HepB carrier from birth with sudden flare ALT >1500 and AST >500

[orientalPearl]

Hi everyone i'm not sure what to make of my 'recovery' so far as I can see some significant drop in my liver enzymes test but still the values are above normal range. How long does it usually take to get all the enzymes back to normal range? I'm currently on Entecavir and Legalon and the cost is really killing me. Any idea what else i can take that will not interfere with Etv ? I read that Chanca Piedra works for some so i'm not sure if its a good idea to take it together with my meds. The doctor says that i can be off Legalon if I have HBeAB but I asked a pharmacist and he says Legalon is just a supplement so I can take it as long as I want it doesn't matter if I have HBeAB or not.
Just would like to know the usual recovery time needed and also to document my current fight with hep B here.

Family history
-------------------
Grandfather(now 79 years old) - drank alcohol and was hospitalized 11yrs ago (currently on Sebivo)
Mother(now 55yrs old) - also drank alcohol and hospitalized at yr 2011 (not on meds now previously on Entecavir)
Me(27yrs old) - did not drink but hospitalized anyway (currently on Etv and Legalon)

Symptoms
---------------
Dark urine and loss of appetite for > 2weeks
Food did not get digested with constant bloating and burping of food >5hrs after meal
Fatigue and mood swings and late menses
Feeling of tightness on right side of abdomen, back pain

Went to the local doctor and did urinalysis, trace blood, leucocytes, ketone, bilirubin and urobilinogen found
Prescribed Ciprox for urinary tract infection and finished 5 day course
Symptom persisted and proceeded with blood test

Blood test result
---------------------
**Blood drawn on 28/12/2012 but result collected 1week later**
Total Bilirubin 32 umol/L
AST 553 IU/L
ALT 1519 IU/L
GGT 95 IU/L
Prior to this test, past blood tests have never had any out of range values for Liver Function Test
Started on Bitter Melon tea for 2 days before seeing the specialist (improved appetite observed)

Hospitalized after seeing the hepatologist with blood test result above
Doctor ordered another set of test
***7/1/2013***
Total Bilirubin 14.6 umol/L
AST 184.9 IU/L
ALT 581 IU/L
GGT 77.3 IU/L
HBsAg 6614.05 IU/ml
HBeAg 1057.61 S/CO
Ultrasound done with no liver enlargement observed (but i can still feel tightness around abdomen)
Doctor started me on Entecavir and Legalon

After 1 week on Entecavir and Legalon
***14/01/2013***
Total Bilirubin 13.1 umol/L
AST 46.4 IU/L
ALT 146.6 IU/L
GGT 52 IU/L
HBeAg 708.3 S/CO

Any feedback is welcome. Hope to hear about the recoveries of others from hep B! Really need something positive right now :)  Thanks everyone!

[StephenCastlecrag]

I am glad your ALT is returning to normal after a very severe flare. Next time when you have your test, be sure to test for:
1. your HBeAg status - here we are hoping that you will seroconvert to HBeAg negative after such a big flare;
2. your viral load (hbvdna), this will provide more useful information;
3. if possible a quantitative assay of your HBsAg - here we are hoping to see a big decline.

I think you should give up Legalon since you are already on Entecavir. It is a herbal supplement and serves no useful purpose as your ALT is returning to normal.
You may like to try get cheaper generic Entecavir from India or China.

Just my opinion.

[stef2011]

check both hbeag and hbsag quantity, such a high flare on entecavir can mean:
hbvdna decrease but also hbeag seroconversion and also hbsag seroconversion and follow hbsag quantity in particular you may be one of the lucky who clears on etv by 1-3years use

[orientalPearl]

Im back with my latest test result after a month on baraclude n legalon

**04/02/2013**
Total bilirubin 9.2 umol/l
Ast 21 u/I
Alt 22.1 u/l
GGT 23.9 u/l

Hbsag 6453.81 s/co
Hbeag 324.55 s/co
Anti hbe 4.261 s/co

I noticed that the hbsag test are in different units compared to my first test.. Which unit is more accurate?

By the way, the hbv DNA result from 7/1/2013 during my flare is out.
It was 94,100 iu/ml n I will be taking another test in another 6 months.
I'm really happy that my liver function has returned to normal but I'm not quite sure about the other results. If alt goes back to normal mean slower clearance of virus or hbsag?
Any feedback is welcome!

