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Results after 44 weeks of TDF+Peg+NTZ

In March 2012 (Before Treatment)
HBV DNA --  450,897 copies/ml
HBsAg (Quantitative) --  3054.03 IU/ml (cut off= 0.05 IU/ml)
HbeAg  -- Neg
AntiHbe -- Pos
Fibroscan =  4.2 Kpa
Geno Type C
Precore BCP ( T 1762 / A 1764 ) Mu
PC codon 28 Mu

22-October 2012 (After 12 weeks of PEG + TDF + NTZ )
HBV DNA --  186 copies/ml
HBsAg (Quantitative) --  2869.70 IU/ml (cut off= 0.05 IU/ml)
25-OH vit D3 --61.3 ug/l
ALT - 81 u/l
AST - 89 u/l
Platelet Count is low - 140

31-December 2012 (After 24 weeks of PEG + TDF + NTZ )
HBsAg (Quantitative) --  2606.72 IU/ml (cut off= 0.05 IU/ml)
25-OH vit D3 --   46.1 ug/l
ALT - 52 u/l
AST - 63 u/l
Platelet Count is normal - 150
Fibroscan =  6.1 Kpa

15-May 2013 (After 44 weeks of PEG + TDF + NTZ )

HBsAg (Quantitative) --  2612.48 IU/ml (cut off= 0.05 IU/ml)
25-OH vit D3 --   54.8 ng/ml
ALT - 84 u/l
AST - 80 u/l
Platelet Count is normal - 177

Last week, I had the last shot of Peg. I am very disappointed with my HbsAg results. It's not going down anymore. Doc said the effect of Peg will stay on very long even after the last shot. I continue taking TDF but stopped NTZ now. My Alt and Ast is also still high. Very disappointed!
29 Responses
Avatar universal
Must be patient.  Can continue with serial treatment to prevent HCC and cirrhosis.  TNf is very good drug.  No resistance.  The next generation of drugs will be out in a few years.  
Avatar universal

we do know that pegintf non response is due to t-regs suppressing hbv specific immune responses and probably other parts of immune system too.use of antivirals lower t-regs and rescue specific hbv immune system response so i do suggest to keep tdf for about 2-3 years at least and when there is some hbsag lowering again add on pegintf again.
non response after use of thf or etv for more than 3 years is very rare, 10% but this was not even on tdf or etv but on lam+adv

it is also probable hbsag will lower a little after pegintf is finished, you may try some maitake too and see if it works.in vitro maitake improves pegintf response 9 folds and if you start it right now it is kind of an add on to the peg effect which will remain for about 1 year
Avatar universal
No need to be discouraged.  You gave it shot, but there are no guarantees in getting results.  Peg should continue to benefit you for years.  Did you do labs just prior to starting treatment (March to October >12 weeks)?  with regards to Peg, they have very clear stopping rules now as to whether you have a chance of SVR.  I have been researching because my doc wants me to go on Peg.  If >/10% HbsAg drop coupled with >/2 logs drop in HBVDNA at week 12/24 has high correlation with response.  Obviously in your case TDF obscures HBVDNA drop.  

If you don't mind me asking, what was your Doc's rational for prescribing both TDF and Peg?  I understand the studies from Add-On point of view after several year on TDF, but not sure starting them together.  Any research that you are aware that would increase SVR chances?  

Also your AST are constantly higher that ALT.  That is strange for someone with healthy liver.  That may be result of working out or something.      
Avatar universal
add on has about 50% clearance at 48weeks and hbsag lower than 300iu/ml on the rest of 40% patients, just one failure 10% but no using tdf or etv but adv+lam

pegintf plus tdf all at once is much much lower results, but it is possible to retry after few years on etv or tdf
Avatar universal
Who prescribe NTZ? Does the Dr know you take NTZ?
Avatar universal
What's worrying is the Fibroscan result : you went from 4.1 to 6.1 within ~6 months of treatment that should help this result not worsen it from what Ive read.
You need to stay positive IFN will help despite the HBsAg result, there are studies that it lowers HCC risk a lot despite no SVR. I'm on IFN week 40 now and my HBsAg results behave similar to yours - it stays on same levels.
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