My Hep B results. Please provide treatment suggestions

[82prasad]

Hi Stef, Vijik and others,
Please provide treatment suggestions for me.

I am having HBV for the last 9 years atleast and my age is 30 years now
My latest results are as follows:
CBC - Normal
Liver funtion test - Normal
ALT - 47 (range is 30 to 65 U /Lt)
AST - 24 (range upto 35 IU/Lt)

HBeAg - Positive (29.901)
Anti ABeAb - Negative (1.53)

HBV Viral Load - 207 (Reference: Sensitivity limit: 3.8 IU/ml)
HbsAg, serum - Positive (>250)   (reference: Negative: < 0.05 IU/ml)

Thanks,
Prasad

[Rome70]

For your information ALT = 47 is not considered to be in "normal range" for HBV patients anymore. The upper limit is 30 for males and 25 for women.

Please do not misguide people in this forum with your senseless answers.

[Nmarius]

Well, good results! Happy for you. Put your ALT. AST results. Normal range for male is >30 and females >19.

[82prasad]

HBSag has increased from 26000 (3 years back) to  38000. AST ALT is around 35. My doctor wants me to stop TDF and monitor

[82prasad]

Hi all,
Can you please interpret these biopsy results

Modifies knodells score
- Necroinflammatory index 4/18
- Fibrosis score 1/6

Starting with TDF.

[82prasad]

Hi all, on 3 months TDF, my Viral load dropped from 56315 IU/ML to undetectable (<20 IU/ML). AST ALT at normal levels.

[82prasad]

hi Stef, Aduiski and others,
I am doing well with TDF, i.e. my SGPT is in control and DNA viral load in control. However the pain in my liver surfaces often. Please advise if over these years any more potent medication is available. I am on TDF for the last 3 years

[stef2011]

still on tdf as well, nothing better for now.as to liver pain check your diet, add natural anti inflammatories like curcumin, black seed oil, glutathione, resveratrol and so on, keep healthy weight by excercise

[82prasad]

Also Stef aduiski
I am asked to take evion (vitamin e) and ursokol for a month with tdf... Any interference you see?

[82prasad]

Thanks.Stef
I got your reply on another thread that its best taken after bf

[82prasad]

Thanks.Stef
I got your reply on another thread that its best taken after bf

[82prasad]

Hi all
Good news is that I am able to convince my doc to prescribe me tenofovor (reviro)
He asked me to take this empty stomach before breakfast. Is that the right way to take it?

[82prasad]

Hi Stef aduiski I got my fibrosis results
Modifies knodells score
- Necroinflammatory index 4/18
- Fibrosis score 1/6

Can u pls tell me interpretations of this

[Aduiski]

1. get a new fibroscan value.

2. you can always measure ALT which indicates the current level of liver inflammation

[82prasad]

Got Biopsy done finally. Will get results coming saturday and start treatment soon...

[82prasad]

Hi Adusiki,
No it is definitely a real pain and not psychological. Maybe liver inflammation or something. Its troubling right showlder and back too.... Lets see... hope for the best. In my country it is a very slow process to take biopsy and fibroscan appointments. Even hepatologists approintments need 15 days here... and after such waiting period, we find out that the doctor is only academic :(

Last year same month my KPA was 5.8. I wish its not much elevated....

[Aduiski]

In other words there is no bad news for you...as u have assumed.

[Aduiski]

It is probably related to thinking about hepatitis b, a psychological thing.
It happened to me on a number of occasions that when I was thinking about possibility of hcc (and this would happen especially days before screening for hcc) or hep B complications, I would be getting pains around my liver and surrounding areas. The more I worried about hcc, the more would pain be increasing...the less I worried the pain would disapear.
This pshychologically induced pain can become very strong indeed.

I am pretty certain that your pain is also a psychologically related....once your tests shows you are fine the pain will disappear all of the sudden.

[82prasad]

Hi Aduski, Stef,
Bad news is I am facing pain under the right ribs, now backache and right showlder ache since last 10 days. Earlier I attributed this to incorrect sleeping posture but after reading on net I know this is due to liver. I am anyaways doing a biopsy this week but do u suggest I should also get an ultrasound done? Is this pain due to liver inflamation or fibrosis. (I had a fibroscan done last year - 5.8 KpA and my doctor had said fibrosis is a slow process so it wont harm for few years atleast)

[82prasad]

"my hbsag went from 7200 to 700iu/ml by 6 years so i dont think it will last another 6 years and years go fast"

Congratz on this Stef, but I hope you dont leave this site ever even after you clear HbsAg:) May I know did u use NUC monotherapy or peg or both to achieve this?

