Avatar universal

comment needed for f3 hbv (hbeag became negative) patient please

Dear All,

My mum was diagnosed cirrhosis. 6 months ago I posted a question about it thanks to stef2011 I had some advises. her situation is changed.

Below is the story. I am worrying about the strategy that her doctor following at the moment.
I need your advises. She was using entecavir 0.5.
After 6 month with entecavir 0.5, her hbeag became negative and her doctor
Increased entecavir to 1mg instead of combining with tenofovir.

I appreciate a lot, please if you can have a look and answer my questions in regard to her results.

1/ do you think increasing entecavir to 1mg is a good idea? (what should we expect? Or how can we understand increasing to 1mg works?)

2/ what exactly means that hbeag became (-)? Is virus mutated and hbvdna is not representing number of virus anymore?

3/ hbvdna seems going down but not still undetectable is it a bad sign?

4/ since she is f3 and not f4, would interferon be useful for her? Or let me ask if q hbsag is lower than 1000 would she still be able start interferon?
(I know I need info of q hbsag and genotype but in turkey they do not check :(  that I am now trying to find a lab to know)

5/ any advices ?

historical info;

4th november 2013 ====> started entekavir 0.5
hbv-dna=1020000 IU/ml
alt 40 U/L (ref 33)
ast 51 U/L (ref 32)
hbeag +

27th november 2013
hbv-dna=16400 IU/ml
alt 22 U/L (ref 33)
ast 25 U/L (ref 32)
hbeag +

17 december 2013
Fibroscan median 10.5 kpa (206 db/m  ====> F3 diagnosed!!!!)

27 february 2014
Hbv-dna = 696 iu/ml
Alt 26
Ast 21
hbeag +

04 april 2014
Alt 19
Ast 24
hbeag  grey zone
Antihbe grey zone

30april 2014  =====> entecavir incremented to 1 mg :(
Hbv-dna = 696 iu/ml
Alt 26
Ast 21
hbeag (-) ===> became negative
Hbeab (+)

P.s: she did not start vitd3 and gmcaf yet, she lives in Mediterranean region of turkey there are a lot of sun + she follows diet (berry fruit etc) ; fresh vegy, fruits etc, walking 2 times a day.

Thanks in advance!
40 Responses
Avatar universal
if hbvdna 75iu/ml keep etv 1mg and check that it gets undetectable.no need of tdf add on at all

do check hbsag as soon as possible, when hbeag gets negative hbsag should be very low around 1500iu/ml
Avatar universal
correction on historical info

30april 2014  =====> entecavir incremented to 1 mg :(
Hbv-dna = 75 iu/ml
Alt 18
Ast 27
hbeag (-) ===> became negative
Hbeab (+)
Avatar universal
etv 1mg does not add much potency, try for 2 months and if hbvdna not und go for tdf combo and once hbvdna und go for tdf mono

the use of etv may be justified if kidneys function is not good only

vitd25oh must be checked and supplemented, the levels does not depend on sun, she can burn 24hrs under the sun and have no vit d
the levels of vit d are controlled by hbv virus and liver damage, there is no way for an hbv carrier with a lot of virus and liver damage to make it.if liver is damaged doses are very high but you have to try and see, for me only 20.000iu per day worked when liver was damaged, today 10.000iu is enough to keep t around 100ng/ml

hbsag less than 1000iu/ml is also a must for the lowest hcc risk, not only for peg add on.you may use pegintf add on when hbsag less than 1000iu/ml irrispective of hbv genotype.if you want to test for genotype you need to make test before hbvdna is very low

hbeag is of no importance
Avatar universal
thanks for your rapid answer stef.
I will send her asap lab to check hbsag and vit (25-oh)d3. I will inform you.

if you don't mind i've some questions to clarify my understanding;

1/ if hbeag is not the reason why would her doctor incremented the amount of medicine to 1mg?

