Aa
i'm gonna have the peg,in one or two weeks. have some questions
here is my condition.http://www.medhelp.org/posts/Hepatitis-B/my-hbsag-is-35639IU-mi-need-advise-please/show/2216087#post_10625469
1.should i take tenofovir while injecting the peg? because i once heard taking tenofovir could suppress my immune system.
2.should i stop injecting when my hbsag is underdetectable?
3.when should i use hepatitis B vaccine?
your advice will be very important. thanks
1.should i take tenofovir while injecting the peg? because i once heard taking tenofovir could suppress my immune system.
2.should i stop injecting when my hbsag is underdetectable?
3.when should i use hepatitis B vaccine?
your advice will be very important. thanks
post your latest hbsag quant in iu/ml, your hbv genotype, hbeag and hbvdna, vitd25oh level
if hbeag neg
pegintf can work only if hbsag less than 1000iu/ml, if it is high it is best to go for tenofovir and add pegintf when hbsag has declined to around 1000-1500iu/ml.usually by 5years of tdf 50% of treated get hbsag 1000iu/ml or less
if hbeag neg
pegintf can work only if hbsag less than 1000iu/ml, if it is high it is best to go for tenofovir and add pegintf when hbsag has declined to around 1000-1500iu/ml.usually by 5years of tdf 50% of treated get hbsag 1000iu/ml or less
hbsag 270iu/ml?
if so low go for pegintf as soon as vitd25oh is about 100ng/ml, dont add tdf unless hbvdna is very high but i guess it is low with such low hbsag
if so low go for pegintf as soon as vitd25oh is about 100ng/ml, dont add tdf unless hbvdna is very high but i guess it is low with such low hbsag
my hbvdna is underdetected for 6 years or more. im afraid that the virus would mutate without tdf. could tdf really affect immune system?
could u tell me the reason why injecting peg without tdf when the hbsag is under 1000 and hbvdna is underdetected? im really confused
i've read two forum posts which you post:http://www.medhelp.org/posts/Hepatitis-B/Clinical-Trial-results-Combined-PegIFN--Entecavir/show/2387226
http://www.medhelp.org/posts/Hepatitis-B/NUC--Interferon-switch-to-or-add-on/show/2409254
it seems that "add on peg" is better than "Switch to peg"?
what do you think? here is my condition:http://www.medhelp.org/posts/Hepatitis-B/my-hbsag-is-35639IU-mi-need-advise-please/show/2216087#post_10625469
http://www.medhelp.org/posts/Hepatitis-B/NUC--Interferon-switch-to-or-add-on/show/2409254
it seems that "add on peg" is better than "Switch to peg"?
what do you think? here is my condition:http://www.medhelp.org/posts/Hepatitis-B/my-hbsag-is-35639IU-mi-need-advise-please/show/2216087#post_10625469
i thought you were not on treatment.in your case you have absolutely to keep the antiviral tdf and add on pegintf to it.
please update on results, according to the trials you hve 91% chances to clear hbsag and develop hbsab and if you dont clear you will be lowering hbsag anyway
what is your vitd25oh now?because you need to make vitd25oh 100ng/ml and intact parathormone 10-20pg/ml before adding pegintf
please update on results, according to the trials you hve 91% chances to clear hbsag and develop hbsab and if you dont clear you will be lowering hbsag anyway
what is your vitd25oh now?because you need to make vitd25oh 100ng/ml and intact parathormone 10-20pg/ml before adding pegintf
You have asked a very good question, I am afraid I don't have a definitive answer for you because I am not an expert. Also, I think the profession does not have an answer yet. But in your case, I will agree with Stef2011 that add-on, that is, PegIFN added on to your existing TDF treatment will be the choice.
Basically, the understanding is this: long term use of NUC not only reduces hbvdna but also restores the adaptive immune functions. So it is not true that taking Tenofovir (or other NUCs) suppresses your immune system. Because NUC suppresses the production of hbvdna, it reduces inflammation and hence immune reaction, as indicated by normal ALT and allowing the liver to recover. It has been observed that for some patients, after long term use of NUC, stopping NUC will cause a flare, but will lead to HBsAg clearance. This is the subject of on-going clinical trials and the results are not known. However, in other cases of stopping NUC after long term use with undetected viral load load and normal ALT, a majority of patients will suffer a re-bounce, both in viral load and ALT.
So it does seem that the restoration of adaptive immune system after long term NUC use may not be sufficient to clear HBsAg on stopping.
Seum HBsAg is known to suppress the immune system, it also acts as a surrogate marker for cccDNA. So a low level of serum HbSAg may indicate a lower quantity of cccDNA and more immune control. PegIFN is known to reduce HBsAg, and it also modulates the innate immune system. Therefore, when serum HBsAg is low, adding PegIFN to NUC may restore innate as well as adaptive immune functions, with further lowering of serum HBsAg to reduce suppression of the immune system, all these may lead to a higher chance of clearing HBsAg.