[StephenCastlecrag]

Your ALT is very good. You are right, your HbsAg test this time is not a truly quantitative test and so comparison with your previous test result is not possible. Next time, insist on the test that reports in iu/ml. It does seem your HbeAg is coming down too. I am guessing that your hbvdna is already on the way down when your ALT peaked. So hopefully your next test in 6 months will show that you have seroconverted your eAg and your hbvdna will be undetectable.

Your are right, the price of normal ALT is that your immune response to virus is quietened too. Remember, not all flares will clear the virus and they do cause fibrosis.

If Baraclude is too expensive, try to buy them from India, it should be cheaper.

[orientalPearl]

By the way, I forgot to add..I didn't just take baraclude n legalon. I also took bitter melon tea ( fresh melon without seed slow cooked for 4 hrs) almost daily. It helps me to digest n I notice that the days I didn't drink it my stomach discomfort will be back. I  don't know how it will interact with my meds though. So far only side effect is low blood pressure at one point 76/48 so I stopped for a few days.I've started planting phyllanthus, will start to drink that consistenly soon.  I'm thinking of meds+herbs for 6mths to see how it goes. Other than that, I drink chlorophyll n propolis once a day too. Prior to my flare, I drink all sorts of tea on a daily basis, ranging from fennel tea to goji berry+American ginseng slice, cats whiskers ( orthosiphon something), lemongrass+mulberry leaves tea to coconut juice to a lot more ( mostly from the garden).
Don't mean to deviate from the topic, just sharing in case anyone want relieve of symptoms, do give bitter melon a try.

[orientalPearl]

Hi all i'm back with my latest test result

This is my first major follow up checkup, the rest was just liver function test which by the way was always within range

30/07/2013
-------------
Ast 24 iu/l
Alt 15 iu/l
Ggt 8 iu/l
Hbsag 445 iu/ml (called up the doc n didnt see with my own eyes so I could have misheard)
Hbeag 99.05 s/co reactive
Hbeab 4.5 s/co negative
Afp 3ng/ml
Ultrasound normal n well outlined
Fibroscan 4.8kpa f2 fibrosis stage
Hbv dna still pending will know in 3 weeks time

So what do u guys think? My doc is asking me to go for IFN injections but I dont think I can afford because the fee is way too astronomical n insurance dont cover for hep b. I'm really not sure what to do.. :(

[andrey19]

I think 4.8 kpa does not correspond with F2 stage fibrosis but with F0 fiborosis. As for peg, it very expensive in Thai. Somewhat around $1000 for shot.

[orientalPearl]

The full report says

Fibroscan interrogation of the liver parenchyma was performed with an M sized probe. A total of 10 measurement was performed. The readings range from 3.6-5.3kpa. Mean stiffness reading of 4.8kpa. Correlating with the liver (kpa) andfibrosis stage according to Metavir score, the reading corresponts to below f2 fibrosis stage.

Sorry it says below f2. I totally missed that one! Lol thanks for pointing that out at least I can be a little bit happier now. :)

[andrey19]

I think with such low readings of 4.8 kpa your liver is in perfect conditions.

[orientalPearl]

I found that my situation is a little bit different from others because I don't have elevated ALT/AST values but HBSAG is on the decline. Is this considered as inactive carrier state? The decline looks significant so I'm not sure if I should go with IFN treatment as advised by my doctor. Can you share your opinion?

[Jeff912000]

should go for interferon since your are responding.  Cheaper in the long run if you get rid of it.

[Magda123]

Definitely should go for int.

You may check with Otan, int is cheaper in indonesia @USD200/injection (roche) or with Cyrus in HongKong @USD180/injection.

I strongly believe you're a good candidate for int as you are hbeag positive.

[StephenCastlecrag]

You are still HbeAg positive according to the test. You will get a better picture when your hbvdna result is available. Based on your ALT, I guess you are responding well to Entecavir and your viral load could be very low, even undetectable.

Patients who respond to Entecavir will be "inactive" in the sense that hbvdna is very low and ALT is normal. Usually, inactive is used to describe those patients who are not under treatment but have hbvdna < 2,000 iu/ml and normal ALT. Research show that patients who are not under treatment and who are in the inactive phase usually have a lower level of HBsAg.

