biopsy and genotype

[japonego]

hello,
I just got my results for the genotype wich is a1/a, and my biopsy wich I attached in portuguese ( stefano lo penso che tu capisca, il portoghese e molto simile a quello italiano! ).
please let me know what you all think about it, and how to treat it right.

thanks and grazie

ciao

[stef2011]

do you think it is a flare from a mutation or could this be a real body reaction?

if you mean alt flares they are good they mean immune system reaction if you have at the same time hbsag or hbvdna decrease

i agree with your doctor

[japonego]

thanks for those links!
I went to the doctor yesterday, and got some tests results, wich I forgot at her office, so I´ll try to remember:
my anti-hbsag raised from 34 to 162.
alt from 328 to 66

That´s all I can remember. next tuesday I´m doing whole new hbv tests wich take a month to get the results, so she said she wants to wait and see if it still gets better and then we think better about the anti viral strategy.
do you think it is a flare from a mutation or could this be a real body reaction?

thanks

[stef2011]

there are several articles, these are the ones of this year int'l liver congress easl

http://www1.easl.eu/easl2011/program/Posters/Abstract582.htm

http://www1.easl.eu/easl2011/program/Posters/Abstract591.htm

http://www1.easl.eu/easl2011/program/Posters/Abstract597.htm

http://www1.easl.eu/easl2011/program/Posters/Abstract603.htm

http://www.journalofclinicalvirology.com/article/S1386-6532(09)00475-2/abstract

[japonego]

ciao stefano,

could you send me any link with that strategy I want to show her and check if she is aware of it. thanks for the good information as always.
one other doubt. according to the genotype test, the virus is the a1/a type and the examen said it had no mutations...

[stef2011]

it looks like you have hbsag mutation since both hbsag and hbsab and hbcab igm are detactable and even hbeag is detactable

since data on results of these mutants are little i'd strt tenofovir first and then add interferon and alinia as a try to eradicate infection, what does your doctor think about results of this strategy presented at easl 2011 berlin?

[japonego]

hello,

from a oct 2010 examen:
hbv dna: 9650000.0 UI/mL - 6.98 log UI/mL
hbsag: S/CO: 163,42 M.E.I.A method
anti HBSAg: 34 mUI/mL
ALT: 328
AST: 142
HBeAg: S/CO 215,61
anti HBcIgM: S/CO 2,29
anti HBc: 0,088


thanks

[stef2011]

data from int'l easl conference have been published online there are studies that indicate better hbsag seroconversion starting with tenofovir or entecavir for about 1-2years and when hbvdna is fully undetactable and hbsag/cccdna little lower combo with interferon and off label alinia can eradicate hbsag

you might try this strategy, what is your hbvdna, hbsag both in iu/ml and alt/ast?is your hbeag positive?

interferon might have no response if hbvdna is very high because the virus is able to suppress also interferon (not only our immune response).one thing is certain tenofovir monotherapy is totally useless for you because you have no liver damage and too young so only if you plan the combination strategy it makes sense to start a treatment otherwise better wait
another good thing is that in 2 years while you treat with tenofovir interferon lmbda might be available and it has less sides than normal interferon

[japonego]

hello,

after my results my doctor said it would be better to take tenofovir.
she said that viral activity is too high for the interferon. (?)
I just took more blood test to check alt ast.
I´ve got little fibrosis, also.
what to do?
she gave me option for them both (tenofovir, interferon) and here in my city the government pays for those expensive drugs.

thanks and best regards

[stef2011]

for the genotype wich is a1/a

genotype a has better results with interferon+alinia

i am not sure about biopsy rsult, what really matters is fibrosis grade but i couldnt find it, inflamation seems grade 2

anyway just check fibrosis anywhere in the biopsy result and if it is less than 3 grade you have little fibrosis