Aa
hbv is not Cytopathic, but some mutants selected by nucs are hence USE OF LAMIVUDINE, ADVEFOVIR and TELBIVUDINE IS "CRIMINAL"!
said in easy words, less potent nucs make hbv monsters mutants that damages our cells directly when infected........
although low genetic-barrier NAs may decrease viral load and increase survival in the short term, we predict that there may be long term detrimental effects in patients who have selected these variants. Supporting data comes from a recent study(Hosaka et al. 2010. Hep Res) where the rtM204I variant, which can cause sW196*, was shown to be a significant risk factor for the development of HCC, whilst the rtM204V variant, which does not result in truncated HBsAg, was not.
hence USE OF LAMIVUDINE, ADVEFOVIR and TELBIVUDINE IS "CRIMINAL"!
Directly Cytopathic Drug-Resistant HBV Variants
N. Warner1; S. Soppe1; D. Colledge1; L. Selleck1; S. A. Locarnini1
1. VIDRL, North Melbourne, VIC, Australia.
Background: Treatments for CHB include antiviral nucleoside/nucleotide analogues (NAs) which target the virus by inhibiting reverse transcription. NA resistance is widespread, characterised by point mutations in the overlapping polymerase/envelope genes which encode amino acid changes in the reverse transcriptase domains of the HBV polymerase, and can encode two types of changes in the surface proteins; 1) stop codons at the C-terminal end of the surface proteins, and 2) amino acid changes that do not truncate the surface proteins. In this study we examined the pathogenicity of these variants in vitro.
Methods: Huh7, HepG2 and PH5CH8 cells were transfected with genotype D HBV infectious clones or surface protein expression constructs encoding 1) surface stop codons rtM204I/sW196*, rtA181T/sW172*, rtV191I/sW182, or 2) full-length surface proteins rtA181T/s172L, rtA181V/sW173F, rtM204I/sW196S, rtM204V/sI195M. HBsAg expression and secretion were measured by Western blotting and quantitative serology. Proliferation, apoptosis, and intracellular HBsAg levels of transfected Huh7 cells were measured using flow cytometry up to 5 days in culture.
Results: HBV variants encoding surface stop codons were completely defective in HBsAg secretion, which could be partially rescued by co-expression with wt HBV. HBV encoding full-length surface proteins were secreted from the cell with varying efficiency. Flow cytometry was used to show that the truncated surface proteins accumulated to high levels intracellularly. Cells transfected with these stop codon variants had low levels of proliferation and high levels of apoptosis. The most cytopathic variant was rtM204I/sW196*, followed by rtV191I/sW182* and rtA181T/sW172*. This cytopathic effect was shown to be directly due to expression of the truncated surface proteins. HBV encoding full-length surface proteins had wt levels of apoptosis, proliferation and intracellular accumulation.
Conclusions: HBV surface stop codon variants selected during NA therapy accumulate inside, and are directly cytopathic to the host cell, causing apoptosis. Apoptosis and chronic liver injury are strongly associated with disease progression and the development of HCC. Hence, although low genetic-barrier NAs may decrease viral load and increase survival in the short term, we predict that there may be long term detrimental effects in patients who have selected these variants. Supporting data comes from a recent study(Hosaka et al. 2010. Hep Res) where the rtM204I variant, which can cause sW196*, was shown to be a significant risk factor for the development of HCC, whilst the rtM204V variant, which does not result in truncated HBsAg, was not.
Professor Locarnini is always scary. He has been warning about mutant hbv for several years now. He is worried that these may already escape into the general population and may not be deterred by vaccination.. Mutants infected patients may be harder to treat.
hence USE OF LAMIVUDINE, ADVEFOVIR and TELBIVUDINE IS "CRIMINAL"!
And what about entecavir?
And what about entecavir?
rate of mutations is very low, only 1.2%, on the contrary if you see lam and adv monotherapy (especilly lam) they make so many primary and secondary mutations
one thing is certain only tenofovir can be conisdered extremely safe on monotherapy, there are italian studies by ultra deep sequence while on nnucs, these might show if etv monotherapy is dangerous or not by detecting mutants that are not even selected, they can quantify the mutants from as low as 0.01% population
i should have results ready by one month, i am sure they will apply the ultra sequence to me since cirrhosis
in any case i asked researchers in pisa if etv mono might develop hbsag mutants but they said it is extremely unlikly
they just collected etv data from etv treated patients in italy, all geno a or d and hbeag neg (very very very few other geno or hbeag pos, usually imigrants).the rates of resistance was extremely low, maybe just one patient with previous lam resistance
Professor Locarnini is right if you get an epidemic of these mutants population is not covered by vaccines and they may be very dangerous and untreteable......
despite no hbsag and no hbvdna when virus gets cleared the cccdna inside the cells keeps making hbsag which is not released and damages dna making cancer cells/cirrhosis development and how do you treat that since we have no drugs to target cccdna?
