Aa
Starting a family
What about if the Hep B carrier is the male and he is currently on medication? I have heard from my hepatolgist that i will need to switch my medication routine and only use Lumuvudine and not the combination of that and Adevior. i'm slightly confused and concerned about this.
Steven: I will try and get you my stats. What do i actually need for you lot to tell me how serious my condition is?
Oh and guys as i am relatively new here what on earth does URQ mean?
Steven: I will try and get you my stats. What do i actually need for you lot to tell me how serious my condition is?
Oh and guys as i am relatively new here what on earth does URQ mean?
Hey,
Thanks for that article.... i will have a good read when i have time. Recently moved to another role internally at J P and its been quite hectic with training etc... often find myself quite tired!! Anyways i got my last results back for ATL and it has since gone down to 46 from 90+. I guess that is positive. What is even better was, i went out for my leaving do last weekend and managed to avoid any type of alcohol and still had quite a good 'social' time... Lol... How is everyone?
Thanks for that article.... i will have a good read when i have time. Recently moved to another role internally at J P and its been quite hectic with training etc... often find myself quite tired!! Anyways i got my last results back for ATL and it has since gone down to 46 from 90+. I guess that is positive. What is even better was, i went out for my leaving do last weekend and managed to avoid any type of alcohol and still had quite a good 'social' time... Lol... How is everyone?
I think every three months is good and I'd look for a set of 3 so that's about 9 months. Of course, I'm treatment naive so maybe on treatment there's a different standard. Steven would know. You need to ask where they want the VL and by when.
Really, you need to read this article:
http://www.medscape.com/viewarticle/570478
You may need to log in but it is a free site. I may try to find a way to post it for everyone but it is long. Very important stuff though.
Really, you need to read this article:
http://www.medscape.com/viewarticle/570478
You may need to log in but it is a free site. I may try to find a way to post it for everyone but it is long. Very important stuff though.
Guys,
When you say i need to get lab test over time, how long are we talking about? I don't see my hepo for at least 3 months, in which i get a new blood test and my next 3 months of combo treatment. Do i need to clarify what stage they would want my VL and ATL to be at at the moment? What other questions do i need to ask and post for you guys?
When you say i need to get lab test over time, how long are we talking about? I don't see my hepo for at least 3 months, in which i get a new blood test and my next 3 months of combo treatment. Do i need to clarify what stage they would want my VL and ATL to be at at the moment? What other questions do i need to ask and post for you guys?
Left out a word:
Most knowledgeable MDs don't use mono LAM for long term treatment anymore due to the resistance issue. ADV is good but risk of resistance will creep up after 3 years if doing monotherapy. I think that is why your doctors gave you LAM and ADV, to increase the antiviral power and enhance the resistance profile. But if you still have detected DNA with this combo, I think you should ask to change it. I think (my own opinion) that LAM + ADV is about equal to mono Entecavir. Entecavir + ADV will be great. Entecavir + Tenofovir is even better. Especially if you need long term treatment, which I'm * NOT * sure if you do. Can't comment on that since I don't know your doctor's reasoning / thinking.
Most knowledgeable MDs don't use mono LAM for long term treatment anymore due to the resistance issue. ADV is good but risk of resistance will creep up after 3 years if doing monotherapy. I think that is why your doctors gave you LAM and ADV, to increase the antiviral power and enhance the resistance profile. But if you still have detected DNA with this combo, I think you should ask to change it. I think (my own opinion) that LAM + ADV is about equal to mono Entecavir. Entecavir + ADV will be great. Entecavir + Tenofovir is even better. Especially if you need long term treatment, which I'm * NOT * sure if you do. Can't comment on that since I don't know your doctor's reasoning / thinking.
>>>"Sorry for being so ignorant...."<<<
We were all ignorant at one point. We are all still learning and hoping to stay ahead of the game. It's important to know the basic so you could have good conversations with your MD, and be able to challenge them if need be. It's your liver after all.
Most knowledgeable MDs don't use mono LAM for long term treatment anymore due to the resistance issue. ADV is good but risk of resistance will creep up after 3 years if doing monotherapy. I think that is why your doctors gave you LAM and ADV, to increase the antiviral power and enhance the resistance profile. But if you still have detected DNA with this combo, I think you should ask to change it. I think (my own opinion) that LAM + ADV is about equal to mono Entecavir. Entecavir + ADV will be great. Entecavir + Tenofovir is even better. Especially if you need long term treatment, which I'm sure if you do. Can't comment on that since I don't know your doctor's reasoning / thinking.
