will I be able to give birth to my own child without infecting him with hepatiti

[ashwin070]

Dear Sir

My name is Ashwin Bundhan I am 27 recently married.I
came to know that I am Hepatitis B positive (Hbs
Ag)..I want to know will I be able to give birth to my
own child or I will need to go for sperm washing or
artificial insenimation .My wife is been vaccinated
for Hepatitis B & she is tested negative.Presently I am
using  contraceptives .But wife wants to go for a baby..I am confused what to do ???Please help...Scared may be I will pass the infection to the infant

Pls be advised what to do ???

Waiting for your important feedback

Regards
ashwin Bundhan

[mikesimon]

I made the same association when I was writing but I felt it was just my own twisted personality and that no one else would make the association. Thanks to you now it's either that I'm not really that twisted afterall or else I've found another as twisted as me. Either way I don't feel so lonely anymore. Mike

[TnHepGuy_]

Yep - terrific analogy, Mike.

I believe part of having a disease like this is the need to bring knowledge/info to a 'meeting of the minds' with the docs. To have everything be one-sided is to offer up the chance to be steamrolled. As it stands, we have so many unknowns with Hep C research and tx - that we end up putting tremendous faith in little hard facts. Do I have 'faith' in my docs? You betcha - a very measured faith. We can't help but have to make decisions - both big and small - which require us to turn parts of our lives over to others (e.g. - doctors). But that doesn't mean we we have to do it passively nor ignorantly.



P.S. - I was going to make a comment on the close association of dog diarrhea and runny eggs - but I thought the better of it.


TnHepGuy

[TnHepGuy_]

Where does the 3 mg. dosage/day of the anti-rejection drugs leave you - in terms of immune susceptibility? Knowing what the interferon does to the WBC and ANC counts - are you getting a 'double-whammy' - and therefore have to be that much more careful re: general infection?

How soon after the 'steroid blast' did you begin tx? I imagine they had to give your immune system a bit of time to recover from the slamming it took. You had mentioned about having to force the docs to put you on a full-dose regime. Was just getting you started on combo something that you had to push for, too?

Also - did you chose Pittsburgh? or did Pittsburgh chose you? (i.e. - was the decision to transplant there purely based upon geography? or were there other factors in play?).



BTW - if I'm going overboard with the questions - please feel free to chime in with a hardy "SHUT UP!!!" ... hahahahaha.


TnHepGuy

[mikesimon]

I didn't respond about lowering rejection meds. I doubt I will ever get to the point where the patients that get their T Cells knocked out get - like 1 mg. per week. I take 3 mg. per day and believe that I could go to 2 mg. per day soon. There are studies of dendritic cells going on in Pgh. now and they believe they can predict the patients that can safely be reduced but as this is purely research they conceal their findings from the clinical side so as not to pollute their studies. Now that is a real cath 22. When it was suspected that I was rejecting all my surgeon had was a biopsy and rejection and hep c reinfection are indistinguishable on biopsy. The rule was if the event is close to transplant it was assumed to be rejection and the further from transplant the more likely it was that it is hep c. The research team could probably have told them from looking at the scatter pattern of dendritic cells but since the research is isolated that information wasn't made available so it was basically educated guess work.

The steroid blast basically shuts down completely the immune system. I don't know the total implications of this treatment but there is strong reason to believe it is not at all good for the battle with hep c since the virus has a clear and open playing field in the wake of this immune shutdown - the speculated result is the proliferation of quasi or sub species of the virus. Just a little hurdle in my fight to get well. Thanks again for you interest and wisdom. Mike

[TnHepGuy_]

Mike - thanks for all you offer to everyone here at the forum - most certainly myself included.

Glad to hear your last bx was a good one. Though I can't imagine what that type of steroid dose would do to a body.... WHEW!!! .... what are the concerns (short-term and long-term) from receving such a high dose as that?

We are at just the beginning time of data coming in on various extended tx regimes. Sadly, that leaves all of us who are on tx now and considering extending, fumbling for any kind of 'right' answer. Add in to the mix doctors reluctance and ignorance of the subject and insurance companies 'natural' desire to not want to pay beyond 48 - and the picture gets murkier still.


Best to you, Mike.


TnHepGuy

[mikesimon]

My last biopsy looked good and showed only portal inflamation but this when was rejection was suspected and treated with solumedrol(intravenous 1 gram dose of steroid given in less than 1 hour). I doubt that there has been any fibrosis since that biopsy - I've been on tx pretty much the whole time. I have never had a pcr of my biopsy because at the time they knew I had hep c so it would have undoubtedly have been present in the tissue. I think I am going to continue till June and at this point I'm considering extending beyond that. I know this is a crapshoot to an extent so maybe I should just keep shooting - I am on a roll. Thanks for the feedback Tn. I do appreciate bouncing this off of you. Mike

[cuteus]

if hep c has taught me something; I guess it is how to ride, great analogy.
My attitude has changed from a meek, trusting, and naive patient to a more take charge one.  If I don't look out for myself, no one else will.

