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Best Treatment for HBv

I am 53 years old last month I have went for preventive health check up and based on the report findings the followings noted; SGOT 83 IU/L ,SGPT 200 IU/L , Doctor recmended me to see the Gastro.consultant , the gastro.consultant advised me to go for others test the result are as follows: Anti-dsDNA 16.6 IU/ml. , HBsAg test value 9520(Reactive) ,HCV,IgG test value 0.12 ( non Reactive) ,Anti Nuclear Antibody ( ANA) 0.12 , Immunoglobulin IgA 279 mg/dl , Tissue Transglutaminase antibody IgA 0.40 U/mL , Anti Mitochondrial Antibody , Serum 0.26 UL/ml , ASMA 2.70 U/mL , LKM Antibody 0.02 U/ml , Hepatitis B envelope Antibody test value (Ab) 43.0 ( Reactive) , Hapatitis Be Antigen ( HBeAg) 0.15 ( Non reactive),AFP 4.38ng/ml  , HBV DNA Quantitative,Real Time PCR 5156250 IU/ml. Based on this the Doctor advised me for the treatment  Tab.Entavir 0.5 mg one daily. Here i went for second opinion with Lever specialist consultant and he advised me to go for Fibroscan which the result is 5.91 Kpa ( Negative for fibrosis).Now the lever specialist advised for Viraferon Peg 80 mg once in a week and monitor CBC & S creatin every 15 days.I have not started the treatment yet as I am going out of India for 1.5 months as Doctor told me that this treatment will be given under there supervision , please suggest which treatment is suitable under these report.Also with vaccine this problem will be solved and how long i have to take this treatment.
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Avatar universal
antihbs are ok, vit d too low

later today i ll post a study just published about centenarios it happens that they have good vdr or high vit d while others dying younger bad vdr and bad vit d levels
Helpful - 1
2 Comments
jcm60
Hi Stef11 & all other expert in the forum:
Please find my last blood test & USG whole abdomen and Fibroscan:


Vitamin D,25 Hydroxy:

Date 9 July 2016: 47.8 ng/mL.
on 21 March 2016: 56.6 ng/ml.
- On 9 Dec.2015 : 71.69 nmol/L.
- on 10/10/2015 : 44.6 ng/ml.
- on 8 Nov.2013 : Vitamin D , 25 - Hydroxy ,Serum ( CLIA ) 41.05 nmol/L.
- on 22 June 2014Vitd25oh :18.22 ng/ml.
- on 24/8/2014 : 51 ng/ml.
- on 8 Nov.2014 : 51.2 ng/ml.
- on 5 Feb.2015 : 157.55 nmol/L ( Sufficient range 75-250 nmol/L )
- on 7 march 2015 : 164.50 nmol/L (CLIA method) Range 75-250 sufficient)
- on 3 April 2015: 174.12 nmol/L ( CLIA method - Ref.renge 75-250 sufficient )
- on 1 May 2015 : 65.2 ng/ml
- On 13/6/2015: 41.1ng/ml
- On 8/8/2015: 26.01 ng/ml ( Insufficient range)

PTH ( Parathyroid Hormone) Intact, Serum :

Date: 9 July 2016: 87.72 pg/mL.
-on 21 march 2016:89.1*(High)pg/ml.
- On 12 Dec.2015: 77.3 pg/ml.
- on 10/10/2015 : 89.5* H pg/ml.
- on 5 Feb.2015 : 73 pg/mL ( Ref.Interval 14 - 72 )
-on 7 March 2015: 86.60 pg/mL ( CLIA method Ref.range 14-72 )
-on 3 April 2015: 73.60 pg/mL.
- On 1 May 2015: 83.80 pg/mL.
-On 13/6/15: 63.45 pg/ml.
-On 8/8/2015: 95.40 pg/mL. ( HIGH)

S.Creatinine:

Date 9 July 2016: 1.15 mg/dL.
-On 21 march 2016: 1.05*(High)mg/dl.
- On 12 Dec.2015 : 1.11mg/dl.
- On 10/10/2015 : 0.90 mg/dl.
-On  10 May 2015: S.creatinine : 1.4 mg/dl.
-On 13/6/2015: S.creatinine : 1.09 mg/dl (HIGH)
-On 8/8/2015: 1.00 mg/dL

