immune system is activated to fight with HBEAG and produce ANTI-HBE. There are very effective natural supplements to lower down the ALT, such as; parsley cure and lavender cure. I tried lavender cure before my treatment (5 months ago). On the other hand, there are also very effective immune booster natural supplements (may increase ALT), such as; kephir. Should I try to lower my ALT with something lavender cure, or should I try to help my immune system (which may cause ALT increase) with something kephir?? Please answer this by considering my biopsy is F3 and fibroscan is 6.6
3. My HBV-DNA is still positive (26000) and my ANTI-HBE is negative. Is it a bad sign? Does it mean any drug resistance?
4. Is it possible that the seroconverting period makes me cirrhosis?
test hbsag quantity otherwise you dont know what you are doing
you must not lower alt, you must increase it to clear hbv.do not take any antinflammatory or supplements with this action because they will weaken your immune response now
hbvdna is meanless, its lowering just means etv is working to lower it, no other meaning
no to make cirrrhosis you need 40-50years of high oxidative stress in the liver.alt can be 3000-5000 for 3-6months and make no fibrosis, it is not high alt to make fibrosis but the broken balance ebtween damage and repair thought to be due to oxidative stress
My doctor told me that we should re-test HBVDNA after one month to see it increase or decrease. He added that if HBV DNA increases, we will change treatment. What do you think that if he get a bad signal?
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