2/ if hbvdna becomes und, would it keep like that all life long? or could we see that it I sometimes detectable. im just trying to understand what next step is? as far as I understand from your other posts (honestly speaking im a bit lost :( ) after 4/5 years antiviral drug than pegint or int can be started, correct? my mum is 60 years old, she has other medical probs such as heart/hyper tension etc, would pegint still be helpful to her?

sorry to bombard with questions and thanks a lot for your help.


Avatar universal
1 hbvdna not undetectable

hbeag is meanless, it is not even a part of the virus or needed to replicate.just an immune system suppressor with hbsag and hbvdna

2 she will go on with etv with no trouble and monitor hbvdna and fibroscan every 6 to 12 months.hbvdna will stay und as long as etv is taken everyday, breakthru very rare.in 5 years fibrosis will clear

vit d and healthy organic diet, bmi less than 25 are a part of this.without these other interventions antiviral alone may do nothing to liver health
Avatar universal
high vitd25oh around 80-90ng/ml, very little diaries and possibly no milk, antioxidants and low weight might reverse all the other healthproblems as well
Avatar universal
Düzen Labaratuvarı'nda qHBSAG ölçtürebilirsin. 300 TL masrafı var.

You can test qHBSAG in Duzen Laboratories with additional 300 TL cost.
Avatar universal
thank you guys! I really appreciate your answers and help.

Avatar universal
for stef
how you say that hbe is meaningless and is not a part of virus!did you see the structure of hbv ?
it is a part ,and its positivity means replication because hbv i mean virus at each replicationi  it leaves  a part of  its component hbe adn.....and for this the doctors ask to do it ,and if t is not important why researchers develope drug according to hbe and when we are Under treatement their task is to turn hbe+to - wich mean the virus is not replicating
Avatar universal
i used the wrong words, hbv replicates freely both with hbeag or without it.it is welknown that hbeag is not needed by hbv and hbv with hbeag positive is rare worldwide today (it may have been like this even before, we test more today)

several studies demonstrated that hbv uses hbeag to suppress immune system and maybe to infect the baby before birth since hbeag can get thru the placenta

all hbv drugs are indipendent from hbeag, we do know this today, and all things said in the past are wrong and hbv personalized therapy is based on hbsag levels, hbvdna levels and hbv genotypes with hbeag poor responders to all treatments and hbeag negative better responders

Avatar universal
hbv cure is today personalized treatment by hbsag levels on sequential treatment, all guidelines will be on this the next few years, maybe easl even earlier

this is independent from hbv genotype, hbeag, il28b and response depends only on hbsag levels baseline
Avatar universal
yes i agree with you in such points but i think every  thing concerning  the hbv  is important to analyse and to test because every part of the virion indicate  some thing and how the action of virion is in the liver ;starting from hbsag to dna ,and according to thse elements treatemnt is imposed or not,
Avatar universal
I would like to share latest result of my mum

vit d-3 (25-HidroksiVitamin D) 8.1 ng/ml
HBsAg (Kantitatif) 8313.00 IU/mL

thanks for warning about vitd level!
I am now looking for reliable vital d product in Turkey.
she will start immediately.
Avatar universal
vit d-3 (25-HidroksiVitamin D) 8.1 ng/ml

how is it possible doctor are so negligent, your mum is at risk of death of any cause, especially liver failure being vitd25oh<10ng/ml.vitd can t be less than 30ng/ml, and very danagerous if less than 20ng/ml but such levels as your mum are extremely dangerous

just to have a little knowledge of the risk she has

get a doctor as soon as possible for correction of this extremely deficnecy

the best brand is biotech, for such low level 50.000iu dose is needed at first, get a doctor to monitor but which is expert on vit d deficiency on cirrhosis or liver disease because damaged livers cannot make it with usual doses

after good levels are reached d3plus from biotech has also cofactors like vit k and magnesuim.d3plus is low dose d3 so to make 5000iu you need 3 pills (d3 1666iu per pill)

another interesting brand is liposomal d3 from maxhealthlabs this may have better absorption but i dont know if there is any benefit over non-liposomal so it may be money wasted
Avatar universal
hello stef,

