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]

hbvdna is just the virus replication and does not reflect infected cells, immune control or clearance of infection.it also makes sense very easily that if the goal is hbsag eradication the most indicated test is its quantitative

the test is easy and cheap and known from as early as 2008, i guess it s not available widely because of antivirals use, antivirals monotherapy is useless against virus and this test will clearly show it, i dont see other reasons not to use this test

you should check with the most advanced centers in your country for hbv therapy and send us a sample for hbsag quantification

[cougaruda]

Thanks for the reply Stephano.
Can you tell me the difference between testing Hbsag Quantitative vs HBV DNA?
How come doctors have never tested me for Hbsag Quantitative?
Thanks

[stef2011]

hbsag quantification is needed to know if you have chances to make it negative, there is also a study on hbe negative by 3 or 6 months i dont remember now, that predicted hbsag loss.in anycase you are doing very good on peg and should absolutely check hbsag decline, in case hbsag gets very low it is better to make 2 years of interferon

http://www.natap.org/2009/AASLD/AASLD_01.htm

i do suggest to add nitazoxanide too so that you have very high chances to get rid of hbv

[cougaruda]

Hi,
I was wondering if you can give your thoughts on my latest blood work:
-   Hbeag changed from Positive to Negative
-   anti-Hbe is now positive
-   HBV DNA is still undetectable since late October
-   AST 22
-   ALT 24
-   All other blood work normal
I am currently on Pegasys and just had my 25th injection last Tuesday.
Any thoughts would be much appreciated.
Thanks

[stef2011]

What does it actually mean that hbv DNA is undetectable?

not detactable in the blood by commercial assays in the blood but of coruse what you see in the blood is not what happens in the liver, in any case there is a correlation between virus in the blood and virus in the liver as regards suppression

as regards interferon there are 3 tests to see if interferon is working:
hbsag quantification by abbott architet, this will tell if you are clearing infected cells by virus, very very important with interferon, if you have no decrease by 12weeks interferon can be stopped because not working
hbvdna, if no decrease by 12 weeks interferon can be stopped because not working, by 12weeks at least 2 log decrease are necessary

by monitoring hbsag decrease you will see if you have chances of eradicating hbv

or are they all laying dormant?
no virus is always active even when you clear hbsag, it just means that replication (not number of virions or infected cells) is decreasing.hbvdna has no meaning to say if you are eradicating hbv, it is just used to see if drug is working

actully the best way to understand what is happening is a biopsy and a measure of the antigens, hbvdna, cccdna directly from the liver cells, but this is not necessary and usually done in best research centers.it is not very important to do biopsy for this, only in case you want to know if tenofovir or entecavir are eradicating virus this might be useful or to see virus mutations with maximum sensibility

why can't this stupid virus ever just disappear forever?
this virus like others, have many ways to suppress immune system, only lowering or making hbsag the immune system can start to work again and clear hbv
in any case you started with the best drug in terms of virus clerance, see alinia posts and if you like you can order it on line and combo with that to have more chances, it has no sides and for now only used on hcv combo therapies with interferon

in any case do not be fooled by hbvdna, it means nothing in terms of virions and infected cells, only hbsag quantity cn tell you that.hbsag quantity has very poor correlation with hbvdna, alt/ast and has good correlation with infected cells and cccdna (the virus template inside cells)
all the virus is made by cccdna inside cells, interferon and alinia are the only drugs to have a strong effect on this template and on number of infected cells

sorrry if i can t be very clear but hbv is quite complicated and survive because replication which causes liver damage, infected cells and number of virions, mutants are not exactly correlated to one another but in concert make virus persistance

[cougaruda]

Thanks for the detailed write up.
What does it actually mean that hbv DNA is undetectable? Since my count went from more than 110000000 to undetectable does that mean that they all died or are they all laying dormant? Is the Hbsag positive coming from the remaining hbv dna that the test can't detect? Does this mean that before there were billions of hep b viruses swimming in my body, but now there are only a couple of hundred of thousand? I notice a large drop from 110000000 to undetectable all of a sudden, so why can't this stupid virus ever just disappear forever? Sorry for the stupid question. It's just so frustrating. Good is just never good enough with this virus.