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]

stoppingntz doesn not change your situation but i think liv52 did because hbsag has increased frominactive carrier to cronic hbv

anyway having alt 200 is not bad at all if hbvdna is extremely low or undetactable because it means your immune system see the virus and is fighting, if you find also hbvdna high that would be a big problem

get back to ntz+vitd3 (37 is too low, get it to 80ng/ml)

then check hbvdna too, if hbvdna is low i d go for ntz lead in for 12 weeks and then addon generic interferon+simvastatin+vit d3 to clear hbv

[stef2011]

in case hbvdna is high we have to use tenofovir or see if alinia is able to lower it monotherapy

[4est]

do you have also some other (previous) test results ?

I can agree with you that it seams that stooping NTZ couses ATL/AST flare but I wandering if this is the case (should be something else and to be only a coincidence)

how was your qHbsAg before styrting NTZ ? (NTZ decrese this value ?)

how about your HBV DNA - is this increasing / decreasing also ?

(NTZ = alinia ? )

[stef2011]

checking all your tests:

creatinine is a bit high, nothing to worry and easy to correct, do you make gym/bodybuilding, hbv can also attak kidneys

hdl is very low, this is bad because hdl has also antiviral effect.glutathione by injections or liposomal+vit d3>50ng/ml, fish oil omega3 or fish diet, can increase to 65-70 easily

alt 255 is a good flare after we know hbvdna we can understand immune status by comparing hbsag and hbvdna and kinetics

[smile_boy]

I didn't check qHbsAg before taking Alinia (Nizonide-Ntz) . After 2 months of taking Ntz it came to 1000iu/ml and after 4 months it even came to 500 iu/ml.

But after that it gradually increased to 730 iu/ml (with Ntz) . So I stopped Ntz and later I started with Liv 52 HB,
After that my qHbsAg has increased t0 1789 iu/ml

My HBV DNA was 9000 Copies/ml  on Decemeber-2011. After that I have not checked DNA Values.

[smile_boy]

Stef,

I don't go for gym or any body building exercises. I have normal physique (178 cm/82 Kg) .

[smile_boy]

I didn't check qHbsAg before taking Alinia (Nizonide-Ntz) . After 2 months of taking Ntz it came to 1000iu/ml and after 4 months it even came to 500 iu/ml.

But after that it gradually increased to 730 iu/ml (with Ntz) . So I stopped Ntz and later I started with Liv 52 HB,
After that my qHbsAg has increased t0 1789 iu/ml

My HBV DNA was 9000 Copies/ml  on Decemeber-2010 (sorry not on dec2011) . After that I have not checked DNA Values.

[stef2011]

creatinine is a very poor test for kidnesys because big muscles can make creatinine even 1.4 not correlated with kidneys.if you want to be on the safest side take a 24hrs urine test of creatinine clearance that will confirm kidneys function.i stress again this is to be ultra safe side and to prevent in any case.

kidneys function can be improved by making hbvdna und, by fibroguard, by antioxidants like vit d and gluta injection or liposomal

anyway youare still close to hbsag 1500iu/ml which has highest chances to clear hbv, according to the hbvdna level we may think an off label combo like this:
alinia-tenofovir lead in 24 weeks and then recheck hbsag/hbvdna if low

alinia-tenofovir-interferon or peginterferon-simvastatin-vitd3, i am sure you ll clear fast like it happened to otan on such a combo

[stef2011]

since we dont know your baseline hbsag and hbvdna there is another way to think about what happened.

your baseline could have been hbsag 1700iu/ml and hbvdna 9000iu/ml, alinia lowered them and when you stop they just got back to baseline values

the difference can be your immune system is now stronger and made a alt flare trying to clear the infected cells, it is better to act while we have the alt flare and i think alinia is the best to retry now and then add interferon

[4est]

" .. After 2 months of taking Ntz it came to 1000iu/ml and after 4 months it even came to 500 iu/ml. But after that it gradually increased to 730 iu/ml (with Ntz) . So I stopped Ntz and later I started with Liv 52 HB,  After that my qHbsAg has increased t0 1789 iu/ml "

so it seams that NTZ is not fully responsible for HBsAg variation (qHBsAg decrease and increase also under NTZ).
Could you please give us the date's when you made the qHBsAg tests (all dates). I was thinking to see that after you stop the NTZ HBsAg increase faster or just increase with the same rate.

could you remember something different during the decrease period vs increase period (what yoe eat, sport or eating or sunbath or .... )

[smile_boy]

Before taking Ntz (i.e on Dec-2010 my HBV DNA was 9000 copies/ml (i.e around 3000 iu/ml). Had No idea of qHbsAg. ALT/AST was Normal