A chronic HBV infection have different phases. First the immune tolerant stage is when your immune system ignores the virus and it just replicates like crazy, but since your immune system doesn't attack it, it does little damage. It's like the 2 armies (your immune system and the virus) are just standing still, looking at each other.
If infected at birth, during the 3rd to 4th decade of the infection, it enters the immuno-clearance phase. The armies go to war and taking alot of collateral damage that is your liver cells. For some reason, your immune system wakes up and attacks the virus, killing the liver host cells with it (thus leaking ALT into your blood). If all goes well, your immune system will re-establish some control over virus but neutralizing the eAntigen with the eAntibody (this is the eSeroconversion process which could take years). The viral activity goes down, replication, and DNA goes to low levels. This the the inactive phase of disease if you are lucky.
Over time, like 50% of successful eSeroconversion folks would eventually have disease re-activation because the virus will mutated away from eAntibody control. Hopefully this won't happen or happen when you are very very old, like 85 or something, since that would mean, your liver had a very nice break from the onslaught of the virus. But this is why even inactive carriers must monitor. If you the virus did an immuno-escape (by mutating) and disease re-activates early, you pretty much need life long treatment to hold down the virus. This is why the resistance issue is so darn important. We can't afford to let the antivirals lose it's ability to hold down the virus.
1 or 2 ALT readings won't tell you much. You need lots of ALT, DNA levels (regularly) over time to tell what's happening. Graphing it over time. But since you are on treatment, it's hard to tell what your immune system is doing and what antivirals are doing. It's unclear to see what's holding down the virus. This is why I ask you why your doctor decided to treat because with your limited posted info, it wasn't clear.
We were all ignorant at one point. We are all still learning and hoping to stay ahead of the game. It's important to know the basic so you could have good conversations with your MD, and be able to challenge them if need be. It's your liver after all.
Most knowledgeable MDs don't use mono LAM for long term treatment anymore due to the resistance issue. ADV is good but risk of resistance will creep up after 3 years if doing monotherapy. I think that is why your doctors gave you LAM and ADV, to increase the antiviral power and enhance the resistance profile. But if you still have detected DNA with this combo, I think you should ask to change it. I think (my own opinion) that LAM + ADV is about equal to mono Entecavir. Entecavir + ADV will be great. Entecavir + Tenofovir is even better. Especially if you need long term treatment, which I'm sure if you do. Can't comment on that since I don't know your doctor's reasoning / thinking.
A chronic HBV infection have different phases. First the immune tolerant stage is when your immune system ignores the virus and it just replicates like crazy, but since your immune system doesn't attack it, it does little damage. It's like the 2 armies (your immune system and the virus) are just standing still, looking at each other.
If infected at birth, during the 3rd to 4th decade of the infection, it enters the immuno-clearance phase. The armies go to war and taking alot of collateral damage that is your liver cells. For some reason, your immune system wakes up and attacks the virus, killing the liver host cells with it (thus leaking ALT into your blood). If all goes well, your immune system will re-establish some control over virus but neutralizing the eAntigen with the eAntibody (this is the eSeroconversion process which could take years). The viral activity goes down, replication, and DNA goes to low levels. This the the inactive phase of disease if you are lucky.
Over time, like 50% of successful eSeroconversion folks would eventually have disease re-activation because the virus will mutated away from eAntibody control. Hopefully this won't happen or happen when you are very very old, like 85 or something, since that would mean, your liver had a very nice break from the onslaught of the virus. But this is why even inactive carriers must monitor. If you the virus did an immuno-escape (by mutating) and disease re-activates early, you pretty much need life long treatment to hold down the virus. This is why the resistance issue is so darn important. We can't afford to let the antivirals lose it's ability to hold down the virus.
1 or 2 ALT readings won't tell you much. You need lots of ALT, DNA levels (regularly) over time to tell what's happening. Graphing it over time. But since you are on treatment, it's hard to tell what your immune system is doing and what antivirals are doing. It's unclear to see what's holding down the virus. This is why I ask you why your doctor decided to treat because with your limited posted info, it wasn't clear.
