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Hepatitis B Community
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Avatar universal

Treatment options

Hi,

My test results:

12/21/06:  HEP B PCR QUANT = 107000 IU/ML
03/19/07:  HEP B DNA, ser/plas, PCR = 100316 IU/ML
02/29/08:  HEP B DNA, ser/plas, PCR = 487165 IU/ML

               ALT       AST
03/19/07:  31         27
10/29/07:  87         49
11/30/07:  123       50
12/31/07:  34         29
02/29/08:  46         36

Questions:  What does the change trend mean?  Should medication treatment start?  What medication to start with?  What dosage?  How long should I prepare to stay on that medication?  What side effects to expect?  What is the monthly cost?  Thank you for your feedback.
190 Responses
181575 tn?1250202386
It means you are sustaining liver cell damage from HepB.

More information is needed to understand your disease status.

How old are you?

When were you infected?

What ethnicity are you?

What is your eAntigen and eAntibody status?

What did your doctor tell you so far?
Avatar universal
Age 48, when infected not sure, ethnicity Asian, eAntigen=HBeAg? if yes =NONREACTIVE, eAntibody not sure, doctor on vacation.  Thanks for your advice.
181575 tn?1250202386
Read the thread started by Mei.  You two have a similiar presentation:

http://www.medhelp.org/posts/show/440703

Since typing the same stuff takes alot of time.  Here's a cut and paste of the relevant points to your presentation:

Sometime prior to Dec 2006, you were probably in the inactive phase of the disease before with eAntigen negative, eAntibody positive, low DNA, and normal LFTs and ALTs.

If you DNA jumped from low to 107,000 IU/ML (which is a sign of the disease breaking through immuno-control) then to 487,165 IU/ML, with elevated ALTs, those are classic signs of a eAntigen negative active disease.  This is a classic sign of the core-promoter mutant strain, which is quite common.  Like 50% of all carriers eventually have this mutation.  This is the re-activation that carriers have to look out for.  If this is you, you should treat.  And start soon, try to cut down the virus' replicating abilities.  Treatment in such cases are long-term.  Consider combo treatment to reduce the risk of resistance.  Lamivudine monotherapy should not be used because of its poor resistance profile.

With a 50 miilion viral load, you could do genotyping now to check for the pre-core or core-promoter mutation.  Ask your doctor for that.  It's probably the core-promoter.

With an eAntigen negative disease, treatment is basically long term.  I think most doctors recommend antivirals because it has minimal side effects and easier to tolerate long term as opposed to Peg Interferon (some on the HepC forum referred to Interferon as doing hard time).

Combo treatment is taking 2 antivirals to cross protect against resistance.  It attacks the virus on 2 fronts to reduce it adaptive abilities.  Important because you may may to take antivirals for the rest of your life.  Always think of the long term.

Discuss the above with your doctor.  Good luck.

And hope you stick around and let us know how you are doing.

181575 tn?1250202386
"With a 50 miilion viral load, you could do genotyping now to check for the pre-core or core-promoter mutation.  Ask your doctor for that.  It's probably the core-promoter. "

Opps, it should be edited for you:

"With 487,165 IU/ML, you could do genotyping now to check for the pre-core or core-promoter mutation.  Ask your doctor for that.  It's probably the core-promoter."

Yes, I am cheating...it takes time to type you know ;)
Avatar universal
Will present your advice to my doctor, will keep you updated.  Many thanks again.
Avatar universal
080318:  Today I saw my doctor who was quite refreshed from rest at home.  He recommended two treatment options, one is injection once a week and the other is baraclude by mouth once daily.  Because the former has side effects that may cause me (the bread earner of my family) to stop working, I immediately chose the latter, which costs $2200 per 90 days.  Would appreciate your sharing your experience if you have used baraclude before.  Thank you.  -cajim
181575 tn?1250202386
Did you ask your MD about the e Antigen / Antibody status, genotyping, etc?

What did your MD say?

"Because the former has side effects that may cause me (the bread earner of my family) to stop working."  -This is why most go with antivirals.

Did you ask about combo antiviral treatment to lower resistance risk?

