high hsag ..when do i start treatment?

[naijagal]

Hello people..i have been following this forum since i was diagnosed of hep b 8months ago .this is my first time im posting my hb profile.. Pls feel free to advise me on how to manage this bugs killing me softly..

18-8-11
Hsag +
Hbc igm -
Hbc antibody +
Hbeag -
Hcv -
Hiv -
Alt 14
Ast 18
S total bilirubin 13
S conj. Bili.      1
S unconj. Bili 12
Dna. 102 iu/ml-- 594 copies- 2.77 log

22/10/2011
Alt 18
Ast. 24
Total protein 5.0g/I
Albumin 4.7.      3.8-4.4
Afp negative
Alkaline phosphatase 34u/I.           60-170u/i

9-12-2011
Alt. 15
Ast. 19
S total bili.  18.       2-20
S conj. Bili.      1
S unconj. Bili. 17
Alka  phosphatase.  32
S gamma GT.  13

15-1-2012
Alt. 13
Ast. 19
Total bilirubin 0.2
Vit d (25 OH) total. 27.8ng/ml. Borderline
Sag quantification 18745.7 iu
Hbvdna.  12iu/ml
Fibro test...f0

I have never been on any medication..i only eat healthy food, exercise and take some vitamins(i know it wont clear the virus but it has improved my general well being as well as lowered my hbvdna)i.e milk thistle,cucumin,vit b,c,e & d, zinc,licorice root,taurine,methionine,and selenium..

I am worried that my hsag is high..what do i do?  

[stef2011]

now you are inactive but such high hbsag doesn t assure 100% it will stay like this, it may stay inactive or reactivate so you need every 6 months monitoring

even if hbsag is so high you can try sequential treatment anyway, one guy on the trial had hbsag 8000iu/ml, which is in the range of interferon non response, despite this entecavir+interferon made hbsag 30iu/ml by 48 weeks of that combo.
before interferon he was on etv mono for 3 years

[naijagal]

Thanks stef for the quick response.. I guess im not amongst the lucky few who have a chance of clearing the bug sob! sob!

One more question stef..do i have active or inactive hep b?

[stef2011]

sorry i wasnt wearing galsses!your hbsg is hiigh i thought i read about 1800iu/ml

with hbsag so high there is little response to interferon, keep healthy life or you may try tenofovir for many years and then add interferon when hbsag gets low enough, studies reported a lowering of hbsag by years of tdf use

[stef2011]

Sag quantification 18745.7 iu

no hbsag is not high, it is very low and it is in the range with highest hbv clearance by interferon

my suggestion is:
first of all make vitamin d to normal level, which is around 50ng/ml, this can be achieved very fast by 50.000iu d3 weekly or 10.000iu d3 daily.check both calcium and 25oh in 4-5 weeks

once vit d is at optimum level:
start alinia (nitazoxanide) 4 weeks monotherapy and then check if hbsag gets lower, if it lowers keep alinia mono until it stops decreasing, in that moment add interferon until hbsag is cleared

if alinia not available you may start tenofovir for 1 year and then add interferon checking that hbsag gets lower during tdf mono

in both cases interferon must be kept until hbsag negative combo with alinia or tdf.if there is no hbsag decrease on the combo by 24weeks you can stop tdf or alinia and then interferon too some months later

[naijagal]

May i also add that im planning to start a family soon and i am yet to see a hepatologist since i was diagnosed..i live in Nigeria(our healthcare system is one the poorest in the world) besides  i dont trust the doctors .. Almost all of them are ignorant of the disease and they are so eager to put patients on lamuvidine. They get on the defensive when u try to explain the dangers of taking such drugs. t