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

[Arti Sharma, M.D.]

Hi there,
Your ALT is in normal range though there is HBV DNA and surface Antigen which are positive and above reference range. The presence of HBeAg is useful for deciding whether to start and when to stop antiviral therapy. Oral antivirals are given till HBeAg seroconversion has been achieved and antibody to HBeAg has developed. After HBeAg seroconversion is achieved, antiviral therapy is usually given for another 6–12 months before stopping. The treatment cannot be individualized. A complete evaluation is important before giving an accurate advice and management. Consult your hepatologist.
Best luck and regards!

[stef2011]

you need to treat absolutely before hbv mutates to hbeag negative and hbeab positive

first you need to go back to the lab because they fraud you not checking hbsag quantity, they have an old abbott kit which needs diluition for hbsag superior to 250iu/ml, which is 99% of hbv carriers, so the lazy lab tech that made no diluition is to kick in the *** for this
to know your chances to clear hbv we need hbsag level absolutely and hbv genotype

hbvdna is of little to no use to predict response to treatment but anyway a low hbvdna is better than a high one, the main immune supppressing part of hbv is hbsag but also a high hbvdna have immune suppressing effect (hbsag is also a part of full virions)

so come back with hbsag level, hbcab igm level possibly, hbeag level

[stef2011]

sorry but your knowledge of hbv is obsolete and just accademic, if you are not updated with personalized hbv treatment avoid answering to this channel, any hepatologist can suggest that, here we discuss only the most updated therapies to clear hbv and not just how to control it

[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.

[stef2011]

and 25 for women.

19 for women

anyway i also noted that  Arti Sharma is confusing because just reporting absolete accademic info on hbv which can be found on any generic website we are actually fighting this uncorrect/obsolete info

[Mrt79]

Pls lets stop fighting over nothing.
I find some of her (Arti Sharma, M.D) answer helpful.
Thanks

[82prasad]

Hi Stef,
many thanks for your valuable inputs. Its been more than a couple of years since Im replying, apologies. My doctor did not prescribe a treatment then and he has asked me to start treatment now with the below latest results
ALT - 50 and HBV DNA (viral load) 56000 IU/ml
Fibroscan - normal
HBeAg - Consistently Negative (it was positive eearlier)
HbeAb - Positive (it was negative earlier)

Despite HbeAg being negative, why is my load still high?
My lab is saying we dont do HbSAg quant :(

My doctor asked me to get a biopsee and genotype test done which are due next week end and I need to choose among Pegasys and Entecavir. Pegasys is too costly for me and also with the dreaded side effects i may go for Entecavir. What do u think?

[Aduiski]

Steff gave you the right advice then but you didn't follow it :)

I just had a big lough at how Steff and Rome slammed that unknoledgable doctor :))

You should be able to find in India a lab to measure hbsag quantitatively. Together with your genotype results (you will most likely by genotype D but lets pray that you are instead a genotype A) you can then get a better guess as to what would your chances be to clear hbsag with PEG-INF (if you can find a way to afford it financially)

[stef2011]

Tdf is better, more potent and cheaper, it is ok to start anyway because we have drugs to clear hbsag by few years but they need hbvdna und and hbsag also goes down on 50% patients on tdf on the year 5th of treatment this will fasten cure by new drugs,by cuban vaccine or by peg add on

Patents on tdf and peg will expire in the near future and this will benefit those without free access to these drugs

[82prasad]

stef what is the resistance of these NUCs specifically entacavir and tdf. Can I take these life long Im just 33. I am assuming a worst case of not finding any curative drug in future and not able to afford pegasys in future.

[82prasad]

Thanks Stef and Aduiski,
Aduisly, you are right. I went to three doctors in India and all of them were adamant on not treating and eventually HBEAg was turned positive. Is this too bad news for treatment now?
Hi Stef,
I will ask doctor to start tdf (if at all he listens to me else entacavir).
Question1) What are the chances of surviving for the next 20 years atleast with these oral antivirals (given a worst case situation of scientists finding no proper cure and pegasys being expensive forever)
Question2) Can I take entacavir / tenefovir life long ?
Question3) If pegasys gets any cheaper say after 3-4 years, Can i take the peg treatment after 3-4 years as I shall be on tdf or entacavir then... Will it help?
Question4) Is genotype D non responder to peg?

Thanks a lot
Prasad

[82prasad]

Hi Stef,
Cuban vaccine is to prevent or cure? I always thought it will only prevent.