Of course, some researchers believe combination of PegIFN and NUC may not be sufficient, other drugs, such as therapeutic vaccine, cytokines, may also need to be added.
These are just my understanding.
Basically, the understanding is this: long term use of NUC not only reduces hbvdna but also restores the adaptive immune functions. So it is not true that taking Tenofovir (or other NUCs) suppresses your immune system. Because NUC suppresses the production of hbvdna, it reduces inflammation and hence immune reaction, as indicated by normal ALT and allowing the liver to recover. It has been observed that for some patients, after long term use of NUC, stopping NUC will cause a flare, but will lead to HBsAg clearance. This is the subject of on-going clinical trials and the results are not known. However, in other cases of stopping NUC after long term use with undetected viral load load and normal ALT, a majority of patients will suffer a re-bounce, both in viral load and ALT.
So it does seem that the restoration of adaptive immune system after long term NUC use may not be sufficient to clear HBsAg on stopping.
Seum HBsAg is known to suppress the immune system, it also acts as a surrogate marker for cccDNA. So a low level of serum HbSAg may indicate a lower quantity of cccDNA and more immune control. PegIFN is known to reduce HBsAg, and it also modulates the innate immune system. Therefore, when serum HBsAg is low, adding PegIFN to NUC may restore innate as well as adaptive immune functions, with further lowering of serum HBsAg to reduce suppression of the immune system, all these may lead to a higher chance of clearing HBsAg.
Of course, some researchers believe combination of PegIFN and NUC may not be sufficient, other drugs, such as therapeutic vaccine, cytokines, may also need to be added.
These are just my understanding.
i've checked yesterday. my hbsag is 249.5iu/ml, my ALT is more than 900, and AST is 348. but to my surprise, my virus data is 0.24*10^3. my doctor asked me to stop PEG and play bottle to reduce the ALT.
my question is can i play bottle while using PEG?
after i talked to my doctor, my doctor still refused to let me use PEG.
my question is can i play bottle while using PEG?
after i talked to my doctor, my doctor still refused to let me use PEG.
i've checked yesterday. my hbsag is 249.5iu/ml, my ALT is more than 900, and AST is 348. but to my surprise, my virus data is 0.24*10^3. my doctor asked me to stop PEG and play bottle to reduce the ALT.
my question is can i play bottle while using PEG?
after i talked to my doctor, my doctor still refused to let me use PEG.
my question is can i play bottle while using PEG?
after i talked to my doctor, my doctor still refused to let me use PEG.
I am not familiar with the phrase "play bottle".
I would like to know whether you add-on Interferon to your existing Tenofovir treatment, or did you stop Tenofovir? What is the unit of your viral load: copies or iu /ml?
I would like to know whether you add-on Interferon to your existing Tenofovir treatment, or did you stop Tenofovir? What is the unit of your viral load: copies or iu /ml?
sorry, it's "having an intravenous drip"
i didnt stop Tenofovir. and viral load is iu/ml
i didnt stop Tenofovir. and viral load is iu/ml
Thank you. It is very unusual that your hbvdna increases from undetectable to 243 iu/ml when you are still on Tenofovir. An ALT flare is not unusual with Interferon, but yours seems to be quite high. In Australia and other western countries, doctors do not use "intravenous drip" of certain medication to lower ALT at all, it seems to be in use in China (not even Taiwan or Hong Kong) only.
In my opinion, and I am not a doctor, I think it is reasonable to stop Interferon, but do keep taking Tenofovir, and closely monitor your ALT, say weekly. There is no need for intravenous drip.
Hopefully the ALT flare may lead to clearance of your HBsAg and will return to normal soon. I can only speculate, just my pure guessing with no scientific evidence, that your serum hbvdna may be due to leakage of intracelluar hbvdna when the infected cells are killed.
I hope stef2011 and studyforhope will also comment on your situation.
Do take it easy and keep us informed.
In my opinion, and I am not a doctor, I think it is reasonable to stop Interferon, but do keep taking Tenofovir, and closely monitor your ALT, say weekly. There is no need for intravenous drip.
Hopefully the ALT flare may lead to clearance of your HBsAg and will return to normal soon. I can only speculate, just my pure guessing with no scientific evidence, that your serum hbvdna may be due to leakage of intracelluar hbvdna when the infected cells are killed.
I hope stef2011 and studyforhope will also comment on your situation.
Do take it easy and keep us informed.
thank you for your advise. i have no choice. my doctor insist on using intravenous drip. my doctor said i can continue to use PEG when my ALT is under 400.
and do you think this 900 thing has something to do with 10000iu VD3? should i stop VD3?
and do you think this 900 thing has something to do with 10000iu VD3? should i stop VD3?
