What now?

[cougaruda]

Hi Everyone,
First off I would like to thank everybody here for contributing to the forum. You guys have provided an enormous amount of information and support for everybody. Ever since I found out I had chronic hepatitis B, I was in shock. My life totally changed for the worst. I use to have a wonderful social life and everything, but now it's the total opposite. I'm hoping in the future my social life can slowly return to some degree of resemblance. I know I have to take care of my liver from now on and try to stay away from alcohol. Ever since the doctor told me to avoid alcohol, I touched it very little - a little sprinkle of whisky with a glass of soda, or mixing 1/3 glass of beer with water.
I just got the results from my last blood test. The doctor congratulated me and told me that HBV DNA was undetectable and that my liver was no longer inflamed, AST was 28, and ALT was 38.
Just back on 30 June 2010 my blood test showed the following:
Hbsag pos
Anti hbs neg
Anti hbc igm neg
Hbeag pos
HBV DNA > 110,000,000 IU/ml
Liver biopsy: marked piecemeal necrosis, mild intralobular degeneration, moderate portal inflammation, fiberous portal expansion. Knodell score: 9.
Diffuse alteration of the periportal plate in all portal tracts, absent of bridging and confluent necrosis, at least one necroinflammitory focus per lobule, mononuclear aggregates in all portal tracts and stellate enlargement of portal tracts without septae formation. Metavir score: 7

Here are test results for 2005 and the past few months:
29 Sept 2005
AST 20
ALT 23

3 Aug 2010
AST 115
ALT 308
Does this mean that I contracted Hep B sometime between 2005 and 2010?

17 Aug
AST 112
ALT 230

14 Sept
AST 202
ALT 355
I think my enzyme levels increased during this period because I smoked pot for 3 nights straight thinking that it wouldn't affect my liver. Was I wrong!

26 Oct
AST 28
ALT 38
HBV DNV undectable

How meaningful are the above results? Or is it too early to tell?
I began my first injection of Pegasys back on 3 August and have already taken 13 injections. My question is what now? The doctor tells me that I have to take Pegasys until the very last injection (injection 48). Is this true or does he just want my money?
Is there any chance that I may have immunity now? Or is it too early to tell and I just need to continue taking the Pegasys injections?
What are the chances that I will seroconvert and test HbSag (Negative) and HbEag (Negative) in the future? When should I go get tested again?
Does this mean that my liver can begin repairing itself now? Will my liver be able to return to its original state before I contracted the virus?
In my current state, do I still need to stay away from alcohol? Can I drink once in a while? Should I wait until my very last injection before taking a drink?

Thanks everyone.

[stef2011]

you please tell me how in my case I will be able to know?

also by a normal test qualitative but you will have a result only in the end while abbott shows when it decreases so if you see it is going down itmight have sense to make a longer interferon treatments or add nitazoxanide and see if it goes down faster.on the contrary if hbsag is stable or increasing (only 11% respond decreasing hbsag on interferon mono, 35% on interferon+lam and probably more on interferon+ntz+etv) you just give up after 1 year interferon mono

Is it the Abbott Architect HBsAg quantification the ultimate test to find out?
yes because you will be able to monitor if you respond or not

What does the test have to show to know that chronic patient is cured?
decreasing hbsag with time until it reaches zero and hbsab appears, sensibility of test is 0.05iu/ml

i suggest to check if you can send a blood sample to a specialized lab to make hbsag quantification if not available in thailand.in hong kong i have seen priavte labs doing both hbsag quantification and cccdna quantification

[cougaruda]

Hi again,
I'm wondering if the way a doctor diagnoses and treats chronic hepatitis B is based on one's financial background?
For instance, in my case, I was treated at an international hospital in Bangkok where I can tell that prices were much higher than other hospitals (Pegasys costs $490 per injection at the international hospital, whereas it costs $275 at another hospital across town). I'm wondering whether the doctor has prescribed me to take all 48 injections just because I can afford it? Whereas if it was another person at another hospital, and that person had financial difficulty buying Pegasys, the doctor would tell that person that he/she is cured (if he/she had the same blood/viral results as me) and doesn't have to take Pegasys anymore.
I'm asking this because I've heard a lot of people here in Laos stopping Pegasys because they said they were "cured." Did their doctors tell them to stop or was it the patient's decision? But I've done much research to know that everybody needs to finish all 48 injections (or does this have to do with the Pharmaceutical companies marketing strategy).

[cougaruda]

Thanks for the quick reply.
Since every chronic hepatitis B patients' wish would be to seroconvert to HBsAg Negative, can you please tell me how in my case I will be able to know?
Is it the Abbott Architect HBsAg quantification the ultimate test to find out? What does the test have to show to know that chronic patient is cured?
Thanks.

[stef2011]

HBsAg - Non-reactive (titer 0.73 s/n)
s/n is not helpful, i also tried it but there are diluitions so we can t say nothing for sure.my is 250s/n corresponding to 4000iu/ml but i don t even know if there is a correlation with s/n and iu/ml
it might be very low but we cant say for sure, do add nitazoxanide as you can see from hcv trials ntz boosts interferon response

Anti-HBs - Non-reactive (titer 0.8 mlU/ml)
well at least it is not 0.00, you should ask them the sensibility of the test, is 0.8miu/ml very low titer of hbsab?if so you are starting to have a response and ntz should absolutely added
if 0.08 is just the test and not the antibody then it doesn thelp to understand if hbsag might be low and response started

Was it the right test? What are your thoughts?
this is not abbott architect, it is another assya, i also have a hospital in my town with these tests, these are the first i made.in any case s/n cn be helpful to understand if hbsag is decreasing if the number goes down keeping the same dilution

my suggestion is to absolutely add nitazoxanide (alinia) since we do know it boosts interferon response without adding sides

[cougaruda]

Hi,
I tried to explain the test I wanted at the International Clinic Lab and they gave me tests for HBsAg and Anti-HBs
Here are my results:
HBsAg - Non-reactive (titer 0.73 s/n)
Anti-HBs - Non-reactive (titer 0.8 mlU/ml)
Was it the right test? What are your thoughts?
It's funny how complicated this disease is. When I initially received my test results, it did not have the titer numbers and so the nurse said "congratulations you tested negative." All I thought in my head was "I wish."

[stef2011]

the name of the best test is abbott architect hbsag quantification by manual diluition 1:1000

in vietnam they do it
http://www.medhelp.org/posts/Hepatitis-B/HbsAg-quantity-in-Phnom-penh--Cambodia-or-Ho-Chi-Minh-City---Vietname/show/1430388?personal_page_id=1694419#post_6523446