Sudden Increase in ALT/AST after stopping Ntz and LIv 52 HB increases HbsAg

[smile_boy]

Hi Stef and Others,

There is a sudden increase in my AST and ALT values after stopping Ntz. I stopped Ntz in August 2011 end and later I started taking Liv52 HB.

Results on Feb-2012:-
ASPARTATE AMINOTRANSFERASE (SGOT )PHOTOMETRY =98.00 U/l M: 0 to 37 - F: 0 to 31
ALANINE TRANSAMINASE (SGPT) PHOTOMETRY = 244.00 U/l M: 0 to 37 - F: 0 to 31

ALKALINE PHOSPHATASE PHOTOMETRY =98.30 U/l M:53 to 128 - F:42 to 98
BILIRUBIN -DIRECT PHOTOMETRY =0.26 mg/dl 0 - 0.3
BILIRUBIN - TOTAL PHOTOMETRY= 0.85 mg/dl 0 - 1.2
BILIRUBIN (INDIRECT) CALCULATED =0.59 mg/dl 0 - 0.9
GAMMA GLUTAMYL TRANSFERASE (GGT)PHOTOMETRY =21.00 U/l M: 0 to 50 - F :0 to 30
PROTEIN - TOTAL PHOTOMETRY =8.30 gm/dl 6.0 - 8.3
ALBUMIN - SERUM PHOTOMETRY= 4.56 gm/dl 3.2 - 5.0
SERUM ALBUMIN/GLOBULIN RATIO CALCULATED =1.22 Ratio 0.9 - 2.0
25-OH VITAMIN D TOTAL= 37.26 ng/ml
HbsAg Quant - 1789 iu/ml



Results on Aug -2011:-
SGOT - 25.90
SGPT - 38.90
HbsAG - 733 iu/ml

Almost SGPT has increased 10 times. Kindly help me. I'm very scared about my situation. If stopping ntz increases ALT ans AST ,we cannot take ntz for life long? please help

[stef2011]

optimum levels are not 40 but 50 and higher

i used to have it around 40, lipo gsh took it to 65 in few months

[smile_boy]

Hi,
Could you please tell me whether there is any relationship between Hypertension & Hep -B

I'm taking olmesartan for Hypertension . But last week my BP went to 150/90. My doctor prescribed me amlodipine 5mg & rosuvastatin 10mg and asked me stop olmesartan . Is there any sideeffects on Liver due to above medicines?

Also my HDL is very low which is 27 mg/dL (normal >40)

DIRECT LDL CHOLESTEROL 103 mg/dL

[smile_boy]

Thanks for the reply. Need to take Fibroscan after 6 months once the ALT is stabilized.  

[stef2011]

very good results by 3 months only, dont worry about hbsag it is about the same as before, i guess it will get stable or go in a lowering trend by 1 year of tdf

[smile_boy]

Hi All,

My Latest result after taking 3 months of Tenofovir

Dec 28 /2013 :
DNA : 68.4 IU/mL (1.84 log)
QHbsAg : 213.56
ALT : 51
AST : 26

Sep 2013 :
DNA : 35‎,‎24‎,‎213 ‎IU‎/‎mL ‎( ‎6‎.‎54 ‎logs‎)
QHbsAg : 83.00 IU/mL
ALT : 506
AST : 201

DNA has decreased to a great extent. But qHbsAG is increasing. Also AST/ALT is about to reach normal .

[newtr]

thank u studyforhope..may b u have gone through grmr case..he is responding quite good after tenovir discontinuation..so i m thinking of breaking baraclude continuation.

[studyforhope]

I do not think that you will develop baraclude resistance in this way. you might also consider switching to tenofovir, that has an even better non resistance behavior.

[newtr]

if i stop baraclude for now after 2.5 undo dna..and see response on intrf without baraclude for few months..and if necessary after few month i can restart baraclude again..do you think this will create baraclude resistance after restart..very high hbsag seems that i started the treatment when i was in immune tolerant phase, 28 years old, e+, high dna, usg normal..just a possibility..please provide your views.