I understand. As for your VD3, I am no expert. Personally, I would stop until things settle down. I am sure Stef2011 will have better advice for you.
Ou need an expert doctor for peg treatment, alt flare at 1000 is the best thing you can dream of while hbvdna und or very low on tdf, this means you are clearing infected cells fast and no need to stop peg as long as liver is not cirrhotic, alt till 1000 is ok even for cirrhotic liver (i know becasue i had it and this is what most expert researchers suggested
if you stop the flare you also stop hbsag clearance.if your liver function is ok like plts, bil, albumin, keep peg or just lower dose.
vitd3 is mandatory to regulate immune response, so that you dont get too much th1 response which is the inflammatory one
so please sum up your tests while on peg plus tdf, vitd25oh included and we can suggest
stop any immune suppressive treatment if they are doing that by iv now.corticosteoids are absolutely bad
if you stop the flare you also stop hbsag clearance.if your liver function is ok like plts, bil, albumin, keep peg or just lower dose.
vitd3 is mandatory to regulate immune response, so that you dont get too much th1 response which is the inflammatory one
so please sum up your tests while on peg plus tdf, vitd25oh included and we can suggest
stop any immune suppressive treatment if they are doing that by iv now.corticosteoids are absolutely bad
ALso look for very expert specialists alt> 1000 and hbvdna<2000 are a sure sign peg is working and you will clear hbv, this doctor is scared about alt andthat means he is not exprt to manage peg treatment
We had another member here who cleared hbv by peg plus lam with alt more than 1000, i repeat alt flare is an issue on decompensated liver or if tests go in to liver failure, alt is not a measure of liver function
We had another member here who cleared hbv by peg plus lam with alt more than 1000, i repeat alt flare is an issue on decompensated liver or if tests go in to liver failure, alt is not a measure of liver function
Ou need an expert doctor for peg treatment, alt flare at 1000 is the best thing you can dream of while hbvdna und or very low on tdf, this means you are clearing infected cells fast and no need to stop peg as long as liver is not cirrhotic, alt till 1000 is ok even for cirrhotic liver (i know becasue i had it and this is what most expert researchers suggested
if you stop the flare you also stop hbsag clearance.if your liver function is ok like plts, bil, albumin, keep peg or just lower dose.
vitd3 is mandatory to regulate immune response, so that you dont get too much th1 response which is the inflammatory one
so please sum up your tests while on peg plus tdf, vitd25oh included and we can suggest
stop any immune suppressive treatment if they are doing that by iv now.corticosteoids are absolutely bad
if you stop the flare you also stop hbsag clearance.if your liver function is ok like plts, bil, albumin, keep peg or just lower dose.
vitd3 is mandatory to regulate immune response, so that you dont get too much th1 response which is the inflammatory one
so please sum up your tests while on peg plus tdf, vitd25oh included and we can suggest
stop any immune suppressive treatment if they are doing that by iv now.corticosteoids are absolutely bad
i still wanna give it a shot. but my doctor didnt give me an option, i have to follow her order so that i will have chance to use PEG in 3-4 days when my alt is under 400. its almost impossible to find an expert in our little city. i even askd some famous doctors online. they also agreed on my doctor's decision.
so do you have some papers or research results? so i can show them to my doctor.
so do you have some papers or research results? so i can show them to my doctor.
Ncrease vit d 3 levels to 100ng/ml this can help modulate immune system to less aggressive.you can also follow your doctor if you are hbvdna und by tdf evn alt 400 have chances to clear
it is important to restart peg whenalt gets lower and dont let it to normal
it is important to restart peg whenalt gets lower and dont let it to normal
You cant ask online for this because it is too much responsability, the doctor must know your liver status and how it is working while alt 1000 to manage peg safely in this situation, try to search medhelp for peginterferon plus lamivudine alt 1000 maybe you find the story of that member
these are my test results from my last three month using the TDF and PEG and VD3 10000iu
Jan. HBSAG 316.530iu/ml
HBSAb 0.32miu/ml
HBeAG 0.506PEiu
Feb. HBSAG 76IU/ML
Mar. HBSAG 0.12iu/ml 0.000-0.050
HBSAb 0.40miu/ml
HBeAG 0.346peiu/ML 0.000-0.228
truly, i'm pretty happy when i got my test. but my question is when should i use hepatitis b vaccine? which kind i should choose,domestic or import?
BTW,i'm in china.
Jan. HBSAG 316.530iu/ml
HBSAb 0.32miu/ml
HBeAG 0.506PEiu
Feb. HBSAG 76IU/ML
Mar. HBSAG 0.12iu/ml 0.000-0.050
HBSAb 0.40miu/ml
HBeAG 0.346peiu/ML 0.000-0.228
truly, i'm pretty happy when i got my test. but my question is when should i use hepatitis b vaccine? which kind i should choose,domestic or import?
BTW,i'm in china.
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