Best Treatment for HBv

[jcm60]

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.

[jcm60]

Hi Stef

I have not tried Vitamin A supplements as yet but will find out & start taking it as well, what should be the dose.

Doctor suggested me multi vitamin named : Lycopene,vitamin,methylcobalamin,folic acid,chromium & sodium soft gelatin capsules( Make Medoscha gold) he asked me to take for 2 months. I noticed this is quite useful i feel more energetic now , last 1 month i am taking 1 capsule daily. Whats your opinion ..

[jcm60]

Thank you Aduiski ,
Yes I am eating healthy diet and takes green tea 2 times on daily basis. I treatment 1 tab.of Tiravir daily after dinner and it has been started since Jan.2014 so almost 2 years now, Doctor advised to continue it further.
I am meeting Doctor next week and share the outcomes.

[jcm60]

Thanks Stef ,

I have stopped taking Vit.3 supplement as my calcium level both in serum & 24 hours urine was high so the vit D3 was stopped almost 3 months , now i have started weekly 60K as per doctor advice , and it showed increase in the result but PTH way high ,
24 /10/15 I am going for calcium check both in serum & urine then will see the result and increase the Vit D3 dose.
I also checked the Parathyroid and found no tumor its normal report.
If my calcium level within normal range i will increase the Vit D3. What you suggest how much Vit D3 should take.
Stef one more question i noticed upper back ach gone through the MRI found all normal but some time the pain is quite severe , it could be related to Vit D diffiency also .
I also lost 10 Kg.weight within 12 months, is it normal or related to HBV .I am concerned on it, please suggest as i am taking overseas job effective 25 Dec.2015 , in Maldives if health permit me i will join there.
My last meeting with Doctor advised me to eat healthy food as normal diet no restriction to any food product.
I am meeting with Doctor next week .

[stef2011]

another thing doctors should consider is possible kidneys damage from hbv but this is very hard to see from the tests only by using antivirals you may see improvements in creatinine clearance and serum creatinine after 1 year therapy

[stef2011]

i think alt and hbsag are not so important now we need to understand why you have problems with vitamin d pathways (severe vit d deficiency confirmed by abnormally high pth which is usually named secondary hyperparathiroidism but this has to do with vit d deficiency or some kidneys issues).what did the doctor say about this?any clue about the disease?

did you try vitamin A supplements the natural type from fish oil?carlson, nordic naturals are very good brands but also nowfoods although they dont have ifos certification

[jcm60]

Hi Stef
Its long time , hope this note will find you in good health ,
I have gone through some test , please find the report along with the previous one , some of the result had increased a lot , please give your expert opinion .


Vitamin D,25 Hydroxy:

- 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 :

- 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:

- 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.-

- On 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.

LFT on 8/8/2015:
AST: 22 U/L.
ALT: 30 U/L.
GGTP: 22 U/L.
Alkaline Phosphatase ( ALP): 143 U/L.
Phosphorus: 2.00 mg/dL.

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.
- 13/6/2016: HBV DNA NOT DETECTED.

HBsAg Quantitative:

- 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 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%

I noted that the ALT  , PTH & HBsAg result had fluctuated a lot from the previous report , please let me know the reasons.

24 hrs urine & serum test is due for next week , i will share with you the result latter.

Thank you,

[Aduiski]

You have fantastic results, except ALT being raised and your liver seems to be fatty (CAP score). You need to take care of your diet and eating habits, and probably also exercise more to lose the fatty liver.