[orientalPearl]

Thanks all for your advice n opinion. I'll be back in 3 weeks time with my hbv DNA results. Meanwhile, I have decided to hold for IFN treatment because I don't think I'm ready yet both financially n emotionally. Can only hope for a miracle for now. Take care everyone :)

[orientalPearl]

Hi Stephen, I'm back with my HBV DNA result. What do you think of my result? After more than 6mths it is still not UND yet. :(

Blood test result
---------------------
28/12/2012
Total Bilirubin 32 umol/L
AST 553 IU/L
ALT 1519 IU/L
GGT 95 IU/L

***7/1/2013***
Total Bilirubin 14.6 umol/L
AST 184.9 IU/L
ALT 581 IU/L
GGT 77.3 IU/L
HBsAg 6614.05 IU/ml
HBeAg 1057.61 S/CO
HBV DNA 94,100 iu/ml

***14/01/2013***
Total Bilirubin 13.1 umol/L
AST 46.4 IU/L
ALT 146.6 IU/L
GGT 52 IU/L
HBeAg 708.3 S/CO

**04/02/2013**
Total bilirubin 9.2 umol/l
Ast 21 u/I
Alt 22.1 u/l
GGT 23.9 u/l
Hbsag 6453.81 s/co
Hbeag 324.55 s/co
Anti hbe 4.261 s/co

30/07/2013
-------------
Ast 24 iu/l
Alt 15 iu/l
Ggt 8 iu/l
Hbsag 445 iu/ml
Hbeag 99.05 s/co reactive
Hbeab 4.5 s/co negative
Afp 3ng/ml
Ultrasound normal n well outlined
Fibroscan 4.8kpa
HBV DNA 31 iu/ml

[StephenCastlecrag]

31 iu/ml is very low - few years ago it would be described as "undetectable". I think the most sensitive assay can detect  20 iu/ml and up. Your HbsAg is below 1,000 iu/ml which is very good. Studyforhope seems to think this is a threshold below which indicate likely immune control. You are still HBeAg positive, given time, you should seroconvert to HbeAg negative. All in all, you are responding well to Entecavir. Keep on taking Entecavir in the short term, in the longer term, you have several options:
1.after HBeAg seroconversion, consolidate for a year or more, then stop;
2.add on Interferon, with the aim to clear HBsAg - stef2011 will give you his comments, LOL.

Just my opinion.

[orientalPearl]

Would seroconversion be possible without inf? I mean if the decline is still ongoing then eventually I'll be able to have some immune control right? Also one other thing I don't understand is, how come my hbsag declines without my alt going above normal level? I've been reading Stef2011's post and he is always saying normal alt is actually not so good cos it means our immune system is not fighting.

[newtr]

in your case it seems that the present hbsag decline is result of previous high alt flare..and see weather the hbsag decline goes on or not. probably it will continue to drop.

[newtr]

but dont waste time, immune activity is going on so add interferon as soon possible atleast for 4 weeks and test hbsag, then you may decide what to do, continue interferon for 6 months or not. this scheme is not too costly. consider.

[StephenCastlecrag]

It is possible to be cured without treatment, just as it is possible to be cured whilst on antiviral treatments. But the percentage is low. Interferon does not cure 100%, but it generally has a better cure rate than antivirals.
Why did your HBsAg decline without a rise in ALT? Good question, I wish I know the answer. It is known that our immune system can eradicate the virus from infected cells without killing the cells. Interferon and TNF-alpha can inhibit HBV replication in a non-cytopathetic manner. Of course, the immune system can also eradicate the virus by killing the infected cells. Our immune system is wonderful when it works, and it is very complex, there is still a lot to be discovered, and a lot for us to learn and understand.

[orientalPearl]

Thanks for trying to answer my question. I'm just very confused over the different progress n stages of this disease. Too many questions to ask..lol.Currently my family is not supportive when I mention IFN even though I told them that it could be a possible cure. Hopefully somebody finds a more definitive cure in the future. Really hope that cure will happen during my lifetime. :)

[StephenCastlecrag]

I am sure a cure will happen in the next few years, that is what I keep saying....

[mustthinkpositive]

Hiya Stephen,

Modern science and evolution should prevail in the fight against this virus. I agree with you that a cure is on the horizon.

BTW, are you looking for a cure yourself or helping others out there with your expertise. A wonderful member to the forum. Always giving good advice. Thanks.

[StephenCastlecrag]

Thank you for your kind words. Just like you and others in this forum, we are here to help each other and in the process helping ourselves.