[studyforhope]

At this time, considering your lab results,  the available treatments or combos are unlikely to bring you to a state of surface antigen seroconversion or loss.
The effect of the antiviral that you take is to reduce the amount of circulating virions dramatically. This in turn reduces the activation of the immune system and threby prevents damaging attacks that cause liver damage and fibrosis. this means your liver disease will not progress and an existing fibrosis might even improve.
The idea that you want to induce an immune attack is only useful when it can lead to final clearance. If it is unsuccessful, more damage is done and the flares will continue, with no eradication.

You should be grateful that with entecavir and tenofovir two antivirals with little and no resistance development are available. They work by reducing the immune attack on your liver, almost completely eliminating liver disease  and that is what mainly matters. It is not clear if they have long term side effects that truly matter, this issue will take a long time to resolve.

While interferon has some chance to achieve a hbsag seroconversion, it is typically only achieved in patients that are already primed in that direction, by showing a low surface antigen before treatment starts.

The arrowhead treatment if it becomes available is not likely to achieve such a seroconversion for you. Only the Replicor treatment combined with immunotherapy has, IMO, a resonable chance to clear someone in your position.

[newtr]

hi studyfor hope..i need your inside..hep b hbeag positive, high viral load 8 log sgpt around 60 three years before so started baraclude and after 3 month combo with interferon.. only little hbsag decrease so stopped peg intf b..then onwards on baraclude..from 2.5 years dna undo alt normal ..but hbsag continuously around 5 log too high..added pegint b recently no stable hbsag decrease ..many times seen hbsag fluctuations between 60000 iu to 100000  iu in between weeks..does it show any immune response..whenever this fluctuation takes place lympho count increases and platelate decreases..but never found sustained value of hbsag and alt is always normal..what do you think if i stopped baraclude and continue pegintf ..do you think it will be useful to trigger immune system as dna will increase after baraclude discontinuation..i m currently undo dna so do you think stopping baraclude will develope any resistance if again used in future..please give your deep precious views about the condition and future management. waiting for ur kind response..thank u.

[studyforhope]

I am not aware of any interactions of olmesartan and tenofovir.That does not mean that they do not exist. Check all drug interactions of tenofovir, also in case you might receive additional medications in the future.

[smile_boy]

Hi,

One last question . Kindly reply
I met a doctor today  He prescribed me Tenofovir 300mg . Already I'm taking Olmesartan 40 mg for Hypertension. Whether Olmesartan drug will have any interactions with antivirals.

He also asked me to consider  IFN treatment too. Before that he wants to take Fibroscan before that.

[studyforhope]

Chronic inflammation reduces the synthetic activity in the hepatocytes. Intense fibrosis is an independent reason for decreased functional capacity of the liver.
Therefore patients with hepatitis tend to have lower cholesterol levels.
This has to be seen however in consideration of the genetic background and other functional impairments like fatty liver and insulin resistance, which typically reduces HDL  more than LDL cholesterol.

[smile_boy]

Hi,

Is there any relationship between lower cholesterol levels ( LDL , HDL) and Liver damage.

I have lower LDL  and HDL which is below normal range -  

LDL : 67 mg% (Normal Range :- 85-130)

HDL : 33mg% (Normal Range : 35-80);

Total Cholesterol :  132 mg% (Normal Range : 125 - 200)

[StephenCastlecrag]

The following information from www.hbvadovcate.org may convince your doctor not to prescribe Lamivudine.

Researchers Suggest Banning or Restricting Lamivudine to Avoid Drug Resistance
A global team of researchers suggest lamivudine (Epivir-HBV) never be used to treat hepatitis B patients because it frequently leads to drug resistance and sets the stage for resistance to other antivirals, such as entecavir (Baraclude).

Lamivudine, the first antiviral approved for hepatitis B treatment, has fallen out of favor in North America and Europe because of its high rate of drug resistance. But because of its low cost, it continues to be commonly used to treat hepatitis B virus (HBV) infection in Asia and Africa, where the majority of the world's hepatitis B patients live.

This report, published in the July 30 issue of PLoS One, examined the molecular make-up of the virus in many patients who had been treated with lamivudine as well as patients who had never been treated. They found the many untreated patients carry a mutation that allows HBV to quickly mutate and develop resistance to lamivudine.

"Our findings strongly suggest that the use of lamivudine will not benefit ...patients," they wrote because of the high risk of lamivudine resistance.