Hi guys,
Firstly what would a more potent antiviral being name terms be? Having read up on your last update it scares me slightly with facts that the current treatment i am on might not be up to scratch and more importantly not needed at this point. I agree the drinking hasn't helped but was the fact a years course of 'Peg interferon' quickly brushed aside with 'it did not get the necessary results and therefore we have decided to put you on combo-treatment' another excuse for something much more serious? So if my VL isn't in the high range but my ALT is what is that indicating? Also please elaborate on the next phase 'immuno-clearance' as i have never heard this before along with eSeroconversion process.... Sorry for being so ignorant....
Also are my stat postings enough or do i need a few more?
Firstly what would a more potent antiviral being name terms be? Having read up on your last update it scares me slightly with facts that the current treatment i am on might not be up to scratch and more importantly not needed at this point. I agree the drinking hasn't helped but was the fact a years course of 'Peg interferon' quickly brushed aside with 'it did not get the necessary results and therefore we have decided to put you on combo-treatment' another excuse for something much more serious? So if my VL isn't in the high range but my ALT is what is that indicating? Also please elaborate on the next phase 'immuno-clearance' as i have never heard this before along with eSeroconversion process.... Sorry for being so ignorant....
Also are my stat postings enough or do i need a few more?
Well first of all, you're an idiot for drinking and elevating your ALT to a 96.
Okay, now that that's out of the way.
It's good that you are seeing a hepatologist. Just from forum exchanges, I see that the treatment model is different in the US compared with other countries. It's also hard to tell what's happening with bits and pieces of info. You really need a series of labs over time.
Now what stands out in your case is the reason why you started treatment in the first place. From what you posted, I don't know. Since you are Chinese, you are probably infected very early on, at 27, you are suppose to be eAntigen positive (which you did indicate). And your viral load is suppose to be very high. But your ALT is suppose to be within range or from time to time slightly elevated. Most in the US don't treat in this case because there is little to no liver cell damage. They wait until evidence of the next phase of the disease, the immuno-clearance stage to treat. Then, treatment coupled with your immune system's response help bring the VL down quicker and help the eSeroconversion process move along (and in my opinion reduce chance of developing mutant strain). I think this could be the reason that you are having a hard time lowering your VL because you are not getting much help from your immune system. Since you started treatment, I would ask about switching to a more potent antiviral because having a detectable VL on treatment is not good.
Okay, now that that's out of the way.
It's good that you are seeing a hepatologist. Just from forum exchanges, I see that the treatment model is different in the US compared with other countries. It's also hard to tell what's happening with bits and pieces of info. You really need a series of labs over time.
Now what stands out in your case is the reason why you started treatment in the first place. From what you posted, I don't know. Since you are Chinese, you are probably infected very early on, at 27, you are suppose to be eAntigen positive (which you did indicate). And your viral load is suppose to be very high. But your ALT is suppose to be within range or from time to time slightly elevated. Most in the US don't treat in this case because there is little to no liver cell damage. They wait until evidence of the next phase of the disease, the immuno-clearance stage to treat. Then, treatment coupled with your immune system's response help bring the VL down quicker and help the eSeroconversion process move along (and in my opinion reduce chance of developing mutant strain). I think this could be the reason that you are having a hard time lowering your VL because you are not getting much help from your immune system. Since you started treatment, I would ask about switching to a more potent antiviral because having a detectable VL on treatment is not good.
Viral load is the best indicator of viral activity. ALT tells us something about how our liver is functioning. Its a measure of cell death.
Your viral load is low for someone not on treatment but how long have you been on your new treatment? There are certain parameters that measure whether treatment is working. Like how rapidly the viral load drops and how low it goes. If it doesn't go low enough, fast enough then the treatment can be considered ineffective. You need to find that out. I'm afraid I just don't know enough about treatment to be able to answer that.
steven?
Your viral load is low for someone not on treatment but how long have you been on your new treatment? There are certain parameters that measure whether treatment is working. Like how rapidly the viral load drops and how low it goes. If it doesn't go low enough, fast enough then the treatment can be considered ineffective. You need to find that out. I'm afraid I just don't know enough about treatment to be able to answer that.
steven?
Hey,
Thank you for your response.... I am really trying hard at the moment as i have realised my liver is the most important factor here.... i love the couple of drinks here and there but so far have had enough will-power to avoid it.... We shall see..
I will be having another blood sample tomorrow so quite interested (anxious) to see how my ALT will do this time..... Is the ALT the best indication of Virus activity?