I didn’t check my qhbsag before taking Ntz. I started taking Ntz around Jan -end -2011

5th,March -2011 – 1088 iu/ml (During this period Ntz was 1.5 g per day)

2nd April -2011 –    567 iu/ml – During this time I played badminton often and took lot of fruits and fresh juices. Also Included Oat Meal (Ntz was 2g).Also in end of April  started taking Lypo-SphericTM Vitamin C and Lypo-SphericTM GSH – Glutathione + Omega 3 +Selenieum

21st April – 542 iu/ml –Ntz -2.5 g per day

20th May – 606 iu/ml – Ntz 2.5 g

3rd June -2011 – 652 .33 iu/ml – Stopped playing and less physical work. Also added 20mg Simvastanin and stopped taking Vit C and Glutathione

15th Aug -2011 – 733 iu/ml  - So I decided to stop Ntz gradually  and started taking Liv 52 HB and added Vit D 5000 iu/ml

5th,Nov -2011 – 1091 iu/ml – only on Liv52HB + Vit D

24th Feb ,2012 – 1789 iu/ml - only on Liv52HB + Vit D


Thanks

[stef2011]

maybe it is best to retry alinia 2,5g daily and no fruits, liposomal vit c and glutathione, no omega 3 and see

we nedd to keep in mind hbsag less than 1500iu/ml respond to interferon wit h clearance and sme thing may apply to alinia

and 500iu/ml or less might respond like otan to interferon+alinia with hbsag clearance before 24weeks

to me the best thing in this case is: alinia 12weeks or 24 weeks until hbsg gets back to around 500iu/ml and then add on interferon, if hbvdna is detactable higher than 100iu/ml i d add tenofovir too right before making interferon add on so that hbvdna is already und when adding interferon.i think you will clear hbv by 24-48weeks on this combo

[4est]

Date     qHBsAg   DqHBsAg      Days         DqHBsAg/ days
30 ianuarie 2011          ?             ?                 ?
5 martie 2011 1088 ?            ?
2 aprilie 2011 567 -521 27.00 -19.30
21 aprilie 2011 542 -25 19.00 -1.32
20 mai 2011 606 64 29.00 2.21
23 iunie 2011 652 46 33.00 1.39
15 august 2011 733 81 52.00 1.56
5 noiembrie 2011 1091 358 80.00 4.48
24 februarie 2012 1789 698 109.00 6.40

[4est]

I don't think that is a real connection between NTZ and qHBsAg, even if the daily increase jump from 1.56 to 4.48 when you stoped the NTZ (but also with the NTZ you experience a increase of 1.4 per day )

[4est]

what puzzle me is the decrease of 19.3 per day (between 05 march and 02 April ) and after that the decrease is relay slow 1.32 per day (between 2 April and 21 April )

[smile_boy]

ya I understand this. But my question is why my ALT got increased to large extent when I stop NTZ? When I was on NTZ , ALT was normal?. I don't understand the logic here

[4est]

I can't understand also the ALT variation.

ALT was under the same variation like qHBsAg ? (start to increase in the seme time ...)

[smile_boy]

I did not check ALT levels often. I checked once in july-2011(normal) and feb -2012

[stef2011]

retreatment with alinia will tell us if hbsag decrease was due to alinia, please let us know one month results with alinia 2,5g daily, also consider that you may use even 4g daily if you can tollerate because aids patients non responding to lower doses have been treated with 3-4g daily with no severe sides and of course the higer dose the better

[smile_boy]

My HB DNA is 6,518,01 Copies /ml.

Please Your comment please.

I Dont know how it got increased to this level. Very Scared

[stef2011]

not alinia for sure......., this is a very high level for you which has nothing to do with inactive carrier you were, nothing to be scared of but if we dont act now you may lose the low hbsag and the chances to clear hbv easily on interferon combos

if you can afford i d go with tenofovir+alinia and add interferon when hbsag gets lower than 1000iu/ml

with this hbvdna the trends are towards hbsag increase if we dont stop relication, although hbsag and hbvdna are not correlated i think this is wht may happen

[stef2011]

chances are tdf+alinia will stop hbsag increase and hopefully stop or make it decrease

[stef2011]

i think we can post hbsag, hbvdna and ast/alt increase during liv52 in a previous inactive carrier with low hbvdna, ast/alt

[smile_boy]

Very Scared

How it could increase within 1 yr . from 9000 copies to 6,518,01 copies/ml. I don't Understand? Is it possible?

It is due to sudden stop of Ntz(Alinia)?

Yes you are right. Liv52 HB is Junk one.

I cannot afford tdf? Should I try Ntz alone?