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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
only if hbsag goes less than 1500iu/ml peginterferon add on before 3 years of antiviral makes sense
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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
nicotinamide riboside works at 300 to 500mg daily, start 300mg and see the effect
take 200mg with breakfast and 100mg before bed
Helpful - 0
1 Comments
Hi Stef2011
My wife got blood tested for HbS Antibody ( Anti-HBs) and the result is 505.28 mIU/mL. and Vitamin D,25 Hydroxy serum - 40.70nmol/L
I know the Vitamin is extremely low and need to know on the test value  of Anti-HBs. please interpret the result.
Thank you,
Avatar universal
maybe you have some genetic difference that makes use of vit d/pth different, where did you send the report?

you may try nicotinamide riboside for boosting energy, i take NR plus liposomal resveratrol and pterostilbene as antiage supplements and i got a very potent boost of energy like in my '30, i have no idea if this can work for anybody but definitely worths a try after reaching 35-40yo
Helpful - 0
1 Comments
Hi Stef2011
Thank you I will find out this energy booster supplement and try to take 1 daily , what is the best time to take this supplement.
I my previous post all the reports sent but i will send once again.
PTH - 89.1pg/ml.
Vitamin D3 - 25 hydoxy 56.6ng/ml.

I am planning to do the parathyroid scan as well. I have done it 6 month back and the report findings were okay but the doctor was not convinced with the report as serum Calcium was high 10.47 mg/dl , phosphorus serum always low 1.98 mg/dL , ALP high 164 U/L. , 24 hour Urine calcium 316.80 mg/day slightly high from the range 100-300 , calcium ionized serum 1.29 mnol/L. phosphorus 24 hour urine 825 mg/day
This time i am going with different lab. to double check.
Shall post you the findings.

Thank you,
Avatar universal
keep this therapy and recheck hbsag every year, usually tdf lowers hbsag on 50% of patients to 1000iu/ml by year 5, dont remember if this was hbeg os or neg
Helpful - 0
1 Comments
Hi Stef2011
Thank you so much,
My Hbeag is -ve and the treatment  started 1st Feb.2014 and till now with Tiravir 300 mg daily , I feel some time very weak and upper back having regular pain.
I am in the remote place maldives these days but keep visiting India almost 4-5 months so getting treatment is not a problem but due to weakness & tiring some time not deleiver 100% at work .
PTH is concern as its not getting down as I said in Maldives the sun is very bright and I almost out in the day time and cycling as well.I have a doubt like parathyroid gland so i will check with Doctor if required will do the scan once again.
My routine to take medicine after dinner ,Is it okay or required to change the schedule.
I sent you the details report how you find the result please let me know.
Avatar universal
as long as creatinine and gfr are within limits it is ok to keep tdf

avoid use of drugs that make kidneys damage, in feb 2015 i had t use antibiotics for 2 weeks and gfr went less than normal and creatinine borderline high and i have not fully recovered to high gfr and very low creatinine like i was before, antibiotics are for sure kidneys killer when using other heavy drugs on kidneys
Helpful - 0
1 Comments
Hi Stef11 & all other expert in the forum:
Please find my last blood test & USG whole abdomen and Fibroscan:


Vitamin D,25 Hydroxy:
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 :
-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:
-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.-
-On 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.

- 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 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%

USG whole Abdomen:
-On 21 march 2016:
Liver is normal in size( cranio caudal span 12.9 cm) it shows diffuse increase in echogencity S/o fatty infiltration ( grade 1) Intraheptic billary radicles are not dilated.
portal vein is normal in calibre and shows normal color filling on application of color doppler.
Gall bladder is distened and shows normal lumen and wall thickness.Perichoecystic fat planes are unremarkable.CBD is normal in calibre.
Pancreas is normal in size,outlines and echo texture .No peripancreatic fluid collection is noted.No obvious intra-pancreatic ductal dilatation os noted.
Retroperitoneum is partially visualized and appears normal.
Spleen is normal in size,outlines and echo texture.No obvious focal lesion is noted.
Bilateral Kidney are normal in size, shape,position,outline and echo texture. Bilateral pelvicalyceal systems appear normal.No evidence of hydronephrosis is seen, bilateral mild increased echogenicity noted 16.6 mm mild pole calcus in mid pole.
Right kidney measure 12.3 cm in size and left kidney measures 12.2 cm in size.
Urinary bladder is distended and shows normal lumen and wall thickness. No free fluid is seen in the peritoneal cavity. Prostate measure 42 cc.
Impression:
Fatty liver grade 1.
Bilateral medical renal disease.
Moderate prostatomegaly.