How do you treat? The mutant form of cccdna produces truncated HBsAg that are not released from the infected cell, eventually killing the infected cell. Since these HBsAg are defective, I assume no new Dane particles are made and released, so no new cells will be infected by this mutant hbv. Therefore, we can survive if we don't have too many liver cells infected by this mutant.
Pure speculation on my part. I have asked before, but never got an answer:
what if two hepatitis B patients got married, which genotype will dominant, or co-exist, or...?
Pure speculation on my part. I have asked before, but never got an answer:
what if two hepatitis B patients got married, which genotype will dominant, or co-exist, or...?
i dont think cccdna gets cleared at all because this mutants are those present in occult hbv and it doesn t stop by itself but goes on for decades
myracludex could be the only drug in this case plus interferon and i guess those cells gets cleared, but i guess because i dont know if immune system can see and clear those cells with cccdna if no virions are produced
to note that cccdna can muliply as those cells with cccdna multiply, if there is no immune system killing i guess they can go on for a very long time
i went to a gastroenterologist sometime ago and he's prescribing LAM when i showed him my latest test results, the moment he said "LAMIVUDINE" i never went back to him anymore. the problem though is that, accdg to him, he PRESCRIBES this to ALL his patients needing treatment...
OMG...
OMG...
i believe many doctors are pushed by drug makers to prescribed failed drugs like lamivudine, adefovir, telbivudine, clevudine.all these drugs are out of guidelines and all of them worsen hbv infection so there is no other explanation for doctors prescribing such rubbish
the worst thng is doctors have becoe so ignorant and unreliable that we, not doctors, have more much more knowledge than them, at this poit it would be better to get these doctors removed by suing them or reporting them to medical boards regulators before they make more damage, such choices can easily lead to death of a patient by time making hbv untreateable monsters
I have observed from this forum that you are so knowledgeable with HBV. Can I have your honest opinion on this:
Which is a better antiviral treatment for a chronic HBV HBeAg-ve patient of more than 18 years now, 57 1/2 year-old Asian lady with HBVDNA of 27,400 and ALT of 31 and AST of 34., with osteopenia. NO genotype and fibrosure tests yet at the moment.
Will I use entecavir or tenofovir given the above situations. Thank you.
Which is a better antiviral treatment for a chronic HBV HBeAg-ve patient of more than 18 years now, 57 1/2 year-old Asian lady with HBVDNA of 27,400 and ALT of 31 and AST of 34., with osteopenia. NO genotype and fibrosure tests yet at the moment.
Will I use entecavir or tenofovir given the above situations. Thank you.
osteopenia is caused by hbv infection and is very common on hbv carriers because virus lowers vitamin d, the only thing to cure this that i know of is gcmaf
vitamin d suplements are a must although it is now very late, so i'd start d3 10000iu daily and check vitamin d25oh to get higher than 50ng/ml as fast as possible and serum calcium.serum calcium is important because as we get older our balance of calcium works less well and while on vit d it may happen to have too much calcium absorption
as to hbv treatment it can t be based on hbvdna alone, a fibroscan and genotype would be necessary, but if these are not available and there is history of hcc in the family or hbv in the area is geno c i'd go with tenofovir
while on tenofovir you have to check carefully creatinine before and after started, about every 4 weeks at start, if you see any change in creatinine better switch to entecavir
if you can afford fibroguard this product can reverse fibrosis of the liver and improve kidneys function, so creatinine will stay normal in any case
tenofovir has no effect on bone mineral density if vitamin d and calcium are kept at optimum levels
Thanks so much Stef.
I started with vit D32000 and it gave me so much headache. I switched to D31000 which is tolerable. I take it with caltrate and expose myself in the sun as much as possible.I take these 2 in the morning. I also juice 1 carrot, 1 beet and 2 small apples which I take when I wake up in the morning in an empty stomach which I started more than a week ago. I thought it wouldnt harm to drink this so-called "miracle drink".
