Should I start treatment or wait for cure for Hep B?

[prom00]

Hi guys,

Since 2011 up until now my HBsAg has been raging from 1000 UI/ml - 2200 UI/ml and my fibromax test was between F2 (0.55 value) in 2014 (lowest value) , and F3 (0.72 value) back in 2011 , now in 2015 I have 0.63 so F3. My ALT and AST in normal value. Been reading a lot and seems like in 2-3 year a 100% cure should be on the way. Never treated the disease before in any way, got it at birth, I am aged 30. So any opinion would be very appreciate since I am new here.  Doc says 1 year interferon then entecavir. tnx

[Aduiski]

I guess your scores are from FibroTest part of Fibromax?
If so it looks like you are somewhere arround F3, meaning you should start treatment IMMEDIATELY!!!
Best thing for you at this point would be to do both interferon and entecavir/tenofovir.
It might be that your medical insurance supports only one of those treatment options and thats why doc suggested to start with interferon and then to continue with entecavir. If I would be in your position I would start IMMEDIATELY both (if you can get the money, if insurance doesn't cover it) because you are close to cirrhosis if Fibrotest estimated it correctly, meaning you are not far away from dying. You need to start treatment bro.

[Aduiski]

Make sure you also do Fibroscan even if you need to pay for it.
What is your ALT and your Platelets count?

[Aduiski]

and what is your AST?

[sorte]

Fibrotest may show results far from real one, you have to make Fibroscan or biopsy. What is your hbv dna load ?

[prom00]

Both ALT and AST are in normal ranges
ALT: 55 u/L (0-55)
AST: 25 u/L (5-34)

The values of F2 and F3 were from Fibromax. Never made a fiborscan as fibromax I hear is more accurate. Regards

[sorte]

It's not true, most accurate is biopsy than fibroscan, other tests are not reliable.
I've asked about hbv dna, so viral load, not alt/ast.

[prom00]

The viral load I have now 2175 ui/ml

[sorte]

notice that HBsAg quant and viral load (hbv dna) is not the same.

[Elijah256]

Since we can't test for hbsag in the United States. Would it be a good idea to start peginterferon after 1-2 years of nucs?

[sorte]

probably, but HBsAg quant and genotype too would give more information.

[Jatashankar]

Cure is uncertain still u better start treatment immediately. U should go first with tdf till ur fibrosis score regresses and then add peg for 24-48weeks depending upon the response.

[prom00]

I have only available here entecavir and peg. tdf is not original, is manufactured here by a 3rd party based on the same formula, but not genuine.
@ sorte , what do you mean by HBsAg? The DNA Viral load?
Regards

[Aduiski]

Elijah...at this point you should not be thinking about the complete cure from hepatitis, but should be thinking about not progressing to cirrhosis, and about getting your liver in better state.

You need to start treatment immediately, so as not to progress to cirrhosis, thats the main point now... Consult with at least one more experienced doctor for hepatitis.

[prom00]

I researched my blood results and  HBsAg is negative. Since my goal is to reduce fibrosis now, what is better ? Viread (tdf) or Baraclude (ent) ?

[Aduiski]

If your kidney test are ok then tenofovir, if not then entecavir.

[hepbcurepls]

you should do a full cbc, ultrasound, fibroscan and make a decision from there. starting treatment also harms the body. the whole point of treatment is to lower viral load to reduce risk of cirrhosis and hcc. you should do these test as they are very important

1. hbsag quant
2. hbv dna
3. abdominal ultrasound
4. fibroscan not fibromax
5. cbc , ast , alt, wbc, rbc, platelets etc (including serum creatinine)
6. hbv genotype and mutations

do you have any family members with hcc 1st or 2nd degree relative? What is your age? These are all factors that warrant treatment or not? There are members here in the community with fluctuating hbv dna from 200 - 18000 that are not on treatment. make sure you check all the test above and make a decision from there. do not be in a hurry to start treatment as HBV only damages liver from immune response. i notice your alt at 55 is not considered normal range for hbv.