My concern is still my HBSag is not coming down , however my Hbvdna not detected since six Oct.2015.
PTH on higher , I am taking daily Vit.D3 supplement 5000iu  one capsule daily and Mk-7 it.k-2 one capsule daily , I am taking both these supplement in the morning after breakfast and Teravir (TDF) 300 mg after dinner.
Please suggest the best option ,

Thank you,

Avatar universal
Hi Stef

Thank you for your kind suggestion , in fact i would like to continue with Tiravir 300 mg. I agreed with you the Sebivo is very weak profile for resistance.
Actully i am travelling to Maldives and have to stay there for 6 months so i am carrying these medicines along with me.
If any issue comes up during my stay at maldives , i shall share with you.

Thank you once again.
Helpful - 0
Avatar universal
sebvivo has a very weak profile for resistance
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Avatar universal
i'd try the combo tdf plus sebvivo, this combo showed to solve the kidneys problems issues

or much better why not use entecavir?
Helpful - 0
Avatar universal
Hi stef

Looking foward your comments on Tiravir 300 mg vs Sebivo 600 mg. as doctor suggested , and also the reports stated in previous mail.

Thank you
Helpful - 0
Avatar universal
Hi stef

Looking foward your comments on Tiravir 300 mg vs Sebivo 600 mg. as doctor suggested , and also the reports stated in previous mail.

Thank you
Helpful - 0
Avatar universal
Hi Stef
Hope you are doing good , it has been long time we haven't communicate. i have done some test in-between ,i will attach these along with the previous one.
Vitamin D,25 Hydroxy:

- 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 :

- 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:

- 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.-

-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.

- 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 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 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%

Todays I showed all report to Doctor , he advised to change TIRAVIR 300mg with Sebivo 600 mg , his idea to change the medicine is to control the creatinine level. I checked the web site the salt is almost same in both the medicine . please suggest as per your experience.
Looking forward your reply.
Thank you,





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Avatar universal
you know my concern is that there is something not working like high calcium with vitamin d within ranges and at the same time high pth with high calcium

before starting all that vit d i would go with low dose daily like 2000iu and take all vitamins correlated with vit d pathways to see if this gets solved.magnesium, vit A, vit k2 all work together with vit d and if there are deficiencies of these vits increasing vit d may not be good

gcmaf is the vitamin d transporter to receptors and nagalase made by hbv blocks gcmaf...i d be curious to see what your nagalase is but this is a research test and too difficult to get this in asia
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Avatar universal
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 ..
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Avatar universal
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.
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Avatar universal
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 .
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Avatar universal
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
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Avatar universal
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
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Avatar universal

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,
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1 Comments
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.
Avatar universal
I will be going 3 years with teravir then may be plan for IFN, aagin depends upon the result & Doctor opinion.
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Avatar universal
You are about to complete 2yrs of tdf treatment. U can try IFN now. Is it sure that hbsag will go down to 1500iu after 2-3yrs of tdf. IFN must be tried in young age and works different in different individuals.
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Avatar universal
Thanks Stef ,
Shall try to bring down the calcium first and then planned for Vit.D3 and Ultra Thistle.
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Avatar universal
what is your say on it?

i know it helps with liver fibrosis, dont know if it has ny effect on kidneys


which is the best time to take this combo.

now to see if calcium goes down fast


I was thinking to bring back the Vit D3 to sufficient level

not now, bring calcium down fisrt
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Avatar universal
Thank you Stef for your revert,
I was looking in the website and you also suggested some time back milk thistle now it is available ULTRA THISTLE 360 mg. what is your say on it?
As suggested by you i will go for vit A from cod liver oil , i am already taking vit k2 mk7 100mcg last 6 month. which is the best time to take this combo.
I was thinking to bring back the Vit D3 to sufficient level , if i take 60K vitmin D3 weekly it helps need your clarification.As you may have noted my PTH is very high beyond the range in this way i can bring down the PTH as well.
Looking fowar your suggestion as always,

Thank you,  
Helpful - 0
Avatar universal
TrY the combo of vit A from cod liver oil 10.000iu daily and vit k2 mk7 200mcg daily and see  if calcium declines even more, stay at least 3-6months away from vit d and ifthis combo works protecting you may restart vit d to keep at least min sufficiency
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