I also take milk thistle and phospatidyl choline for liver support which I take right after lunch and dinner.
I also take vit C after my night snacks.
I dont think we have a family history of HCC.
Which anti-viral treatment are you on? How is it doing with your HBV DNA? How long have you had HBV and are you HbeAg-ve or HBeAg+ve. I have read so much about tenofovir being used successfully to treat chronic HBv without any resistance so far. Some patients have developed resistance to entecavir and takes longer time for HBVDNA to undetectable level than tenofovir; although latter is not so good to kidneys and bone density with me being an older lady. However, as you suggested Vit D and calcium and fibroguard can help.
Is fibroguard an over-the-counter meds or supplements?
I started with vit D32000 and it gave me so much headache. I switched to D31000 which is tolerable. I take it with caltrate and expose myself in the sun as much as possible.I take these 2 in the morning. I also juice 1 carrot, 1 beet and 2 small apples which I take when I wake up in the morning in an empty stomach which I started more than a week ago. I thought it wouldnt harm to drink this so-called "miracle drink".
I also take milk thistle and phospatidyl choline for liver support which I take right after lunch and dinner.
I also take vit C after my night snacks.
I dont think we have a family history of HCC.
Which anti-viral treatment are you on? How is it doing with your HBV DNA? How long have you had HBV and are you HbeAg-ve or HBeAg+ve. I have read so much about tenofovir being used successfully to treat chronic HBv without any resistance so far. Some patients have developed resistance to entecavir and takes longer time for HBVDNA to undetectable level than tenofovir; although latter is not so good to kidneys and bone density with me being an older lady. However, as you suggested Vit D and calcium and fibroguard can help.
Is fibroguard an over-the-counter meds or supplements?
Which anti-viral treatment are you on?
entecavir+nitazoxanide+simvastatin (i will slowly discontinue ntz in 2 weeks and keep usig sim instead)
i am also on an immune modulator therapy waiting to add interferon lambda when available.this immune modultor was necessary even if no hbv because my level of nagalase was 6.7, at these levels all immune sytem is suppressed and there is great danger for HCC.
gcmaf
antioxidant therapy to regress cirrhosis
hepatitis technologies products, this is the one working fast thanks to hbvdna und, fibrosis has already regressed in 1.5years and now we are just looking at histology but thru ultrasound so just looking at nodules to disappear
i add to these products liposomal glutathione and vitamin c
How is it doing with your HBV DNA?
undetactable at 7-8 months and less than 50iu/ml by 5 months
How long have you had HBV and are you HbeAg-ve or HBeAg+ve.
life long and always hbeag negative, it became positive only one time with an acute hbv at 19yo and after this i had hbeab too
Is fibroguard an over-the-counter meds or supplements?
no it is a special combo of antioxidants and antifbrotics made a a team of researchers (some of the more advanced researchers in the world on liver diseases), you can buy only online
i also prefer tenofovir, making mutants is too dangerous but when you reach cirhosis kidneys are little damaged so i could not stand tnf,mybe now i can thanks to fibroguard but i think i will wait to be on interferon to use tenofovir+interferon lambda+simvastatin, entecavir was too poor results on interferon combo
entecavir+nitazoxanide+simvastatin (i will slowly discontinue ntz in 2 weeks and keep usig sim instead)
i am also on an immune modulator therapy waiting to add interferon lambda when available.this immune modultor was necessary even if no hbv because my level of nagalase was 6.7, at these levels all immune sytem is suppressed and there is great danger for HCC.
gcmaf
antioxidant therapy to regress cirrhosis
hepatitis technologies products, this is the one working fast thanks to hbvdna und, fibrosis has already regressed in 1.5years and now we are just looking at histology but thru ultrasound so just looking at nodules to disappear
i add to these products liposomal glutathione and vitamin c
How is it doing with your HBV DNA?
undetactable at 7-8 months and less than 50iu/ml by 5 months
How long have you had HBV and are you HbeAg-ve or HBeAg+ve.
life long and always hbeag negative, it became positive only one time with an acute hbv at 19yo and after this i had hbeab too
Is fibroguard an over-the-counter meds or supplements?
no it is a special combo of antioxidants and antifbrotics made a a team of researchers (some of the more advanced researchers in the world on liver diseases), you can buy only online
i also prefer tenofovir, making mutants is too dangerous but when you reach cirhosis kidneys are little damaged so i could not stand tnf,mybe now i can thanks to fibroguard but i think i will wait to be on interferon to use tenofovir+interferon lambda+simvastatin, entecavir was too poor results on interferon combo
What normally are the symptoms of cirrhotic liver? Do you feel like always bloated and having liver pain?