Do you have insurance for this med?  You may have to take this long term.

And Baraclude is great.  It has a great (low) resistance profile.  I'm taking it now (well not now, it was this morning ;).  No side effects.  Good for the diet too.  You have to take it on an empty stomach (2 hours before or after meal).  So if you take it at night, no more eating right before bed ;)
Avatar universal
Many thanks for your advice and sharing.

My doctor spent more than 30 minutes answering questions from my wife and me:

1.  Genotyping and biopsy can be ordered if I request but the result would not alter the course of treatment.  Genotyping can identify 5 types of something but medicine today does not have a common approach.  Usually one doctor's advice is different that of another's.

2.  I am not sure about my e Antigen / Antibody status but my doctor said my medication requires heavy dosage, 1mg per day.

3.  He advised that Baraclude is more potent than Hepsera and the former does not more easily cause cancer than the latter as a former doctor suggested.  I will ask him about combo treatment by email.

4.  Now I am working and my insurance covers the med with some copay.  The worry is if I become too sick to work, my income stops and the coverage stops too.

You are a wonderful person with a helping heart.  Many thanks.  -cajim
Avatar universal
I would gently insist on knowing your e-antigen/antibody status.  If you are e-positive then the end of treatment is becoming e-negative.  If you are e-negative then the end of treatment is less clear and needs further discussion.
Avatar universal
Doc's reply:  Combo treatments are not FDA approved.
Avatar universal
Combo treatments are part of the arsenal of any doctor who is up to date on the research.  I'm concerned about a doctor who has not bothered to found out your e-antigen status and flatly eschews the idea of combo therapy.
181575 tn?1250202386
I second Zelly's comments.

You posted earlier, "eAntigen=HBeAg? if yes =NONREACTIVE".  Unless you have a truly unique situation, your eAntibody is positive.  Which means you could very well take meds for the rest of your life foe this e- active HepB.  You are 48, so you may need to meds for another 20-30 years or so.  To do so without viral resistance is a tough goal.  This is why resistance issues need to be discussed now.  Say you reach (UND) Undetected DNA on Baraclude, most doctor will not make any changes because you are UND.   They wait to see a rebound in DNA and say "uh-oh", looks like the virus developed resistance to Baraclude.  This will have consequences on your future treatment options...just ask anyone who developed resistance to Lamuvidine.  Resistance is a difficult one way road.

I think it's okay to just go on mono-therapy with Baraclude now since your DNA is still not that high.  But do ask your doctor when is a good time to go with combo.  If the answer is after resistance develops, that's a bad answer.

You don't need FDA approval for combo treatment.  FDA approves the individual meds.  It's up to the doctor to make a clinical decision as to what to treat with.  So personally, I wouldn't accept the answer you got.

Also, I know it's very uncomfortable to challenge your doctor. I've done it and in the end, my doctor thanked me to introducing a new train of thought.   I am on combo treatment with Baraclude and Tenofovir (which is not yet FDA approved for HepB...but it will soon).  Those who know me know that it took alot of work to get my Tenofovir.  Then you ask, hey, isn't that a little dangerous, taking a un-FDA approved drug?  I would say no, because this drug has a nice track record as an FDA approved med for HIV.   Lamivudine, Hepsera, Tenofovir all started out as HIV meds.  Hepsera was scratched for HIV because it needed higher dosage, which wreck havoc on the pts' kidneys.  They reduced the dosage and use the drug for HepB.  So it's not cancer that you have to be concern about with Hepsera.  It's the low antiviral power / resistance profile / and potential to cause kidney problems.

And re: the comment on cancer.  High DNA is correlated to higher risk for liver cancer.  That would be my primary concern.  All meds are tested to see if it causes cancer, so far (to my knowledge) no antivirals are cautioned for any cancer risk.

Re: the genotyping, yes it won't change treatment but the information can't hurt.  Especially all it involves is a drawing a tube or 2 of blood.  It's not like a needle jab into your liver (biopsy).  You have DNA for gentoyping now.  If you start treatment and go UND, you can't do genotyping.  What if they have a new drug that works well with a certain genotype in the future.  The info you get now could help you in the future.
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