[mikesimon]

Like many of us here my immune system has always been vigorous. I haven't had a flu or infection in 15 years - except hep c. That being said I think my immune system is still pretty strong. After transplantation I was instructed not to eat at buffets(particularly sald bars), not to eat runny eggs, eat only well done steak, avoid animal feces etc. Upon returning home from surgery after only 5 days in the hospital I had to deal with an incontinent Akita(125 lb. dog). I wore rubber gloves and cleaned up dog diarrhea for several weeks. Now I eat runny eggs and occasionally medium rare steaks. I still avoid sald bars and buffets but I never ate that stuff anyway. My WBC is at its lowest - 2.7 and I have never needed neupogen. My ANC is 1485, just below normal at 1500. In short I am not that careful although I am sure my surgeon would prefer it if I was.
It's hard to recollect the time between the blast(I had 2 of them - could I have had 3? Brain fog again) and the start of tx but I beleive there was at least a few weeks and maybe longer. I just can't remember that and in fact I may have been on tx for one of them. I'm embarrassed to admit that I don't recall. I could reconstruct it but I probably won't get back into that stuff unless it is important to you. My surgeon, against the advice of the hepatologists put me on regular interferon/ribavirin. The heps thought I was rejecting and my surgeon thought it was hep c. My surgeon was right.
Pittsburgh was the closest center at 25 miles from my home. It is also one of, if not, the leading transplant center in the world. Thomas Starzl founded this center and he is truly that pioneer of organ transplantation. Almost everyone anywhere in the transplant field either studied here or studied under someone who studied here. So much originates here from the introduction of tacrolimus as the premiere anti rejection dug(we still call prograf FK 506 which was the code name of it when Pgh. was developing it for use in transplantation) to islet transplant to small bowel and multi organ transplant to xenographic transplantation. So it was close and also top of the line and I feel fortunate to be so close to such a facility.
Tn, I don't mind one bit answering any questions you have. My experience is open and maybe someone will get something out of the story. The lesson I have learned that I hope others learn faster than I is: DON"T TRUST ANYONE. You alone must watch over everyone associated with your care. People often say to me that I know more about hep c than the doctors. I may know more about hep c than some doctors but I know more about ME than any doctor and that's the difference. So take charge everyone. I liken it to riding a horse. You always hear "show the horse who is boss". Well that's hard to do when you don't know how to ride and the second you mount the horse it realizes your knees are tight across the whithers and you didn't pick up the reins right and the bit is not alive in the horse's mouth. You're not going to control that animal because you're not the boss. When a doctor sees me they know immediately I know how to ride and they can't bullshit me or deny my requests for meds or labs or charts or anything because I take charge immediately. The problem was that I had to get 1 year post transplant to learn how to ride. So everyone else saddle up right away and give those docs all the right signals. Things will go easier once you do. Be well. Mike

[mikesimon]

TnHepGuy,
I've thought about the liver biopsy - I just hate the idea of going back for that. I've had a bunch of those things already and I'm not sure what to do if the liver prc is positive. I mean what else could I do except extend in one form or another and the evidence for that is cloudy at best. I did ask my surgeon about low dose monotherapy but this was in an email and he wasn't responsive to that issue. I think the transplant center has an entirely different perspective on this stuff. Their focus is on the condition of the allograft(transplanted liver) and secondarily the presence of the virus. I guess that makes sense but it creates a bit of confusion for me. I have basically forced them into prescribing the doses I am now taking. They wanted me to do 800 mg. ribavirin and reduced dose of Pegintron. I pushed the full dose Pegasys and 1000 mg. ribavirin. They're cool about it though and will give me whatever supplements I need, like Epogen or neupogen. They're good about that but their real focus doesn't seem to be viral eradication - like it is here among us patients. I'm still thinking over what course of action I'll take. I shoot the Pegaysy Sundays and I am leaning toward another shot this week.

Amerabrit, You're so very sweet to say those things. It means a lot to me even though I think your praise might be somewhat exagerated. Oh, the hell with the modesty ****. Thanks so very much for the kind words. I'll keep you all posted. Be well everyone. Mike

[Amerabrit]

Just a note to let you know I read all of your posts with interest and am always wishing you well.  You are an inspiration to me and everyone else here here, I'm sure.  If bravery, intelligence, motivation, kindness and willpower were the five ingredients needed to beat HCV you would have won by a KO in the first round.  Very, very best of luck to you:).

[darrinwade]

my x-wife is HBVsAG pos and gave her 2nd child hep b but didnt know she had it she has had a 3rd child and this one is hbv free so yes you can have children as long the docters know ahead of time.  i was both hbv and hcv pos.