It was nice to hear that you were undetectable at 7-8 months. How old are you if you dont mind? It could be the age too. I read somewhere that it takes 96 weeks to reach undetectable level with ent and 48 weeks with tnf.
My doctor doesnt like the idea of liver biopsy.
She suggested treatment since one year ago and I am still hesitant to start. She said she is happy starting me with it as well as not starting with it. However, in September, she told me to start already but starting with it is the hardest thing to do because it is hard to decide which one to use between ent and tnf, given my osteopenia problem. Do you think the virus had done damage to my liver in that span of one year? And I should not keep waiting anymore?
When you send your blood samples to India, who would draw your blood for you? It seems hard.
I read somewhere in this forum a person from Cameroon got cured of chronic HBV with traditional meds. Have you any idea about that traditional meds? For all we know, those antioxidants in the fibroguard you suggested are herbals, dont you think so?
So you think fibroguard will help better than the milk thistle I have been taking for more than 10 years now.
It looks like you said antiviral treatment is more effective if your body has correct amount of Vit D3. I hope the Vit D3 1000 that I can tolerate taking will help along with Caltrate and exposure to sun in any possible way.
It was nice to hear that you were undetectable at 7-8 months. How old are you if you dont mind? It could be the age too. I read somewhere that it takes 96 weeks to reach undetectable level with ent and 48 weeks with tnf.
My doctor doesnt like the idea of liver biopsy.
She suggested treatment since one year ago and I am still hesitant to start. She said she is happy starting me with it as well as not starting with it. However, in September, she told me to start already but starting with it is the hardest thing to do because it is hard to decide which one to use between ent and tnf, given my osteopenia problem. Do you think the virus had done damage to my liver in that span of one year? And I should not keep waiting anymore?
When you send your blood samples to India, who would draw your blood for you? It seems hard.
I read somewhere in this forum a person from Cameroon got cured of chronic HBV with traditional meds. Have you any idea about that traditional meds? For all we know, those antioxidants in the fibroguard you suggested are herbals, dont you think so?
So you think fibroguard will help better than the milk thistle I have been taking for more than 10 years now.
It looks like you said antiviral treatment is more effective if your body has correct amount of Vit D3. I hope the Vit D3 1000 that I can tolerate taking will help along with Caltrate and exposure to sun in any possible way.
I started with vit D32000 and it gave me so much headache. I switched to D31000 which is tolerable - do you test your vit D level ? (vitamin d25oh)
Try also a to get a fibroscan (this is a alternative to liver biopsy).
Try also a to get a fibroscan (this is a alternative to liver biopsy).
What normally are the symptoms of cirrhotic liver? Do you feel like always bloated and having liver pain?
there are no symptoms or abnormal blood tests, only when you are about to dye all tests get abnormal.you can detect it only by fibroscan, US can detect only when too advanced with liver nodules becoming visible.it is now regressed with no fibrosis detactable by fibroscan
It was nice to hear that you were undetectable at 7-8 months. How old are you if you dont mind? It could be the age too. I read somewhere that it takes 96 weeks to reach undetectable level with ent and 48 weeks with tnf.
it depends on hbv quasispieces (the mutations of the virus you have), ultra deep sequence studies in italy confirmed this, and also confirmed that if quasispieces slow or stop while antivirals hbsag gets negative
Do you think the virus had done damage to my liver in that span of one year? And I should not keep waiting anymore?
damage doenst depend directly on virus, it is a balance of liver regeneration, your antioxidant defence, your immune system activity...too many parameters involved so there is no time to have damage, the only good thing is monitoring by fibroscan and taking as much antioxidants as possible but all extracted from natural sources, the synthetic ones made in labs are useless
When you send your blood samples to India, who would draw your blood for you? It seems hard.
well i ahve the tests done here initaly.you just get a lab to make it and ship it to india or get a nurse or doctor to draw the blood and prepare it to ship by fedex.labs know how to do it because they ship samples for special tests, if they are not stupid they should help
Have you any idea about that traditional meds?
