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Chronic Hep-B still active after 5 years
I am a patient of Chronic Hepatitis B. I have been suffering from this disease since January 2009. I am constantly following up my disease since its diagnosis. I have undergone through a pegasys injection + Hepsera Tab therapy for one year from May 2009 to April 2010. I have taken Entacavir 0.5 mg from May 2010 to October 2013. and i have been taking oral anti viral tenofo-B from November 2013 to April 2015 and in May 2015 Doctor prescribed me to start centaurus (Entecaver) in addition with Tenofo-B. My Medical history includes HBV DNA by PCR Quantitative is under 10 IU/ml after 5 Years. But HBeAg is still Reactive 27.09 and Anti-HBe is Non-Reactive 3.3. My ALT is 32. My RBC is 4.5 * 10^12/l, My Hb is 13.8, My Platelet Count is 215 * 10^9/l.
Dear Doctor,
I am a patient of Chronic Hepatitis B. I have been suffering from this disease since January 2009. I am constantly following up my disease since its diagnosis. I want your expert opinion and your valuable guidance in my treatment.
Firstly I have undergone through a pegasys injection + Hepsera Tab therapy for one year from May 2009 to April 2010. During my Pegasys+Hepsera treatment my reports were as under
My HBV DNA PCR Quantitative Results were:
March 2009 - 76200000 iu/ml
August 2009 - 1790000000 iu/ml
October 2009 - 1270000 iu/ml
January 2010 - 334000 iu/ml
April 2010 - 179000 iu/ml
My HBeAg Results were:
March 2009 - 511.68
August 2009 - 309.73
October 2009 - 608.9
January 2010 - 528.6
April 2010 - 412
My Anti-HBe Results were:
March 2009 - 16.21
August 2009 - 19.42
October 2009 - 15.48
January 2010 - 27.82
April 2010 - 20.03
Pegasys Treatment of 48 weeks ended in April 2010. My Doctor prescribed me to start Entecavir 0.5mg daily after the end of Pegasys and Hepsera treatment after examining lab reports.
My Entecavir 0.5mg treatment was started in May 2010. The results during this treatment were as under
August 2010 - 56500 iu/ml
November 2010 - 72800 iu/ml
February 2011 - 66000 iu/ml
September 2011- 18600 iu/ml
April 2012 - 1059 iu/ml
October 2012 - 739 iu/ml
October 2013 - 166 iu/ml
During my Entecavir treatment. My HBeAg Results were:
August 2010 - 457
November 2010 - 508
February 2011 - 558.6
September 2011- 202.3
April 2012 - 152.3
October 2012 - 74.45
October 2013 - 65.06
During my Entecavir treatment. My Anti-HBe Results were:
August 2010 - 18.68
November 2010 - 24.69
February 2011 - 37.39
September 2011- 11.68
April 2012 - 6.57
October 2012 - 4.46
October 2013 - 4.68
During my Entecavir treatment. My HBsAg Quantity results were as follows
December 2010 - 64392.42 iu/ml
September 2011 - 29900.35 iu/ml
April - 2012 - 13230.34 iu/ml
October - 2012 - 7408.06 iu/ml
April 2013 - 49.33 iu/ml
After that i did not carry any HBsAg quantitative tests
My Entecavir Treatment of 3.5 years ended in October 2013.
Then my doctor prescribed me to start Tenofo-B 300mg daily after examining lab reports.
My Tenofo B 300 mg treatment was started in November 2013. The results during this treatment are as under
During my Tenofo B treatment. My HBV DNA PCR Quantitative Results were:
May 2014 - 34 iu/ml
October 2014 - 10 iu/ml
May 2015 - 10 iu/ml
During my Tenofo B treatment. My HBeAg Results were:
May 2014 - 61.25
October 2014 - 41.8
May 2015 - 27.09
During my Tenofo B treatment. My Anti-HBe Results were:
May 2014 - 5.39
October 2014 - 3.99
May 2015 - 3.3
I am still under Tenofo B treatment but my doctor added up Entecavir 0.5mg once again in my recent visit. He asked me to follow up after three months.
This is my complete history, Hope you could understand and help out with your valuable opinion.
I am a patient of Chronic Hepatitis B. I have been suffering from this disease since January 2009. I am constantly following up my disease since its diagnosis. I want your expert opinion and your valuable guidance in my treatment.
Firstly I have undergone through a pegasys injection + Hepsera Tab therapy for one year from May 2009 to April 2010. During my Pegasys+Hepsera treatment my reports were as under
My HBV DNA PCR Quantitative Results were:
March 2009 - 76200000 iu/ml
August 2009 - 1790000000 iu/ml
October 2009 - 1270000 iu/ml
January 2010 - 334000 iu/ml
April 2010 - 179000 iu/ml
My HBeAg Results were:
March 2009 - 511.68
August 2009 - 309.73
October 2009 - 608.9
January 2010 - 528.6
April 2010 - 412
My Anti-HBe Results were:
March 2009 - 16.21
August 2009 - 19.42
October 2009 - 15.48
January 2010 - 27.82
April 2010 - 20.03
Pegasys Treatment of 48 weeks ended in April 2010. My Doctor prescribed me to start Entecavir 0.5mg daily after the end of Pegasys and Hepsera treatment after examining lab reports.