[TnHepGuy_]

I guess you saw this recent study: <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15108250">Prediction of sustained virological response in liver transplant recipients with recurrent hepatitis C virus following combination pegylated interferon alfa-2b and ribavirin therapy using tissue hepatitis C virus reverse transcriptase polymerase chain reaction testing</a>

Is there any possibility of you receiving a bx PCR of intrahepatic tissue?

As far as extending - given that you've been clear for over a year now - if you wanted to continue on a maintanince tx of perhaps 1/2 dose interferon and no riba, would that be a possibility? The <a href="http://www.medscape.com/viewarticle/466007?">Tarantino</a> study suggests a higher SVR rate for low-dose continued tx (though they used non-peg interferon on a daily basis).

This type of extension (on peg) would be similar to what Scott and 'twotells' are doing (though 'twotells' is on a gradual declining dose regime). And, you would think (and hope) that the sides with half-dose and no riba must be alot less.


Thanks for the article re: Pittsburg protocol. Is it possible you can eventually have your immuno-suppresant doses lowered? Or is it only a possibility for those who received the drug that kocked out the T-cells prior to transplant?


TnHepGuy

(URL's for the above articles):

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15108250

http://www.medscape.com/viewarticle/466007?

[mikesimon]

Thanks my friend. You're right, but I don't know what will make me more comfortable to be hosest with you. I guess if things don't go right I'll probably second guess myself regardless. I'll work it out this week. Be well. Mike

[simpleman]

I know you didn't ask me but I know you have kinda second guesses yourself on past treatments. I would do what will make YOU feel comfortable now and in the future. Also know you have my good thoughts and prayers for a successful outcome. You have been such a GREAT addition to this board I'm sure everyone else is praying for you too. Good luck, you deserve it.

[mikesimon]

Yes, I am familiar with that development. In fact it originated here in Pittsburgh at my transplant center. I was done in 2000 and the developments since then are really quite impressive. I've copied a portion of an article about the Pittsburgh protocol that will give you an idea of how it works.
I'm doing well I think. I'm on my 69th week and this may be my last. Both the hepatologist at my center and my surgeon said I should stop now - or maybe it was I could stop now. They didn't hesitate about it so I'm leaning toward quitting now. I've had some minor vision things going on and some skin things as well so maybe I shouldn't press my luck. It probably won't matter at this point. I've been undetectable since April of 2003(I think, because April 4 I was 12IU/ML from 3.86 million IU/ML in January 2003 but didn't test again until June 4, 2003). I've been on 180 mcg. Pegaysy and 1000 mg. Ribavirin throughout and I weigh about 162 lbs. What do you think about stopping now? Do you think it's a risk?

This is from:
http//www.postgazette.com/healthscience/20030502starzlhealth2p2.asp

When Starzl discovered more than a decade ago that some of his patients had secretly stopped taking the pills but remained healthy, he realized that the body could become tolerant of donor tissue.

Starzl suspects that the common practice of giving several drugs immediately after transplantation may prevent the body's immune system from developing a tolerance for the transplant. So he devised a protocol in which patients, shortly before transplantation, are given a drug that temporarily knocks out T-cells, the immune cells that attack foreign tissue.

After the operation, patients receive only one anti-rejection medicine, rather than a combination that typically has included steroids. If all is well four months later, they begin to take smaller doses of the anti-rejection drug.

Thanks for asking and good luck. Mike

[TnHepGuy_]

It can't be easy to decide when to stop treating. Most of the studies I've seen show that the riba has done the majority of it's work by week 20 or thereabouts (assuming undetectable staus at that point). Given that you've been clear for over a year - have you considered lowering or just dropping completely the riba?

I can understand your docs over-riding concern being the allograft. But since you've been on tx and tolerated it as well as you have for such a long period of time - you think that they would be even more interested in trying to ensure viral eradication - of course, tempering that with potential long-term treatment consequences. There never appear to be any clear answers in anything tx-realted.

What was the status of your last bx? Have they done any intrahepatic PCR's from any of you bx's?


TnHepGuy

[cuteus]

here is an excerpt of a 1996 study.  I told ya it was an oldie.  it doesn't seem the researchers care to break down reaction to tx by geno 1 subspecies, at present: "Patients with genotypes 1a and 1b had more severe hepatitis. Twenty-eight percent of patients with genotype 1a and 26% of patients with genotype 1b had a complete biochemical response to treatment with interferon-alpha for six months"

[TnHepGuy_]

I posted this in a thread that ended up closing yesterday:

I remember reading a few years ago where there is a thought among a some transplant docs that patients can eventually be weaned off of the anti-rejection drugs - or at least eventually have their dosages minimized . You familiar with this theory at all?

How many shots you have left? What dosage level have they kept you at? Riba, too?

Hope you are doing well.


TnHepGuy

[mikesimon]

Remember that hepatitis B carriers may not feel sick but can still spread the hepatitis B virus to other people.

The people who are in danger of getting hepatitis B infection from a carrier are people in close contact with the carrier. Anyone who has contact with blood, semen, or other body fluids of a carrier is a