that s spam or a coincidence, we would be all clear of hbv if a traditional medicine was wroking on hbv
those antioxidants in the fibroguard you suggested are herbals, dont you think so?
spieces mainly....cucurmin, pomegranate, reservatrol from grape, green tea, lycopene and so on.i think the doses and extraction process is the most important thing and this is made by researcher not just a commercial thing
So you think fibroguard will help better than the milk thistle I have been taking for more than 10 years now.
just google hepatitistechnologies, the full pack has also milk thistle and vitamins, they are all usefull
It looks like you said antiviral treatment is more effective if your body has correct amount of Vit D3
it is all your general helath to benefit, but it is very strange you feel something from 1000iu d3, i dont think that is the reason or maybe the product is not good, in 1hr sun you make 20000iu or more of d3 so it can t be it
there are no symptoms or abnormal blood tests, only when you are about to dye all tests get abnormal.you can detect it only by fibroscan, US can detect only when too advanced with liver nodules becoming visible.it is now regressed with no fibrosis detactable by fibroscan
It was nice to hear that you were undetectable at 7-8 months. How old are you if you dont mind? It could be the age too. I read somewhere that it takes 96 weeks to reach undetectable level with ent and 48 weeks with tnf.
it depends on hbv quasispieces (the mutations of the virus you have), ultra deep sequence studies in italy confirmed this, and also confirmed that if quasispieces slow or stop while antivirals hbsag gets negative
Do you think the virus had done damage to my liver in that span of one year? And I should not keep waiting anymore?
damage doenst depend directly on virus, it is a balance of liver regeneration, your antioxidant defence, your immune system activity...too many parameters involved so there is no time to have damage, the only good thing is monitoring by fibroscan and taking as much antioxidants as possible but all extracted from natural sources, the synthetic ones made in labs are useless
When you send your blood samples to India, who would draw your blood for you? It seems hard.
well i ahve the tests done here initaly.you just get a lab to make it and ship it to india or get a nurse or doctor to draw the blood and prepare it to ship by fedex.labs know how to do it because they ship samples for special tests, if they are not stupid they should help
Have you any idea about that traditional meds?
that s spam or a coincidence, we would be all clear of hbv if a traditional medicine was wroking on hbv
those antioxidants in the fibroguard you suggested are herbals, dont you think so?
spieces mainly....cucurmin, pomegranate, reservatrol from grape, green tea, lycopene and so on.i think the doses and extraction process is the most important thing and this is made by researcher not just a commercial thing
So you think fibroguard will help better than the milk thistle I have been taking for more than 10 years now.
just google hepatitistechnologies, the full pack has also milk thistle and vitamins, they are all usefull
It looks like you said antiviral treatment is more effective if your body has correct amount of Vit D3
it is all your general helath to benefit, but it is very strange you feel something from 1000iu d3, i dont think that is the reason or maybe the product is not good, in 1hr sun you make 20000iu or more of d3 so it can t be it
Thanks as usual Stef for your generous knowledge on HBV and everything surrounding it.
I am leaning towards entecavir for now because of my osteopenia issue. My sister said there is no cure for it. ANd the Caltrate and Vit D3 I am taking will prevent it from going to osteoporosis.
May I know the best recommended dosage for entecavir for someone who will be on anti viral for the first time? How much are you taking?
I am leaning towards entecavir for now because of my osteopenia issue. My sister said there is no cure for it. ANd the Caltrate and Vit D3 I am taking will prevent it from going to osteoporosis.
May I know the best recommended dosage for entecavir for someone who will be on anti viral for the first time? How much are you taking?
Thank you for your recommendation of getting fibroscan. Stef has recommended that too. But I think regardless of its results, I am leaning now to starting with treatment that my doctor has recommended doing since the start of this year and I have kept holding off due to side effects I have been reading.
However, I talked to my general med doctor and she explained to me very well that these anti viral meds were FDA approved because they believe that the benefits outweigh the side effects. And another one said, what would one rather have: liver cirrhosis that can lead to liver cancer or low bone density or kidney problems. As what Stef has recommended, one can take Calcium and Vit D3 for bones and Fibroguard. Besides,kidney functions will be monitored closely while on these meds. And I read too that dosage can be changed if some results on kidney functions change.
