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HBV DNA detected again after stopping Baraclude
I took Baraclude for 3 yrs 3mths and seroconverted to HBe neg/anti-HBe pos. and dna was undetected for about 2yrs. I recently stopped in March. But my recent lab results showed the dna is detected again.
March '12 - Stop baraclude
June '12 - hbv dna 1260 IU/ml
July '12 - hbv dna 966 IU/ml, ALT - 10
My dr said my levels are stable but may also cause liver damage over time. He mentioned the virus in my body belongs to the pre-core or core-promoter mutation group. And he also recommended me to take lab tests every month to monitor.
I wish to know what does "pre-core" or "core-promoter" group mean? What are the repercussions?
Does low hbv dna mean a lower risk of liver cancer?
What should i next do to improve my condition? continue to be on medication? or am I ok to stop and just monitor first. I am thinking of a natural treatment like taking phyllanthus niruri and thymus gland supplement. Anyone knows if it will help?
Appreciate your knowledge here...tks.
March '12 - Stop baraclude
June '12 - hbv dna 1260 IU/ml
July '12 - hbv dna 966 IU/ml, ALT - 10
My dr said my levels are stable but may also cause liver damage over time. He mentioned the virus in my body belongs to the pre-core or core-promoter mutation group. And he also recommended me to take lab tests every month to monitor.
I wish to know what does "pre-core" or "core-promoter" group mean? What are the repercussions?
Does low hbv dna mean a lower risk of liver cancer?
What should i next do to improve my condition? continue to be on medication? or am I ok to stop and just monitor first. I am thinking of a natural treatment like taking phyllanthus niruri and thymus gland supplement. Anyone knows if it will help?
Appreciate your knowledge here...tks.
I'm trying to understand more about the hbv virus, but seems every year there is something new to learn. Last time, seroconversion of eag was the end-pt of treatment. Now, it seems like it's not.
Also, Im trying to figure out if a flare of ALT is good, as I read up that it means your body recognises the virus and immune system is starting to attack the hbv virus. But on the other note, I also read up that its best ALT remain at normal levels as it correlates with liver health. Where is the fine balance?
Also, Im trying to figure out if a flare of ALT is good, as I read up that it means your body recognises the virus and immune system is starting to attack the hbv virus. But on the other note, I also read up that its best ALT remain at normal levels as it correlates with liver health. Where is the fine balance?
There are two kinds of e-antigen seroconversion.
In one the levels of eantigen produced, due to a general reduction of viral burden and expression efficiency becomes so low that the ever present antibody can effectively neutralize the circulating e-antigen, while it is still produced in the cytosol and no mutation took place to block its primary production.
This is a good situation, because now the core and e-antigen specific Tcell responses can come to help reduce the HBv activity, partly by recognizing epitopes processed inside the hepatocytes from the remaining cytosolic e-antigen into core/e-antigen class I specific immunproteasome processable and hepatocyte MHC class I presentable epitopes. Thus the immune response is targeted to infected hepatocytes. Viral load and liver disease gets better and frequently a low level disease carrier state is achieved. Or even a further progression to surfade antigen elimination is achieved in some cases.
The second reason the e-antigen gets seroconverted is, that its intracellular production is dramatically reduced due to mutations that render its transcription to almost or completely invisible.
These are called Precore mutations since the e-antigen precursor protein, the "precore' protein is blocked in its start codon.
As a result no more e-antigen is present in the cytosol and no class I epitope presentation from this potentially quantitatively important "epitope donor" is possible.
Thus the hepatocyte HBV infection is invisible to the outside for Cytotoxic T Lymphocytes (CTLs or cd8 Tcells).
What is left is a class Ii stimulation of dendritic cells by secreted Dane particles that carry the core, that is digested in phagolysosomes of the dendritic cells mainly inside the liver and has several class II epitopes that activate epitope specific helper Tcells (which previously were tolerized by the massive decoy protein, the e-antigen)
but now no more, leading to a proinflammatory intra liver environment with nevertheles relatively low effectivness for virus elimination.
The net result is a lower viral production and load, but often a substantially strong level of hepatitis and consequent fibrosis progression. Stefano is an example of this unfortunate scenario and so are many others.
In this case antiviral are needed to protect the liver by eliminating the majority of the stimulus that results from the above mentioned stimulus of Dane particle processing by dendritic cells and macrophages.
ALT flares are only good if they lead to surface antigen loss and seroconversion. Otherwise they are stepping stones to increased fibrosis and examplary of a chronic war with episodes of destructive battles with no decisive useful but only deleterious outcome.
In one the levels of eantigen produced, due to a general reduction of viral burden and expression efficiency becomes so low that the ever present antibody can effectively neutralize the circulating e-antigen, while it is still produced in the cytosol and no mutation took place to block its primary production.
This is a good situation, because now the core and e-antigen specific Tcell responses can come to help reduce the HBv activity, partly by recognizing epitopes processed inside the hepatocytes from the remaining cytosolic e-antigen into core/e-antigen class I specific immunproteasome processable and hepatocyte MHC class I presentable epitopes. Thus the immune response is targeted to infected hepatocytes. Viral load and liver disease gets better and frequently a low level disease carrier state is achieved. Or even a further progression to surfade antigen elimination is achieved in some cases.
The second reason the e-antigen gets seroconverted is, that its intracellular production is dramatically reduced due to mutations that render its transcription to almost or completely invisible.
These are called Precore mutations since the e-antigen precursor protein, the "precore' protein is blocked in its start codon.
As a result no more e-antigen is present in the cytosol and no class I epitope presentation from this potentially quantitatively important "epitope donor" is possible.
