Re-treatment after stopping Entecavir Treatment

[paak]

Hi, I am 35 years old and was first diagnosed with Hepatitis B in 2004 through HbsAg. The PCR test was Negative then with normal LFTs (30-35 ALT and AST). In 2012, HbsAg was +ve, HBV DNA was “UnDetected”, HbeAg was -ve and HbeAb was +ve. LFTs remained normal as well (around 30). In Nov 2013, my HBV DNA turned out to be Positive and quantitative HBV DNA showed 4,100 copies per ml while LFTs were normal (25-30). My doctor prescribed me “Entecavir”, however, I consulted with an other doctor and he recommended not to start treatment. So, I did not start treatment. In May 2014, my HBV DNA showed 980 copies/ml. However, in October 2014, HBV DNA showed 51,000 copies/ml, LFTs were normal (25) and AFP was 11.7 IU/ml and quantitative HbsAg was 393 IU/ml. I then started taking Entecavir oral daily. In Oct 2017, quantitative HbsAg was 452 IU/ml, LFTs were normal (15-20) and HBV DNA “UnDetected”. From 2014-2021, my HBV PCR remained undetected and ALT usually remained around 15. In July 2021, I tested again and HBV DNA was “UnDetected” and LFTs were normal (ALT 13, AST 15) and I stopped taking Entecavir. After 6 months off treatment, I again tested in January December 2021 and my LFTs were normal (ALT 10, AST 14) but HBV DNA turned out to be positive. I again did quantitative HBV DNA and it showed 1840 IU/ml. Also, I got quantitative HbsAg which turned out to be 63 IU/ml.

I am now slightly seeing pressure and pain in my upper right quadrant, supposedly in liver. Please guide me if I should re-start treatment with Entecavir as the virus after years of suppression to undetected level with treatment has now started replicating again and reached to nearly 2000 IU level. What are pros and cons of starting re-treatment with Entecavir? What are pros and cons for continuing without treatment?

I will be thankful for your kind response.

[StephenCastlecrag]

I want to let you know a few things about stopping NA treatment. Almost everyone on NA will achieve very low hbvdna, even "not detected", because it is the nature of NA to inhibit the replication of hbvdna. But not all of all patients who achieved very low hbvdna are candidates for stopping treatment. Stopping treatment has been investigated very extensively, it can lead to re-treatment(the majority of patients), or becoming inactive without medication, and a few will lose HBsAg. It requires the expertise of an experienced HBV specialist to conclude the likely outcome because after stopping, you can have a viral breakthrough (increase in hbvdna), followed by a biological breakthrough(increase in ALT), or a clinical breakthrough. How high your hbvdna has to rise, how high your ALT has to rise, and for how long after stopping for these breakthroughs, will determine your outcome. Some research seems to indicate a low serum HBsAg at the time of stopping may lead to loss of HBsAg. All in all, you should not consider stopping without the guidance of an expert.

[stef2011]

i would try tenofovir which is more potent lowering hbsag than entecavir and wait for future combo treatments that are very close to approval.or a combo treatment of tenofovir+peginterferon+bulevirtide off label or you may even try Hbig+tenofovir+bulevirtide off label

[stef2011]

i forgot to mention very high dose vitamin d3 (check info on coimbra protocol and a doctor expert on this protocol in your area), it might work by a couple of years when hbsag is so low.you have to avoid all calcium rich foods like dairy products, drink 2-3L of water daily, be sure you have no vitamin A deficiency and combo vitamin k2 mk7 200-400mcg daily

[paak]

Hi @steef2011 Thanks. I was wondering why you recommend calcium rich products like dairy products? Actually, I frequently use milk, cheese and yogurt so was wondering why you recommend against those? Thanks for your answer plz.

[stef2011]

high quantity of vitamin d boosts calcium absorption in the gut too much so the only way to avoid absorbing too much calcium is by avoid calcium rich foods altogether, so there s no way you rich too much calcium

[stef2011]

i mean by avoiding foods with too much calcium content like diary products

[melcul]

What does your doctor say? Also, why did you stop entecavir and not continue with it with such low hbsag quantitative, wouldn't it have been an ideal place to be, losing it slowly?
I can;t give you any advice on what you should do unfortunately, but with such low HbsAg, isn't your doctor monitoring you, maybe your immune system kicks in and clears the virus?

[paak]

I just stopped it considering I was "NOT DETECTED" for several years with normal LFT, so I thought it should be fine to stop. Did not have the opportunity to be monitored. Hope someone can guide here at this forum as to what should be done next?

[FingHb]

Next step is go seek a specialist/ doctor and get blood work done and ultrasound if possible. Then see where to go from there.

[paak]

blood work has been done which i shared in my message.