However, I talked to my general med doctor and she explained to me very well that these anti viral meds were FDA approved because they believe that the benefits outweigh the side effects. And another one said, what would one rather have: liver cirrhosis that can lead to liver cancer or low bone density or kidney problems. As what Stef has recommended, one can take Calcium and Vit D3 for bones and Fibroguard. Besides,kidney functions will be monitored closely while on these meds. And I read too that dosage can be changed if some results on kidney functions change.
gcmaf and osteoporosis
http://www.medhelp.org/posts/Hepatitis-B/for-april9903-or-others--gcmaf-cures-osteoporosis--Asthma-and-autism/show/1591497
gcmaf.eu
research and trials on gcmaf
i'd make resistance test before using entecavir, lam mutations make resistnce on entecavir.as to dose 0.5mg is better because this drug had lung cancer on mices during studies but no cancer on monkeys, so better stay on the low dose, 1mg dose has little more potency
http://www.medhelp.org/posts/Hepatitis-B/for-april9903-or-others--gcmaf-cures-osteoporosis--Asthma-and-autism/show/1591497
gcmaf.eu
research and trials on gcmaf
i'd make resistance test before using entecavir, lam mutations make resistnce on entecavir.as to dose 0.5mg is better because this drug had lung cancer on mices during studies but no cancer on monkeys, so better stay on the low dose, 1mg dose has little more potency
My doctor prescribed 1 mg although what I have been reading is 0.5 mg for naive-treated patients. I thought "naive" here meant patients taking anti viral for the first time.
I have an appt with her on Nov 22 and will ask her more and I know she will not like it that I havent started yet my anti viral meds. It is just so many concerns, issues and questions. It is just so hard to start, because once you start there is no turning back. Stopping it will make more viral replications. I am also waiting for an answer from another doctor his opinion on the dosages
I'm sorry but what is gcmaf?
Thanks.
I have an appt with her on Nov 22 and will ask her more and I know she will not like it that I havent started yet my anti viral meds. It is just so many concerns, issues and questions. It is just so hard to start, because once you start there is no turning back. Stopping it will make more viral replications. I am also waiting for an answer from another doctor his opinion on the dosages
I'm sorry but what is gcmaf?
Thanks.
if you make hbv resistance test 1mg is not needed we still dont know if etv can make lung cancer on long term use, i d definitely stay 0.5mg
the difference between 0,5mg or 1mg is very very little in potency
gcmaf is an albumin protein present in the blood of healthy people and it mainly activates immune system (but it has many other roles too), people with cancer and cronic diseases of any kind (both viral, bacterial and unknown reason) have low gcmaf and immune system non response or immune suppression all research can be found on gcmaf.eu or gcmaf.nl
My next appt with my hepatologist is Nov 22. Which means I will have to wait for her new prescription to say 0.5mg. Almost one month of waiting again.
If you think that the difference between 0.5mg and 1 mg is very very little in potency, then I guess it is ok to take 1 mg then?
I wish my hepatologist is very knowledgeable like you. She said she is making a study about the role of antivirals on chronic hepatitis as part of her research.
If that is so, I am wondering why she did not recommend checking my genotype and fibrosure before start of treatment. It seems that she based treatment acc to the number of years I have had HBV, my age and my HBVDNA of 27,400 (not sure if IU or copies). Acc to her once HBVDNA on chronic HBV HBeAg-ve patients reach more than 10,000 it merits treatment regardless of ALT and AST. She also never recommended Vit D3 check.
If you think that the difference between 0.5mg and 1 mg is very very little in potency, then I guess it is ok to take 1 mg then?
I wish my hepatologist is very knowledgeable like you. She said she is making a study about the role of antivirals on chronic hepatitis as part of her research.
If that is so, I am wondering why she did not recommend checking my genotype and fibrosure before start of treatment. It seems that she based treatment acc to the number of years I have had HBV, my age and my HBVDNA of 27,400 (not sure if IU or copies). Acc to her once HBVDNA on chronic HBV HBeAg-ve patients reach more than 10,000 it merits treatment regardless of ALT and AST. She also never recommended Vit D3 check.
I am 53y old infected for 22y(100%sure)living inSW US where doctors don't know much about hepb,one of the reasons i am holding treat.I saw 2 hepatologists in Europe this summer, one told me to treat with antivirals based on myHBVDNA 20.000iu/ml .The second one based on my labs ,US and fibroscan 4,2kPa,SR 100% said just monitor.He said my liver is better than his.I tried to have my genotype and precore mutants but the result came nonconcludent(it should be D).I just wanted to say that i am lost and confused like you.
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