L.F.T.-

Date 9 july 2016: ALT. 31 IU/L , AST - 24 IU/L. Serum Billrubin Total - 0.6 mg/dl , Serum Billrubin Direct 0.1 mg/dl. , Serum Billrubin Indirect 0.5 mg/dl.Serum Alkaline Phosphatase 165 IU/L. , GGT - 16 IU/L , S.Total Protein 6.8 g/dL , S.Albumin 4 g/dL , S.Globulin 2.8 g/dL , A\G Ratio 1.4

Date  21 march 2016; ALT 23 IU/L ,AST 23 IU/L ,Serum Billrubin total 0.7mg/dl , serum billrubin direct 0.1 mg/dl ,serum billrubin indirect 0.60mg/dl ,Serum Alkaline Phosphatase 127*(H) IU/L ,GGT 14 IU/L , S.total protein 6.9 g/dL S.Albumin 4.1 g/dL , S.globulin 2.80 g/dL , A\G ratio 1.46* (L)
-On 12 Dec.2015:
ALT : 39 IU/L. , Serum Alkaline Phosphatase :135 IU/L , GGT: 20 IU/L , S.Total Protein: 7.2g/dl. , S.Albumin: 4.2g/dl. , S.Globulin:3 g/dl., A\G:1.40.

Date 10/10/2015:

AST/SGOT: 29 IU/L.
ALT/SGPT : 43* H IU/L.
Serum Alkaline Phosphatase: 115* H IU/L.
GGT: 19 IU/L
A\G Ratio: 1.46* L

- 28 Jan.2014
SGOT / AST 48 U/L.
SGPT / ALT - 106 U/L.
ALK . Phosphatase - 139 U/L.

L.F.T.-
-  27/4/2014-
SGOT / AST 40 U/L.
SGPT / ALT  65 U/L.
Alkaline Phosphatase ( ALP ) 143 U/L.

L.F.T :
9 August 2014:

Serum billrubin total ( Jendrassik- Grof) 0.8 mg/dl ,
Serum Billrubin direct ( Jendrassik - Grof) 0.1 mg/dl,
Serum Billirubin Indirect 0.70 mg/dl ,
AST/SGOT ( kinetic-Henry) 10 IU/L  ,
ALT / SGPT ( kinetic-Henry) 26 IU/L ,
Serum Alkaline Phosphatase ( Kinetic) 110 IU/L ,
GGT 22 IU/L , S.total Protein ( Bluret) 7.3g/dl ,
S.Albumin 4.1 g/dL ,
S.Globulin 3.20g/dL ,
A\G Ratio 1.28.

L.F.T
- on 8 Nov.2014:
Serum Biluirubin indirect 0.50 mg/dl ,
AST/SGPT ( kinetic - Henry) 24 IU/L. ,
ALT/SGPT ( Kinetic Henry) 34 IU/L. ,
Serum Alkaline Phosphatase ( Kinetic) 136 * High  IU/L. ,
GGT 17 IU/L. ,
S.total protein 7.8 g/dl. ,
S.Albumin 4.1 g/dl. ,
S.Globulin 3.70*High g/dl ,
A\G Ratio 1.11* Low.

LFT: On 25Jan.2015:
SGOT/AST:  12.8IU/L ( Ref.range 0.0 -37.0)
SGPT/ALT : 24.7 IU/L ( Ref.range 0-41 )

LFT : On 20 Fe.2015:
ALT : 26 IU/L ( Ref.Range 10-40)
Serum Alkaline Phosphatase 112* High IU/L ( Ref.Range 32-92)
GGT : 21 IU/L ( Ref.Range 7- 64)

LFT On 13/6/2015:
ALT 32 IU/L.
AST 19 IU/L.
Serum Alkaline Phosphatase 104 IU/L ( HIGH)
A|G ratio 1.34 (LOW)
GGT 17 IU/L.



HBV DNA Quantitative , Real time PCR : Plasma
- on 28 Jan.2014- 5156250 IU/mL.
- 1 May 2014:  - 33181 IU/mL.

- 9 August 2014: = 5.72x10^2 IU/ml.

- 8 Nov. 2014: 47.5 IU/ml.
- 20 Feb.2015 : 6.04 IU/mi.
- 13/6/2015: HBV DNA NOT DETECTED.