My Entecavir 0.5mg treatment was started in May 2010. The results during this treatment were as under
August 2010 - 56500 iu/ml
November 2010 - 72800 iu/ml
February 2011 - 66000 iu/ml
September 2011- 18600 iu/ml
April 2012 - 1059 iu/ml
October 2012 - 739 iu/ml
October 2013 - 166 iu/ml
During my Entecavir treatment. My HBeAg Results were:
August 2010 - 457
November 2010 - 508
February 2011 - 558.6
September 2011- 202.3
April 2012 - 152.3
October 2012 - 74.45
October 2013 - 65.06
During my Entecavir treatment. My Anti-HBe Results were:
August 2010 - 18.68
November 2010 - 24.69
February 2011 - 37.39
September 2011- 11.68
April 2012 - 6.57
October 2012 - 4.46
October 2013 - 4.68
During my Entecavir treatment. My HBsAg Quantity results were as follows
December 2010 - 64392.42 iu/ml
September 2011 - 29900.35 iu/ml
April - 2012 - 13230.34 iu/ml
October - 2012 - 7408.06 iu/ml
April 2013 - 49.33 iu/ml
After that i did not carry any HBsAg quantitative tests
My Entecavir Treatment of 3.5 years ended in October 2013.
Then my doctor prescribed me to start Tenofo-B 300mg daily after examining lab reports.
My Tenofo B 300 mg treatment was started in November 2013. The results during this treatment are as under
During my Tenofo B treatment. My HBV DNA PCR Quantitative Results were:
May 2014 - 34 iu/ml
October 2014 - 10 iu/ml
May 2015 - 10 iu/ml
During my Tenofo B treatment. My HBeAg Results were:
May 2014 - 61.25
October 2014 - 41.8
May 2015 - 27.09
During my Tenofo B treatment. My Anti-HBe Results were:
May 2014 - 5.39
October 2014 - 3.99
May 2015 - 3.3
I am still under Tenofo B treatment but my doctor added up Entecavir 0.5mg once again in my recent visit. He asked me to follow up after three months.
This is my complete history, Hope you could understand and help out with your valuable opinion.
now start vit d3 10.000iu daily and test after 4 weeks on it vitd25oh, intact pth and hbsag quant and let us know
vit d3 boost immune system and it is possible it fasten hbsag clearance, we will think about pegintf add on in the future after vit d is optimum levels
vit d3 boost immune system and it is possible it fasten hbsag clearance, we will think about pegintf add on in the future after vit d is optimum levels
Thank you for asking me. I am not a doctor.
All your numbers look good to me. You started treatment when you were HbeAg positive, so you were in the Immune Tolerance or Immune Clearance phase.
To me, your doctor seems to be concerned that you are still HBeAg positive and that is why he is now adding Entecavir. It is always my opinion that you cannot make HBeAg negative by treatment, some patients do change from HBeAg positive to HBeAg negative during treatment, especially when treated with Interferon. However, it is not necessary that treatment caused the e-seroconversion, it could be due to the patients' own immune system. A lot of patients e-seroconvert naturally. The researchers are not clear why e-seroconversion occur.
My opinion is that you should just continue with Tenofovir along, there is no benefit in adding Entecavir. Follow stef2011's suggestion, it may help.
The main thing is that you have responded to treatments, whether you remain HBeAg positive is of no importance. Your liver should be in a good state with low hbvdna and low HBsAg. Who knows, you may e-serocovert and clear your HBsAg in the near future.
Just my opinion.
All your numbers look good to me. You started treatment when you were HbeAg positive, so you were in the Immune Tolerance or Immune Clearance phase.
To me, your doctor seems to be concerned that you are still HBeAg positive and that is why he is now adding Entecavir. It is always my opinion that you cannot make HBeAg negative by treatment, some patients do change from HBeAg positive to HBeAg negative during treatment, especially when treated with Interferon. However, it is not necessary that treatment caused the e-seroconversion, it could be due to the patients' own immune system. A lot of patients e-seroconvert naturally. The researchers are not clear why e-seroconversion occur.
My opinion is that you should just continue with Tenofovir along, there is no benefit in adding Entecavir. Follow stef2011's suggestion, it may help.
The main thing is that you have responded to treatments, whether you remain HBeAg positive is of no importance. Your liver should be in a good state with low hbvdna and low HBsAg. Who knows, you may e-serocovert and clear your HBsAg in the near future.
Just my opinion.
hi i e-seroconverted to during my treatment in less than 3months by Viread. I am e-positive since 2009 and from there i only take lamivudine for 3months and stop and ignore. I just resumed to have attention on my HBV last October 2014 and im still e-positive. Meaning I am e-positive for almost 5years wthout seroconverting naturally. And after taking viread become e-seroconverted, now im not sure if its taking Viread or immune system that makes the seronconversion to e.
And by the way I never take interferon treatment., So what makes my e-seroconversion in less than 3months? I only take viread that time and i test this HbeAG and anti Hbe every month. Also i developed anti Hbe.
Most patients e-seroconvert before the age of 40, genotype C generally takes longer time. NA antivirals only inhibit replication of HBV, that is indicated by low or undetectable serum hbvdna, leading to reduction of inflammation, hence normal ALT and little damage to the liver.
Natural e-serconversion occurs during Immune Clearance phase, marked by flares in ALT. If the period of Immune Clearance is long, that is, frequent flares of ALT without e-seroconversion, liver will be damaged as indicated by fibrosis. So whether to treat or wait during Immune Clearance phase is often a difficult decision to make. These days, doctors can be guided by Fibroscan - if serious fibrosis is detected, then treat.
Natural e-serconversion occurs during Immune Clearance phase, marked by flares in ALT. If the period of Immune Clearance is long, that is, frequent flares of ALT without e-seroconversion, liver will be damaged as indicated by fibrosis. So whether to treat or wait during Immune Clearance phase is often a difficult decision to make. These days, doctors can be guided by Fibroscan - if serious fibrosis is detected, then treat.
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