[sorte]

Neither prevent nor functional cure. It's going to make immune system to have some control over infection, like antivirals.

[82prasad]

Thanks Sorte, I hope there is a curative medicine in future...

[Aduiski]

Post all the results you had, including all of your ALT and DNA values over time

[Aduiski]

also...do you drink alcohol...and did you have anyone in your family that had hcc? You should find a way to measure your hbsag quantitatively in IU/ml and measure your genotype.

[82prasad]

Hi Aduiski,
Many many thanks for replying this quick. here is a snapshot
Year 2005: Had first (and only) jaundice. Tested positive for HBsAg.
Year 2009: HbsAg positive, Viral Load 13000 IU/ml
March 2013:  
CBC - Normal
Liver funtion test - Normal
ALT - 47
AST - 24  
HBeAg - Positive (29.901) HBeAb - Negative (1.53)
HBV Viral Load - 207. No treatment

Jan 2015:
CBC, Normal
ALT - 57
AST - 27
HbeAg - Negative, HBeAb - Positive
HBV Viral load - 13000 IU/ml. No treatment prescribed
Fibroscan - No fibrosis, in the first band.


Jan 2016:
CBC normal
ALT - 50
AST - 27
HbeAg - Negative
HBV Viral Load - 56000 IU/ml.
Doctor has advised biopsy which is due next weekend and my genotype test result is awaited. Meanwhile doctor has asked me to choose one among Pegasys or Entacavir. Also he said if my genotype is D, pegasys is useless. As it is its too expensive for me as of now so I told him Ill go with tablet.

I have found one lab in India for HbsAg quantification. Will try my luck.

Please advise me
1) What are my chances of leading a healthy life for the next 20 years atleast (Im just 33, male)
2) Treatment sugessions. Can I go for pegasys post tablet therapies for 4-5 years (thats when I suppose pegasys will be cheaper)
3) Is it feasible to be on life long treatment without resistance or any other complications.

Answer to your questions:
Have stopped alcohol completely. Anyways must have had it very very rarely like once a quarter or so.
No history of HCC as such in family

[Aduiski]

Good. If you abstain from alcohol, keep a regular eye on your hep b, eat and live healthy, then you shall have less then 2.5% chance of dying from consequences of hepatitis B, this is assuming that you are either genotype D or E.

Totally abstain from alcohol, get into regular drinking of coffee, stop smoking if you smoke, don't eat much sugar/sweets/junk food, abstain from fat especially saturated fat (found in large quantities in meat fat), use only diary products (milk, cheese) with reduced fat (unless drinking fresh camel milk), maintain regular (4 times per week or more) exercise, eat lots of fresh/organic fruits vegetables multiple times per day, check your vitamin D levels and if low get yourself lots of sunshine every week but if no sunshine get vit D suplements.

Lets wait for your the results of your biopsy, genotype and HbsAg quantification results...at that point you'll be smarter as of your next move...

[82prasad]

y coffee? to abstain from alcohol or any other reason? Im not at all into coffee hence my question...

[Aduiski]

Coffee is shown in a number of big research studies to reduce hcc chances by 40% if taken regularly 2-3 times per day.
I wasn't into coffee myself, but now I am as I want to shave of 40% of my hcc chances down.
When you drink coffee use natural sweeteners instead of processed sugars.

[82prasad]

Thanks, I consume tea normally will try switching to coffee

[82prasad]

Thank you so much Aduiski
Less than 2.5%... thats very motivating... shall update with biopsy, genotype and quant (if im able to do this) results shortly.

[Aduiski]

forgot to mention, the regular use of black seed (freshly grinded, but don't do it huge quantities as then it can be toxic) and fresh raw organic honey, as these are natural immune boosters. Try avoiding heavy stress, it contributes to cancers as well as most of other diseases...

[Ashutoshh]

Hi all
My father( 60 yrs)recently diagnosed with hbsag +ve accidently . Doctors said not to do anything and be on wait and watch .we went to a specialized hospital ,there they said he has this by birth!!  And told us to get my mother tested ,even though i said that we all got tested for hbsag after this outbreak and came as -ve . They told us to get anti hbs , anti hbc, anti hbc core(total) ,,,,are these tests necessary ???