I'll have my biopsy this friday (have done fibroscan last year - 5.8 KPA) and start NUC. Will keep you posted.

[stef2011]

Also I assume HbsAg as such is not harming to liver if viral load is in control and liver is healthy, am I right in saying this?

you even regress advanced cirrhosis by making hbvdna undetectable, hbsag is harmless and non infectious.its use is mainly suppress our immune system from attacking the virus.
so by antivirals you achieve a perfect liver like if there is no virus

hsag lowers on antivirals, just slow for majority of patients but we have time, my hbsag went from 7200 to 700iu/ml by 6 years so i dont think it will last another 6 years and years go fast, they look like few days to me when i started nucs

vitamin d3 must be taken but not together with antivirals so we are sure to avoid any  possible interference

[82prasad]

Million Thanks Adusiki,
You have been of great help to me.

I hope HbsAg drop if even for HbeAg negative persons? Im ok with smaller percentage drop as well as long as it drops :) and doesnt increase. Sorry what do you mean by 0.34 logs on 26000?

[Aduiski]

log base 10...

http://www.miniwebtool.com/log-base-10-calculator/

[82prasad]

Thanks a ton Stef,
So you say no use to supplement with Vit D medications if im taking ETV right...

I got your point on clearance rates, I agree on it however does NUC's only reverses liver condition and reduces viral load or even reduces HBsAg (in HbeAg negative). I agree it may not clear but is there a chance of lowering this? Also I assume HbsAg as such is not harming to liver if viral load is in control and liver is healthy, am I right in saying this?

[stef2011]

no vit d is better absorbed with meals, etv can t be taken close to meals

tests: vitd25oh, intact pth

genotype A has the highest levels of hbsag among all genotypes but very little studies because all the studies are made on italian genotype D and asian genotypes (no studies in US/UK and nothern europe where genotype A is common) this said it is possible response on hbsag is higher both on nucs and peg, infact genotype A has the highest clearance rates on peg and nucs (not sure if nucs is hbeag pos or neg, i guess pos)

[82prasad]

Hi Stef, Could you please recommend me Vit D test and medications. Also should I take these tablets with NUCs?
HBsAg 26000 IU/ml,
HBV Viral load 56000 IU/ml
HbeAg Negarive
Genotype A
ALT - 50

[82prasad]

Thanks Aduiski,
Shall eats lots of fish and take natural sunlight and await Stefs reply on medications on Vit D.

Can NUCs bring down HbsAg (over years I mean) or is it just that they bring down viral load. Is it ok to have such a high HbsAg then while just lowering viral load (in my case its 26000 IU/ml)

[Aduiski]

Hbsag drop at 4 years for tenofovir and entecavir is on average 0.34 logs, but this is average...for some higher for some lower. If you are an "average" person then for you in 4 years nucs would lower your hbsag from 26,000 to 12,000 iu/ml

[Aduiski]

loosing 14,000 in first 4 years doesn't mean that you will lose other 12,000 in short time...on the opposite...the lower your hbsag gets the harder it is to further lower it. (Basically you can look at it as loosing certain percent of hbsag each year).

[Aduiski]

the above average loss is from some research studies off course, the real data might differ from those...

[82prasad]

Aduiski and Stef,
Can you please recomment me Vit D medicine please which I may take with NUC

[Aduiski]

steff is an expert of Vit D, i'll leave him to recommend the supplments.
However, natural sun (direct, can't be absorbed trough glass) and organic fish should be the best, being the natural, so get them as much and as frequent as you can.

[82prasad]

Yes. But TAF not in my country yet. Till then...long live TDF :)

[82prasad]

Thanks Stef and Aduski,
Hi Stef: Your views on no resistance gives me hopes. Ill try my best to force my doc into TDF over ETV. Im trying to see if there are any other cheaper substitutes of Peg in India like Exurra or Taspiance in which case i might go for peg interferon over NUC if you suggest me to do so. Else Ill go with NUC only.

Stef, with 15 years and no resistance, can we safely say that TDF is almost a cure for chronic HBV...coz even if resitance develops after 15 years, you still have ETV (or vice versa) for another 5-10 years. That would give me 25 years of a safe life which is all I ask for...

[stef2011]

by thw way there are single cases of off label patients who started tdf in 2000, 15years of no resistance

i think there will never be a resistance to tdf and that it will cure hbv on most patients by 2 decades, too bad we can t see hbsag levels on the few patients on it so long time
we have few italian patients reports that after 12years of lamivudine with no resistance hbsag was very very low or cleared

[Aduiski]

indeed...we should celebrate the existence of tenofovir and hopefully equally effective but less toxic TAF.