HBsAg Quantitative:

Date 9 July 2016 - 5236 IU/ml.
- On 21 march2016: 6384 IU/ml.
- On 12 Dec.2015: 6485 IU/ml.
- On 10/10/2015: 6858 IU/ml.

- on 28 Jan. 2014:  : 7767.68 IU/mL.

- on - 1 May 2014:  6812.40 IU/m

- 9 August 2014: 3585 IU/ml.

8-  Nov.2014: 4633 IU/ml

- 20 Feb.2015 : 5174 IU/ml.
- 13/6/2015: 5431 IU/ml

FibroScan:
- On 21 march 2016; Cap( db/m) median 268 , E(kpa) median 4.2.
- On 10/10/2015: 3.8 (E kpa) , CAP ( dB/m) 272.
On 26 Dec.2014 : 4.7.
On 9 August 2014 : 4.9.
on 13/6/2015: CAP ( dbm) Median 270 , IQR 21. , E(kpa) Median 3.5 , IQR 0.5 , IQR/med 14%

Other test result are as follows:
Date 9 July 2016
Serum Calcium 10.5 mg/dl , S.Magnesium 2.18 mg/dl.

Date 21 March 2016:
Serum calcium 10.2 mg/dl.
S.Magnesium 2.18 mg/dl.

Based on these report Doctor suggested Tab Seviro 600 mg instead of Tenofovir 300 mg daily.
Please check the report and give your expert opinion .

Thank you,
Hi Stef2011 : Its long time i was not active in the forum , I have one question to you please let me know in Thailand Bangkok the HBV patient is allowed to get work permit. My HBV DNA is undeducted since 4 years but the HBsag is still exist. looking forward your kind response.
Avatar universal
this pth level is so strange, if there are no troubles with Parathyroid scan i d suggest to supplement with vit d cofactors like magnesium chelate 400-600mg daily, vitamin A retinoids about 3000iu daily.maybe vit d is not workign because there are other deficiencies but the very strange thing is calcium is high and pth is out of range.

when calcium is high pth must go down if not so there is something in Parathyroids not working, some parathyroid glands disease

it is best to lower vit d for now, what did Endocrinologist suggest to lower calcium?
Helpful - 0
Avatar universal
Thank you so much , i shall do this test as well and update accordingly.
Helpful - 0
Avatar universal
Hi
The test you recommend before starting treatment is done , please find the result:
HBsAg test value = 9520 ( Reactive)
Is there any other test to be done , please suggest.
Helpful - 0
Avatar universal
Hi,

Is the measurement for HBsAg in iu?

Looks like you are definitely a candidate for treatment (high ALT and viral load). The fact your Dr reco Viraferon, I assume it's the PEG version.

Either anti-virals like ETV or TDF or Interferon, you will have to decide.

Helpful - 0
Avatar universal
The result is not mentioned any unit but they mentioned  :
Interpretation of test result ( Vitros ECi)

One Doctor advised Tab.Entavir 0.5 mg one a day ,

I went for second opinion with Gasto. & liver consultant , he had asked me to go for Fibroscan which the result is 5.91 Kpa.
He advised me - Viraferon Peg 80 mg once in a week.

Since I was travelling he suggested me to start after I come back.
Can be posible if I start with Tab.Entavir now and switch over to Viraferon Peg 80 mg once i return to India.Thank you.
Helpful - 0
Avatar universal
first of all the hbsag test you did is useless and absolete, in india you can find hbsag quantificationin iu/ml in best labs, the machines which are old as well, available from 2000, but not absolete from the sixties like the one you used, are abbott architect or roches elecsys.if the labs dont have these machines and the kit for hbsag quantification don t go there

second point, it is useless to start entecavir and peginterferon together, and it is useless to start peginterferon without hbsag quantity.another point entecavir is not the most potent, tenofovir is

the best thing is to start entecavir or tenofovir for about 3 years and then add on peginterferon, only if hbsag goes less than 1500iu/ml peginterferon add on makes sense
Helpful - 0
Avatar universal
Hi
Thanks for your opinion , i shall check the lab. where i find the facility to check HBsAg quantitative iu/ml.
Get the test done & revert you.
Thank you,
Helpful - 0
Avatar universal
Hi
I have not started the medicine as yet as I am out of country, need to check with you how long i can delay the treatment if the reports are positive.