His results are as follows _
Hbeag  negative 0.23
Hbv dna  34 iu/ml  which increased to 242 iu/ml in 3 mnths
Afp serum 2.52 ng/ml
IgG serum 19.8 g/l
HbsAg  302 iu/ml
Anti HBe 0.02 reactive ,,,AHBeAb-T  5.09 NEGATIVE ( found 3 mnths back )
Fibroscan 3,2 KPa
UGIE ENDOSCOPY NORMAL
CT upper abdomen triple phase ,,shows   EARLY SIGN OF PARENCHYMAL DISEASE of liver
GEnotype could not be determined.
KFt and LFT  are normal  ,,,ast 28iu/ml  alt 36 iu/ml  
In DLC HE IS FOUND EOSINOPHILS 18%

They prescribed ZENVIT( MULTIVITAMIN TAB ) + TENOVIR
ONE doctor prescribed LAMUVDINE .

.PLEASE suggest what should we do .
I am also confused with anti HBE Values ,,,is anti Hbe and AHBE Ab_Total  are not same  ??
What about paranchymal disease?

Thank you

[Ashutoshh]

What are the chances of spread of hepatitis b virus  in a household ?

[82prasad]

100% between spouces/partners. 100% from mother to child. Not significant in any other cases. But take a vaccine...

[Ashutoshh]

Hi all
My father( 60 yrs)recently diagnosed with hbsag +ve accidently . Doctors said not to do anything and be on wait and watch .we went to a specialized hospital ,there they said he has this by birth!!  And told us to get my mother tested ,even though i said that we all got tested for hbsag after this outbreak and came as -ve . They told us to get anti hbs , anti hbc, anti hbc core(total) ,,,,are these tests necessary ???

His results are as follows _
Hbeag  negative 0.23
Hbv dna  34 iu/ml  which increased to 242 iu/ml in 3 mnths
Afp serum 2.52 ng/ml
IgG serum 19.8 g/l
HbsAg  302 iu/ml
Anti HBe 0.02 reactive ,,,AHBeAb-T  5.09 NEGATIVE ( found 3 mnths back )
Fibroscan 3,2 KPa
UGIE ENDOSCOPY NORMAL
CT upper abdomen triple phase ,,shows   EARLY SIGN OF PARENCHYMAL DISEASE of liver
GEnotype could not be determined.
KFt and LFT  are normal  ,,,ast 28iu/ml  alt 36 iu/ml  
In DLC HE IS FOUND EOSINOPHILS 18%

They prescribed ZENVIT( MULTIVITAMIN TAB ) + TENOVIR
ONE doctor prescribed LAMUVDINE .

.PLEASE suggest what should we do .
I am also confused with anti HBE Values ,,,is anti Hbe and AHBE Ab_Total  are not same  ??
What about paranchymal disease?

Thank you

[Aduiski]

Throw away Lamivudine prescription and never see that doctor again!

I am not familiar with PARENCHYMAL disease....maybe someone here will be able to shed more light on it.

[Ashutoshh]

Thank you ADUISKI

[82prasad]

Hi Aduiski,
Ill get this black seed. Thanks for your feedback.
Im having a tough time getting genotype and HbSAg quant tested in India. Will try a new lab tomorrow. Want to anyhow test HbsAg before starting NUCs.

[Ashutoshh]

Hello prasad ,,,try at i.l.b.s. delhi

[82prasad]

I stay in Pune so trying to search a lab in Mumbai/Pune.

[82prasad]

Hi Stef, Aduski and others
Good news is that I have found a lab for HBsAg quant and HBV genotype. I will get the results today evening and shall post both. Will get a better picture of my case now. Biopsy is planned this weekend.

[82prasad]

Hi Aduiski,
Why do u say Genotype A is better than D? Is it handled better by treatments or lower risk to HCC?

[82prasad]

Got my blood results:
1. HbsAg(Quant) - 26536.35 IU/ml
2. HBV Genotype - A (mutations None)
3. HBV Viral Load - 56000 IU/ml
4. HbeAg Negtive

What I dont understand is how come by HbsAg and HBV Viral load both are so high despite HbeAg being mutated. Please help...

[Aduiski]

Great news, you should celebrate these results (Geno A).
Geno A has lowest change for HCC and highest chance to be cured by pegasys.

Find a good doctor to check whether you have any contraindications (risks) for taking pegasys, if you don't, then if I would be on your place I would go for Pegasys without even thinking, not for Entecavir/Tenofovir. Make sure your doctor has a good clinic as you'll need to be followed regularly while on treatment, to minimise any risks from side-effects.

Good luck...