Unfortunately, doctors in Turkey are not aware the relationship between Vit D and HBV.
Avatar universal
i would write a lot of things about Turkey & doctors but this is not a right place and im scared of myself when I start writing and thinking about it.

thx again,
Avatar universal
what about that;

her gastro specialist prescribed her ZENTIUS D which contains only
600 mg kalsiyum,
400 I.U. Vitamin D3 which is extermely less than what you advised.

she also will have appointment with another department which is specialist for bone density test.

if nothing comes up from doctors I will take the reponsiblity and let her take higher dosage.
Avatar universal
i dont know why doctors even here in France are not interrested in vit d in hbv patients?now reading the importance of vit d ,it s up to me to ask doctor to analyse my vit d level ,the last time i talk to my doc about this she told me that taking 3 amples of vitd3 1 million unit for 3 monthes is enough but now i should nsist on her and all hbv patients shoul do
Avatar universal
4/11/2013 hbvdna 1020000 iu/ml -> etv 0,5mg
27/11/2013 hbvdna 16400 iu/ml
27/02/2014 hbvdna 696 iu/ml
30/04/2014 hbvdna 75 iu/ml -> etv 1mg
29/05/2014 hbvdna 48 iu/ml

still not undetectable :(
she started taking vitd, (even though low dosage ) not tested again yet
Avatar universal
bad results being not undetectable by 7 months, tenofovir would have been better of a combo of etv+tdf, in cases of severe liver damage there is no time to waste

if you take less than 10.000iu daily of d3 you wont get any results in a severely damaged liver, levels must be corrected by 1-2 months.also keep in mind skin of healthy people in equatorial countries all day at the beach make 20.000iu of d3 per day....
Avatar universal
Stef & All,

I need your advises please,
according to below updated values
Could you please comment and advise?

last month doctor advised to start using tenofovir but due to health assurance
policy my mum has to wait to finish 12th month with etv (baraclude)
I am willing to pay myself and start tdf as soon as possible
(I dont know how can I do it in Turkey but lets see).

1/ do you think hbv started resisting?
2/ do you think tenofovir switch needs very urgent?
3/ do you think combo (etc+tdf) is better than only tdf?
4/ do you think for an f3 patient (like my mum) interferon treatmant would help?

4/11/2013 hbvdna 1020000 iu/ml -> etv 0,5mg started
27/11/2013 hbvdna 16400 iu/ml
17/12/2013 fibroscan 10,5 kpa (f3 diagnosed)
27/02/2014 hbvdna 696 iu/ml
04/04/2014 hbeag grey zone
30/04/2014 hbvdna 75 iu/ml -> etv 1mg started
30/04/2014 hbeag (-) negative
10/05/2014 vitd(25OH) 8.1 ng/ml -> vitd started
10/05/2014 hbsag (kantitatif) 8313 IU/mL
29/05/2014 hbvdna 48 iu/ml
04/07/2014 hbeag (-) negative
04/07/2014 hbvdna (-) negative
25/08/2014 hbeag (-) negative
25/08/2014 hbvdna 20 iu/ml
19/09/2014 HBsAg (Kantitatif) 7965 IU/mL
16/09/2014 vitd(25OH) 39,6 ng/ml

thank you.
Avatar universal
you wrote me earlier actually, I should have read better;
"etv 1mg does not add much potency, try for 2 months and if hbvdna not und go for tdf combo and once hbvdna und go for tdf mono "

do you think that is still the case?
Avatar universal
tenofovir is definitely more potent than etv, so it is your case to change but you have no rush, hbvdna 20iu/ml is not worrying too much

your vitd is still too low, take at least 10.000iu daily and make it 100ng/ml with pth less than 20pg/ml
Avatar universal
thank you stef, I buy vitd for her from belgium.
more vitd is on the way
Id like to ask one more question please;

what is exact name of 'pth' she never did a pth test?
thanks again.
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