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.

[StephenCastlecrag]

My specialist is from Storr Liver Clinic at Westmead.
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I was thinking of Prof Strasser from RPA.

Reasons why I am leaning against the Lambda trial are:
a) Treatment is limited to 48 weeks finite period, followed by 24 weeks post treatment follow up. I remember reading that interferon treatment can be continued past 48 weeks if signs are showing that it is working. If it is effective, wouldn't they ask me to stop treatment?
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Yes, in China, Interferon treatment can go beyond 48 weeks because it is not working, not because signs are showing that it is working.Western doctors follow guidelines and a course of Interferon treatment is 48 weeks. Ask you specialists about measuring HBsAg quantity to predict the outcome of Interferon treatment.

b) If I am part of the trial, I am pretty sure they won't let me take Alinia or anything else in order for the trial to be completed in a controlled environment.
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Alinia is also an immunmodulator. It is untested. Stef2011 takes it but Stef2011 has access to very good medical advice and he can monitor his own progress very well. No doctor in Australia will advise you to take Alinia, you will be own your own, perhaps with help from Stef2011.

c) The stated benefit to Lambda is fewer side effects, not actually improve treatment efficacy.
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Here, we are talking of a chance to get rid of HBV, and not just controlling it as with the antivirals.

d) My wife is currently pregnant (first baby due in 2 months! yay!) and I think it makes me not eligible.
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Interferon can affect your fertility (I think), but since your wife is already pregnant, so I don't see how it will affect you, unless you plan to have another child in the near future. This, you have to discuss with your doctor.

I am open to listening to your opinion if you think I should still go on lambda trial.
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Look, it is your choice. Interferon gives you a chance to get rid of hbv altogether and it has a finite treatment period. Antivirals will let you control your hepatitis and usually you have to take them for a long time. Talk it over with your specialists, it seems to me you are not asking the right questions.

I asked for combined treatment to lower HBVDNA to give interferon a better chance. But according to the clinic, Australian government only supports mono treatment. Unless I pay for everything myself.
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Some years ago, doctors had this idea too, lower hbvdna before Interferon treatment. So they did clinical trials using Lamivudine as pre-treatment for Interferon. The results were disappointing, there was no difference in efficacy. So Interferon remains as a mono treatment. But Stef2011 thinks that combination treatment of Interferon with a nucleo(t)side should be considered again and I agree with Stef2011. Indeed there are trials on-going now testing Interferon with Entecavir. The idea is that we should use oral antiviral to reduce hbvdna to zero before starting Interferon. (Stef2011 will correct me if I am wrong). Remember, nowadays, we have better assays to monitor hbvdna and HBsAg quantity.

As for chinese meds, my GP also advices me against it. But it was prescribed by senior, experienced and trusted extended family member. So far, it's the only thing that I can think of leading to lower ALT and AST.
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In China, they use herbal medicine to lower ALT, but it is only a short term solution. It is treating the symptom and not the cause.

I am interested to find out what you mean by masking ALT number?
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When you are using the herbal medicine, your ALT is usually lower, but western doctors use ALT number to gauge the activity of our immune system as it is our immune system that is killing the infected liver cells and thus releasing the ALT enzyme within these cells. All HBV treatments, oral and Interferon, are optimal when our own immune system is active.

Just my opinion, I am not a doctor.

[stef2011]

http://www.medhelp.org/posts/Hepatitis-B/nizoral-tablets-might-damage-hbsag--in-vitro-reduction-72/show/1550189

consider also ketoconazole, with close hbsag quant and liver function you can check if this in vitro result can be achieved in vivo too.
drug makers will never make trials on these extremely cheap  and old generics like nizoral or alinia but actually we dont need them at all we can just make perfect monitoring and check results ourselves

[stef2011]

by the way i didn t noticed you are hbeag positive, definitely immune modulators are btter than nucs for you, check also hbcab igm quantity because any value higher than 0.2s/co has very high chances of response on interferons

interferon lambda is definitely a good choice, you will find a way to get drugs in combo indipendently from your doctors....(indian is very easy to get etv or tnf and they are very cheap)
me and researchers in pisa were thinking about it but since i am hbeag neg there was no way to do it, after this i got to know about gcmaf so i opted for this, in case this wont work i'll definitely try lambda when available, especially for the combo interferon lambda+telbivudine which should have no PN sides at all since this type of interferon has effects only on the liver and higher potency too

[stef2011]

gave me muscle pains

this is due to coq10 depletion, try nano q10 from sollgar and normal coq10 and take 200-300mg daily distributed during the day.with coq10 the higher the better is not true so after 300mg you my just try and see if muscles pains persist.
if you get rid of pains retry 80mg dose, the 40-80mg dose are the most potent on hbv

you may also try bitter melon becuase research showed equal potency as rostiglitazone and this has also effect on hbv

metabolic syndrom, fatty liver, high cholesterol are all ways hbv tries to take control of our body and get more food to make its antigens, so if you change your diet like i did for my fatty liver this wont help hbv.if you have a chance check insuline resistance too because this is another factor that lowers interferon response and makes hbv stronger.
i use 1liter of bitter melon tea at meals

About 2 months later, my ALT and AST started to flare. Maybe the drop in simvastatin jump started HBV viral activity.
alt jump is a good thing, it means you are infected infected cells if after alt rise hbvdna and hbsag decrease.i think definitely an effect of sim, also interferon and sometimes nucs make a alt rise when you respond

I remember having some red yeast rice as a kid and absolutely hated it. But I think it is mainly due to how my mum cooked it. I guess I'll have to find a way to like it.

it is better to take pills where monacolins quantity is standard but dont mix sim and res yeast rice.the goal is totchol<150, ldl60
hdl and vitamin d level have a direct antiviral effect so concentrate on these two.hdl can rise by panthetine and niacin but niacin has sides effect on liver so i think panthetine is much better, it has no toxicity at any dose, the doses used are 600-1200mg daily so i do go for 1200-1300mg distributed during the day

also omega3 fish oil wth EPA 1800mg – DHA 900mg helps, most formulas are fake with very little epa and dha

more confidence on making treatment decisions.
yes it is definitely better to improve all these easy parameters before starting

[lxstr]

The most recent test I've got for HBVeAg was 10 Feb 2011, which was at the start of the current flare.

Results:
HBVsAg +
HBVeAg +
HBVeAb -

HBC Ag/Ab -
HBC Ag/Ab Ratio 0.16

[lxstr]

I will ask for HBeAg and HBeAb test next week, thanks for your advice.

My specialist is from Storr Liver Clinic at Westmead.

Reasons why I am leaning against the Lambda trial are:
a) Treatment is limited to 48 weeks finite period, followed by 24 weeks post treatment follow up. I remember reading that interferon treatment can be continued past 48 weeks if signs are showing that it is working. If it is effective, wouldn't they ask me to stop treatment?
b) If I am part of the trial, I am pretty sure they won't let me take Alinia or anything else in order for the trial to be completed in a controlled environment.
c) The stated benefit to Lambda is fewer side effects, not actually improve treatment efficacy.
d) My wife is currently pregnant (first baby due in 2 months! yay!) and I think it makes me not eligible.

I am open to listening to your opinion if you think I should still go on lambda trial.

I asked for combined treatment to lower HBVDNA to give interferon a better chance. But according to the clinic, Australian government only supports mono treatment. Unless I pay for everything myself.

As for chinese meds, my GP also advices me against it. But it was prescribed by senior, experienced and trusted extended family member. So far, it's the only thing that I can think of leading to lower ALT and AST.

I am interested to find out what you mean by masking ALT number?