[Elijah256]

I think most people on here want a complete cure and not have to live with this for the rest of their lives. I've been on treatment for over a year and it's brutal. Nobody wants to take a pill or jab a needle for life.

[Jatashankar]

Ya rite Elijah , everyone is in hope for a cure and soothen their heart by talking or reading even a bit about it. But the ground reality is its atleast 5 years away from now yet uncertain.

[prom00]

Hi,

What are these:
hbsag quant?
cbc , wbc, rbc, platelets etc (including serum creatinine)
hbv genotype and mutations  ? I am new here and do not know the short terms.
My mom also has HBV but NOT HCC. I believe I got it from her. In the previous message there has been a mistake my ALT is 40.6 [10-50] and AST 20.4 [10-50]
I tend to believe I damaged my liver really hard, and simply did not care, around my highschool and college years when I was partying a lot. Anyway, I am still not confident if I should start now or wait. If we are to take a look back, from 2011 up until now the virus did no do any damage , it just sits there. But since 2011 until now I stopped drinking alcohol and maintained a more healthier life. Regards

[StephenCastlecrag]

I just want to say it is unrealistic to expect a cure for HBV within the next two years. There are several drugs being investigated, but they are in the very early stages. None of them seems to be a magic bullet that can cure Hepatitis B with a short course of treatment. The new drugs would most likely be used in combination with existing drugs, such as Tenofovir, Entecavir. and Pegylated Interferon.
So it would be a better strategy to have treatment to stop disease progression, make sure the liver remains in a good state, and wait for the new cure treatment that will certainly happen in the not too distant future.

[Jatashankar]

Stephen by saying 2yrs u have shed a bit of happiness though it may be later but still it gives a hope for new sun rays of cure.
It will not come before 2020. No updates are available for myrcludex and rep9ac still says will take time like it said in 2010. I am trying to get some trial place of any of these drugs but have not set out yet. No trials in india. Wish it was India for rep9 instead of Bangladesh.

[hepbcurepls]

Damage to the liver is done by immune system not HBV alone. When ALT raises it shows inflamed liver. ALT rises can be from different things so check if you have fatty liver and if no fatty liver ALT rise over 30 iu is considered damage by hep b according to guidelines. The 2 most common ways to check if you have damage in liver is by fibroscan and biopsy. Hardly anyone does biopsy anymore because it is to invasive plus you can only do 1 biopsy every 3 years +. Most of us do a test called fibroscan which measures stiffness of your liver.

HBSAG quantitative test how much antigen virus is in your blood at the time. When this becomes 0 you have a chance of developing antibodies. The higher it is the stronger infection is in your liver. This in conjunction with HBV dna gives you a understanding of your virus in your liver

CBC is a complete blood count test. WBC is a test for white blood cells. It is said when you have cirrhosis of the liver your white blood cells will be low and your platelets in your blood will be low. There is a poor mans biopsy that measures the AST , WBC and platelets to determine if you have liver damage. It is not 100% reliable and fibroscan is needed to truly measure liver damage. Serum creatinine is a test to measure creatinine in the blood because and assess kidney damage. If you have no kidney damage and need to start treatment tenofovir (TDF ) is recommended over entecavir (ETF) because of tumors created in mouse models and mitochondrial toxicity of cells. Long term TDF is more safe at this point in time. As Stephen pointed out there are many potential treatments in the near future, but cure will be close to 10 + years away. The best thing you can do as of now like the rest of us is to preserve liver function and wait for a cure.

The liver is really strong and partying will not damage the liver as much as you think. I am 37 and I started smoking cigs at age 13 quit at 32, was drinking at age 21 up to 32, plus occasional drug use from marijuana to mdma and my liver is still fine, plus I am overweight with fatty liver. Do not worry about the pass and think of the future and how to improve your liver now. Start exercising eating healthy and takes MEDS if you have to.

[sorte]

Guys, could you think twice before you post any comments about the terms of the future hbv cure, it's just my kind petition, do whatever you like. But notice that with speculations like this you don't help anyone and no one of you is a specialist.

[sorte]

it was for Jatashankar and hepbcurepls