Thus the hepatocyte HBV infection is invisible to the outside for Cytotoxic T Lymphocytes (CTLs or cd8 Tcells).
What is left is a class Ii stimulation of dendritic cells by secreted Dane particles that carry the core, that is digested in phagolysosomes of the dendritic cells mainly inside the liver and has several class II epitopes that activate epitope specific helper Tcells (which previously were tolerized by the massive decoy protein, the e-antigen)
but now no more, leading to a proinflammatory intra liver environment with nevertheles relatively low effectivness for virus elimination.
The net result is a lower viral production and load, but often a substantially strong level of hepatitis and consequent fibrosis progression. Stefano is an example of this unfortunate scenario and so are many others.
In this case antiviral are needed to protect the liver by eliminating the majority of the stimulus that results from the above mentioned stimulus of Dane particle processing by dendritic cells and macrophages.
ALT flares are only good if they lead to surface antigen loss and seroconversion. Otherwise they are stepping stones to increased fibrosis and examplary of a chronic war with episodes of destructive battles with no decisive useful but only deleterious outcome.
What is the most common kind of e seroconevrsion for the people that seroconvert naturally without NUC's. (I think that this is most common way for e seroconversion)
As far as I know for people that seroconvert naturally we have second kind, the one with Precore mutation and in this case one question will be why in the treatment guideline is not indicated to treat in immunotolerant phase in order to be maximise the chance not to select a Precore mutation
In case of Precore mutation you say that we have a proinflammatory intra liver environment. How this can be see ? (ALT / AST or ? )
As far as I know for people that seroconvert naturally we have second kind, the one with Precore mutation and in this case one question will be why in the treatment guideline is not indicated to treat in immunotolerant phase in order to be maximise the chance not to select a Precore mutation
In case of Precore mutation you say that we have a proinflammatory intra liver environment. How this can be see ? (ALT / AST or ? )
I had VL come back up after taking ETV for 4 years..
As soon as I stopped it (a month later) Viral load went up to, 100,000 in a month time, and to 300,000 in two moths time of the Baraclude.
So I started taking it again. and my VL in a month was undetected again. What was interesting though my ALT and AST levels were normal as HBV was rising. I have too precore/basal core promoter mutant infection.
This is what I have, very nasty form I am told..
T1762/A1764 mutant
Precore Codon 28 wild type
Genotype A
What was surprising to me is how quickly I have HBV bouncing back up without ALT and AST getting elevated. My Hepatologist thought that maybe I should not worry about DNA levels and wait till it gets up there in the millions with abnormal ALT and AST and then try to treat to it with Peg..
But got scarred of this VL and went back on Baraclude.
As soon as I stopped it (a month later) Viral load went up to, 100,000 in a month time, and to 300,000 in two moths time of the Baraclude.
So I started taking it again. and my VL in a month was undetected again. What was interesting though my ALT and AST levels were normal as HBV was rising. I have too precore/basal core promoter mutant infection.
This is what I have, very nasty form I am told..
T1762/A1764 mutant
Precore Codon 28 wild type
Genotype A
What was surprising to me is how quickly I have HBV bouncing back up without ALT and AST getting elevated. My Hepatologist thought that maybe I should not worry about DNA levels and wait till it gets up there in the millions with abnormal ALT and AST and then try to treat to it with Peg..
But got scarred of this VL and went back on Baraclude.
I took Phyllanthus Amarus. back in 2007, before Baraclude. And ND I saw promised me he will cure me. But VL was multiplying almost weekly..
My 2007 VL before treatment was kinda going like this..
February 2007 - 5,000,000 copies
March 2007 - 11,000,000
April - 26,000,000 (on Phylanthus)
May or June, 246,000,000 (on Phylanthus)
ALT was slightly elevated I think it was like around 80. With 246 mil HBV DNA I was loosing about one pound a day..
Started ETV 1mg in July 2007 I think VL was close to 500,000,000
September of 2007 VL went down to 16,000,000
October 2007 VL around 100,000
November 07 was Undetected..
Bristol Mayers were very happy took all my labs, also dumped me from medication assistance program because at that time I had no health insurance because I was to messed with stress to be able to work with all this.
So the bottom line here Baraclude definitely works and Phyllanthus did not at least the one I tried that is sold here in capsules at health food stores..
My 2007 VL before treatment was kinda going like this..
February 2007 - 5,000,000 copies
March 2007 - 11,000,000
April - 26,000,000 (on Phylanthus)
May or June, 246,000,000 (on Phylanthus)
ALT was slightly elevated I think it was like around 80. With 246 mil HBV DNA I was loosing about one pound a day..
Started ETV 1mg in July 2007 I think VL was close to 500,000,000
September of 2007 VL went down to 16,000,000
October 2007 VL around 100,000
November 07 was Undetected..
Bristol Mayers were very happy took all my labs, also dumped me from medication assistance program because at that time I had no health insurance because I was to messed with stress to be able to work with all this.
So the bottom line here Baraclude definitely works and Phyllanthus did not at least the one I tried that is sold here in capsules at health food stores..
strange but these are facts.. yours as well as mine..i am not sure how the powder is made in case of capsules..i am taking the fresh leaves whenever it is available and powder made from leaves whenever fresh leaves are not available.. i am taking this along with turmeric and pepper powders along with other siddha medications (thripala and Karisalai Karpam Tablets and amukkara chooranam)..I am not going to post anything till I get some concrete results from my medication..
Again pls do not follow my medications as siddha medications are recommended based on one's medical condition and the medications will vary from person to person
Again pls do not follow my medications as siddha medications are recommended based on one's medical condition and the medications will vary from person to person
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