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.

[lxstr]

Hi Stef2011, you are a godsend. Many thanks for your informative reply and your contribution to this community.

Up until a week ago, I've always thought my high cholesterol, low vitamin D and chronic hepatitis B were three totally unrelated problems with my biochemistry.

9 months ago, my cholesterol specialist diagnosed me with Familial hypercholesterolemia and put me on Vytorin 10/80 (80mg simvastatin). It did bring my cholesterol to within ULN but also gave me muscle pains. 3 months later, I decided to half the dosage myself and the muscle pains went away.

About 2 months later, my ALT and AST started to flare. Maybe the drop in simvastatin jump started HBV viral activity.

Now that I know simvastatin actually helps with fighting HBV, I'll go back to 10/80 dosage and increase my vitamin D supplement intake.

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.

I will have a blood test next week and ask for HBV DNA count, HBVsAg count, LFT, cholesterol and vitamin D. After which, I should be able have more confidence on making treatment decisions.

[StephenCastlecrag]

It seems to be that you are in the immune clearance phase. Actually your conditions are ideal for treatment by Interferon: activity grade 2, high ALT, and Genotype A. The only non-ideal condition is high hbvdna.

I don't why you are not keen on the Interferon Lamda trial as you will be well monitored. Is your specialist from RPA, Sydney?

In your next test, be sure to test your HBeAg and HBeAb status as you may have already seroconverted to HBeAg-ve inactive state.

Why take Chinese herbs? It will only mask your ALT numbers. Just my opinion.

[stef2011]

you should check hbsag quantity by architect, that's the ony way to know if you have chances, as you ve probably seen in posts hbsag<1500iu/ml has the highest chances

do make vitamin d level to 50-60ng/ml and tot chol<150 ldl60 this way you will weaken the virus and improve interferon sensibility.to lower cholesterol i am using red yeast rice which contains natural lovastatin just because it has almost no sides but simvastatin is the one shown to have the higher potency on hbv

as toliver damage f1 is nothing, even people with fatty liver or just trash food eaters (fast foods, lot of meat, fats, no vegetables) have f1.in any case you can reverse this by hepatitistechnologies products, just avoid fibroguard if you start interferon because fibroguard lowers interferon response

i do suggest combo or wait for better drugs or see if gcmaf actually works on hbv.

it would be good to try staggered interferon+telbivudine this is sure to lower hbsag but do not go over 6months because of possible  PERIPHERAL NEUROPATHY sides, vitamin d should be able to prevent this as shown in a recent research on telbivudine.with stricked monitoring for myophaty this is the best try even with high hbsag:
interferon+telbivudine+alinia+vitamind3 supplements, use of simvastatin before start of this combo and after better use red yeast rice with coq10 or nothing for choesterol just for extra safety as regards PERIPHERAL NEUROPATHY

after 4 to 6months of telbivudine as soon as hbsag drops 1log i'd stagger with tenofovir, researcher said this combo worth a try for shorter than 6months because  PERIPHERAL NEUROPATHY developped after 6months, the good news is that almost all patients had a minimum of 0.5log hbsag drop and a maximum of more than 1log which puts you in the range of high chances of clearance even with interferon mono.so since almost all hbeag negative are in the 3log range (3000-9000iu/ml) 1 log drop takes you to 300-900iu/ml which has a very high chances of clearance

if we add having good vitamin d levels, low cholesterol and alinia the chances should be very very high