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

[halt651]

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.
http://www.medhelp.org/posts/Hepatitis-B/cirrhosis-diag---help-and-advice-needed-for-reading-results-/show/2047474#post_9686062

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!
halit

[halt651]

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,

[SafiSifa]

hello stef,

Unfortunately, doctors in Turkey are not aware the relationship between Vit D and HBV.

[stef2011]

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
http://en.wikipedia.org/wiki/Hypovitaminosis_D

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

[halt651]

hi,
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.

[flyinsky]

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,

[stef2011]

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