Treatment options

[lxstr]

Hi all,

I was diagnosed with Hepatitis B over 10 years ago and was confirmed to have chronic Hep B. During the same test I also found out I've got very high cholesterol (almost 2 x ULN). Since then, I've monitored my LFT roughly every 6 months as I am taking cholesterol medication. ALT has hovered around 110%-130% ULN and AST within ULN for the past 10 years.

3 months ago, the virus became very active. My results history:
23 Apr 2011
ALT: 152
AST: 65

26 May 2011
ALT: 242
AST: 134

10 Jun 2011
ALT: 364
AST: 143

17 Jun 2011
ALT: 397
AST: 161
GGT: 69

21 Jun 2011
ALT: 482
AST: 175
GGT: 73

HBV DNA >1.70 e+8 (IU/mL), the date of this test was 10 Feb 2011 and it's the only one I've got. I will ask for this test next week.
HBV Genotype A-1

Liver biopsy performed 25 June 2011 and the results were Portal activity - 3, Lobular activity - 2, Fibrosis - 1
METAVIR activity grade A2, Fibrosis state F1 (portal fibrosis without septa)

I am 29 years old, born in Taiwan, moved to Australia 20 years ago.
My liver specialist's first option for treatment is to go on trial for BMS's Peg-Interferon Lambda test. She's told me the success rate is only 1/3 but has a finite 48 weeks treatment period. I asked her about oral treatments but she said I might have to take the tablets everyday for the rest of my life. I have not started treatment because I am still searching for the optimal option.

For the past 3 weeks, I've been taking Chinese herbal medicine twice daily plus high dose of milk thistle to protect my liver. Last week (9 July 2011) my LFT results improved:
ALT: 265
AST: 97
GGT: 67

I am booked to see another specialist in 4 weeks time. I know I should to start treatment asap.

Two weeks ago, I was learning towards combined oral (Baraclude or Viread) treatment with Peg-Interferon. But the Australian government only supports mono-treatment.

At the moment, I am leaning towards getting interferon (Peg-A) to give my body a chance to fight the virus on its own. Hopefully this will achieve seroconversion from HBVeAg+ and HBVeAb- to HBVeAg- and HBVeAb+.  

I don't think I'll take the Peg-Interferon Lambda trial as it's a strict mono-treatment.

I am also intrigued to take Alinia with Interferon (Peg-A) for possible (albeit very slim) chance of eliminating HBVsAg.

Please, any suggestions would be much appreciated. Thanks in advance.

[stef2011]

as you can see before alinia interferon was getting much worst than baseline and in 2 months of alinia everything got reversed:
hbvdna 851c/ml which is an increadible lowering for any mono therapy interferon or nucs, very rare on etv and tnf too it is 5log drop in 2 months

hbeag lowered from 365 to 80.49

too bad they did not check hbsag and the doctor was absolutely incompetent.the doctor thought it was interferon to make the increadible response and increased from 300U to 500U, the guy had severe depression and never posted again, i guess he stopped treatment

[stef2011]

2.18 is hbeab antibody, 8.24 was the baseline value.hbeab detactable is equal to less than 1
6538.00 is hbsag, the baseline value was 4581
80.49 and 365 is hbeag.the baseline value of hbeag was 1000

[stef2011]

values got messed up posting here....


DATE DNA     ALT AST HBeAB HBsAg HBeAg HBsAb HBcAb
8-6-2010 851c/ml                                                  80,49
12/04/10  add NTZ                         2,18      6538,00      365        <2.00         0,01
21/03/10  17300000c/ml 143  87
01/02/10                     35   30
09/11/09   start INF        94 49
03/11/09 9110000c     80 42   8,24 4581,00   1000   2,86         0,003

[stef2011]

as to pretreatment with nucs to make hbvdna zero

this is also a good strategy because both hbvdna and hbeag are immune suppressive more than hbsag, so hbvdna zero may reduce immune suppression but i'd skip this and go straight for lambda

another good test is hbeag quantification altogether with hbsag and hbcabigm but i dont know if you have this one available too.

we have also data from a chinese guy who tried conventional interferon+alinia, unfortunately we ve lost follow up, i think he stopped the normal interferon alpha because of severe depression.the worse sides effects of interferon alpha are on brain function and depression

DATE DNA     ALT AST HBeAB HBsAg HBeAg HBsAb HBcAb
8-6-2010 851c/ml                          80,49

12/04/10  add NTZ                         2,18        6538,00      365        <2.00         0,01
21/03/10  17300000c/ml 143 87
01/02/10               35       30
09/11/09 start INF         94 49
03/11/09 9110000c/ml   80       42   8,24 4581,00 1000   2,86         0,003
15/06/09  12100000c/ml 179 97
23/06/08             118       53
27/06/2007     122       68
25/06/2006      80       40

[stef2011]

as i posted earlier an hbsag quant and hbcab igm quantitative can help very much to guess possible resoponse.

before starting the treatment:
vitamin d 50-60ng/ml
nizonide500 pretreatment mono at 2g daily
simvastatin to get best chol values to weaken hbv
panthetine 1300mg daily, to increase hdl

[stef2011]

i think that if you have access to hbsag quantification (i believe they do in the hospital otherwise they cannot make trials), fibroscan and bimonthly liver function/kidney function/hbv markers checkups you are ok with all the drugs i suggested, they are all free of sides and approved for babies even one year old, so no big deal except for nizoral and to a much lesser degree simvastatin

but as long as you are monitored bimonthly at start and then every 4 months after 6months everything is ok

fibroscan and ultrasound every 4-6months

at this point is all a matter of expense and australian coverage but if you enter the lambda trial i think they do all the close chekups i posted......you just have to cheat about monotherapy and if hbsag decreases a lot you just switch to another hospital and start immediately interferon alpha when you finish with lambda

as to the cost of alinia and sim they are very cheap, alinia generic is made by lupin is called nizonide500 and the cost is about 130usd for 1000pills in india

i would not combo with tenofovir and entecavir if using lambda i thin that lambda+alinia+sim should have a great impact on hbsag anyway