Thank you,
Helpful - 0
Avatar universal
Can you do combo treatment with ETV/TDF and IFN? Suggest that to the Doc.
Helpful - 0
Avatar universal
Hi Stef

Hope you are doing good ,

I last conversation wity you wherein you suggest to redo the HBsAg test on quantative , it has been done and the result is as below:
Result: 7767.68 IU/mL ( in the report its mentioned as CMIA , i think this is test method.
So far I have not started any treatment please suggest.
Looking forward your response.

Thank you,
Helpful - 0
Avatar universal
please post also previous hbasg, hbvdna, ast/alt, hbeag/hbeab, genotype and firbsocan

value is too high for pegintf, if any therapy it is tdf to start with
Helpful - 0
Avatar universal
Hi Stef

Please find the previous report:
AST 83 IU/L dated 7/11/13 , AST 48 U/L dated 27/1/2014.
ALT 200 IU /L dated 7/11/2013 , ALT106 U/L dated 27/1/2014
HBsAg : 9250 ( Interpretation of test result ( Vitros ECi) dated 9/11/2013
HBsAg serum ( CMIA ) : 7767.68 IU/mL dated 28/1/2014
HBV DNA : Quantitative ,Real Time PCR : 5156250 IU/mL dated 10/12/2013.
Fibroscan: 5.91 Kpa
Genotype : not tested.

Doctor advised me for Viraferon Peg 80 mg once a week.
Ttreatment not started yet.
Please suggest the best option.

Thank you,
Helpful - 0
Avatar universal
Hi Stef

Few more test report , please note:
HBe Ab : 43.0 dated 6/12/2013 .
HBeAg : 0.15 dated 6/12/2013.
AFP: 4.38 ng/mL dated 5/12/2013.
Anti-dsDNA result : 16.6 IU/mL dated 13/11/2013.HCV,IgG 0.12 dated 9/11/2013.
Anti Nuclear Antibody ( ANA) 0.12.IgA : 279 mg/dL dated 9/11/2013.
AMA : 0.26 UI/mL dated 11/11/2013.
ASMA : 2.70 U/ml dated 13/11/2013.LKM 0.02 U/ml dated 11/11/2013.

Thank you,
Helpful - 0
Avatar universal
both hbsag and hbvdna too high for pegintf to respond, you may try 24 weeks and then go for tenofovir

i myself would go for:
tenofovir plus telbivudine 1 year and then discontinue telbivudine and add on peg to tdf

or tdf 3 years
tdf+pegintf 2 years
Helpful - 0
Avatar universal
Thank you so much Stef2011 , tomorrow i will discuss with Doctor and go for the best option . Shall up date you .

Thanks for your kind suggestion.
Helpful - 0
Avatar universal
Hi Stef

Hope you are doing good ,
Today I consulted my Doctor and discussed the report , he suggest me to go for TERAVIR 300 Mg one daily.
Also ask me to repeat the blood test after one month for CBC , LFT & S.creatinine.
Please guide me the treatment is okay.

Thank you,
Helpful - 0
Avatar universal
very good choice
Helpful - 0
Avatar universal
Hi Stef

Thank you so much , shall share the outcome.
Helpful - 0
Avatar universal
Hi Stef
Hope you are doing ,
I have one question in mind please let me know " Is there any relation with HB Virus vs.HIV1 & HIV2.

Looking forward your best opinion.

Thank you,
Helpful - 0
Avatar universal
no whatsoever, also keep inmind that hiv has never been isolated and purified so all hiv tests say in the booklet of producers "you can t use this test to diagnose hiv infection".....if you don t purify you can t have a goldstandard for testing, see "house of numbers" on youtube and what scientists that won nobel prize think of this and then you can have an idea of yours
Helpful - 0
Avatar universal
my idea is "hiv retroviruses" probably exsit but if you dont purify and isolate the virus all the tests are of very little help
Helpful - 0
Avatar universal
Hi Stef
Thank you for your quick reply , actually i joined new company where they asked to do the medical test and in that requirement they asked to go for HIV1 & 2 test , since I suffered with HBV little worried if HIV1 &2 comes may be they will consider me in there company..
Helpful - 0
Avatar universal
just google online for hiv test false negative there are so many interference.

Helpful - 0
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