"Finally, since patients can quickly develop drug resistance to entecavir in the presence of lamivudine mutations, the lamivudine mutations can significantly compromise the efficacy of entecavir," they concluded.

They proposed that doctor screen patients for these mutations before ever prescribing lamivudine,"... to most effectively treat chronic hepatitis B patients by selecting only sensitive drugs."

An unrelated article published in the Annals of Medical and Health Sciences Research, also criticized the over-use of lamivudine in hepatitis B patients in Sub-Saharan Africa. Lamivudine was originally developed to treat HIV, but today African providers use it frequently to treat anyone with hepatitis B (when HIV is not present) because it is inexpensive and more effective hepatitis B antivirals, such as tenofovir (Viread) or entecavir, are more costly or unavailable.

But over-prescription of lamivudine for hepatitis B in this region has:

    Increased drug resistance in African hepatitis B patients
    Reduced availability of the antiviral to both HIV and HBV patients
    And driven up the drug’s cost, which reduces its availability for more appropriate HIV treatment.

Critics say a bioethical dilemma has evolved, where doctors prescribe lamivudine to hepatitis B patients without explaining alternative treatment because they assume the patients don’t understand or are too poor to pay for more effective antivirals.

“Implied consent is no justification to embark on a particular treatment course,” researchers from Njala University in Sierra Leone wrote. “To tackle the growing problems of drug resistance and shortages with respect to lamivudine and other antivirals in HIV/AIDS treatment, health care resources should be prescribed with caution, irrespective of whether implied or explicit informed consent has been sought.”

    Association of Preexisting Drug-Resistance Mutations and Treatment Failure in Hepatitis B Patients
    Source: ww.ncbi.nlm.nih.gov/pmc/articles/PMC3728369/
    Lurking Dangers Behind Overuse of Lamivudine to Treat Non-HIV Hepatitis B Patients in Africa
    Source: ww.ncbi.nlm.nih.gov/pmc/articles/PMC3728885/

[smile_boy]

Sure Stephen. I have booked appointment with Hepatologist today.  My only concern is whether doctor will prescribe Tenofovir ? Doctors here are not very updated . They may start from  lamivudine too.

[StephenCastlecrag]

Studyforhope has given you excellent advice and explanation. Treatment should be considered.

[smile_boy]

Thank you very much for your reply

[studyforhope]

Full sequencing would be necessary to detect this kind of mutations.
Tenofovir will work to suppress even those.

[smile_boy]

Hi StudyforHope.

Thanks for the reply. Please let me know is there any way to detect mutants?

Tenofovir can tackle the mutants?

[studyforhope]

It looks like you have a mutated form of surface antigen, that escapes proper quant measurement.
I would use tenofovir to suppress future flares. These flares can accelerate development of fibrosis and cirrhosis.
Fibroscan or liver biopsy are needed to determine your current fibrosis status.

[smile_boy]

Hi Sudyforhope , Stef and stephen

Please find my QhbsAg and HBV DNA


BLOOD - SEROLOGY
:‎
HBsAg - QUANTITATIVE  : 83.00 IU/mL  Less than 0.05 IU/ml : Negative
Method : CLIA - ARCHITECT
:‎

HBe  Ag  : NEGATIVE‎
Method : CLIA
MOLECULAR BIOLOGY

HBV VIRAL LOAD BY REAL TIME PCR : 35‎,‎24‎,‎213 ‎IU‎/‎mL ‎( ‎6‎.‎54 ‎logs‎)

The test is done on Roche COBAS TAQMQN ‎48 ‎Real Time PCR ‎
Analyser‎

DNA is very very high.

What I should do? Tenofovir or entecavir ? Which is good for this high viral load ?

Please reply. any possiblity of liver Fibrosis or cirrhosis?
:

[StephenCastlecrag]

I think there are links between serum iron parameters and chronic hepatitis. It is quite a complicated area, I believe. Best to consult your doctor.

[stef2011]

iron content is increased in infections and it helps viruses to replicate, proper vit d levels are reported in several studies to help make it normal

there is also liver damage due to iron overload but i am not expert on this and you d better refer to your doctor, although levels dont look so high