Once again i will have to ask my hepatologist in regards to what they would like my VL to be at this point....
Currently taking combination med: Adevoir & lumudivine.......
Just to clarify it is 668 IU/ml.... mis-typed the original where n wasn't suppose to be included.....
Finally what do i need to ask in regards to the VL (million-copies) that i have seen so often in this forum... I would be quite interested to find out what mine is.... Is there a certain term for it?
Thank you for your response.... I am really trying hard at the moment as i have realised my liver is the most important factor here.... i love the couple of drinks here and there but so far have had enough will-power to avoid it.... We shall see..
I will be having another blood sample tomorrow so quite interested (anxious) to see how my ALT will do this time..... Is the ALT the best indication of Virus activity?
Once again i will have to ask my hepatologist in regards to what they would like my VL to be at this point....
Currently taking combination med: Adevoir & lumudivine.......
Just to clarify it is 668 IU/ml.... mis-typed the original where n wasn't suppose to be included.....
Finally what do i need to ask in regards to the VL (million-copies) that i have seen so often in this forum... I would be quite interested to find out what mine is.... Is there a certain term for it?
I'm a little confused by the viral load. If that is 668 IU/ml I understand that but I don't understand the Log (10) count. 668 IU/ml is not a high viral load but what would they like it to at this stage of your treatment?
You are e-antigen positive still so you have active disease. You are currently on treatment after one failed treatment. I would strongly urge you to not only cease all benders but to consider not drinking at all while you have active disease and are on treatment. A "normal" ALT for a man your age is closer to 30. Your last one was 3x the upper limit of normal. Sure, it can go much higher but your liver is saying, "No mas!"
You were asking about using milk thistle while on treatment but if you're going to drink enough to shoot your ALT from a 27 to a 96 I wouldn't bother with the milk thistle. I mean, come on, its basically a dandelion - it can only do so much. Go outside and pour some gin on a dandelion and see how it does after a couple of weeks. Sorry to be so harsh, Pete, I like you...you seem like a nice guy...but I'm also a mom and I'm now pulling rank and giving you a swift kick in the bum
Give your body a chance to put this virus into a less active mode. Eat well, rest, don't do things that make your liver hate you. Okay?
Tell again, what you're taking and for how long.
You are e-antigen positive still so you have active disease. You are currently on treatment after one failed treatment. I would strongly urge you to not only cease all benders but to consider not drinking at all while you have active disease and are on treatment. A "normal" ALT for a man your age is closer to 30. Your last one was 3x the upper limit of normal. Sure, it can go much higher but your liver is saying, "No mas!"
You were asking about using milk thistle while on treatment but if you're going to drink enough to shoot your ALT from a 27 to a 96 I wouldn't bother with the milk thistle. I mean, come on, its basically a dandelion - it can only do so much. Go outside and pour some gin on a dandelion and see how it does after a couple of weeks. Sorry to be so harsh, Pete, I like you...you seem like a nice guy...but I'm also a mom and I'm now pulling rank and giving you a swift kick in the bum
Give your body a chance to put this virus into a less active mode. Eat well, rest, don't do things that make your liver hate you. Okay?
Tell again, what you're taking and for how long.
Ok Guys:
Stats as promised:
HBV Viral Load 668 nIU/ml
Log (10) = 2.83
ALT: 96
Hep B e antigen = detected
Origin: Asian (Chinese)
Does this help at all? I believe my ALT before was 27 before but recently went to Sweden where i went a bit drink crazy..... and it shot up... I will be having another blood sample in the next couple days.....
Is it looking bad?
Stats as promised:
HBV Viral Load 668 nIU/ml
Log (10) = 2.83
ALT: 96
Hep B e antigen = detected
Origin: Asian (Chinese)
Does this help at all? I believe my ALT before was 27 before but recently went to Sweden where i went a bit drink crazy..... and it shot up... I will be having another blood sample in the next couple days.....
Is it looking bad?
You basically need a personal history, series of labs (pre and post treatment) to really understand what the virus is doing.
Since you are 27, those lab markers Zelly indicated is very important.
In general, going mono LAM for long term treatment is usually not a good plan.
As for the 25%, I have good and bad news. First the bad news. Since you are a male, it's actually 35%. Female 15%. Average them, you get the 25%.
Now the good news: the % are based on earlier Asian studies, where Asian Men drank and smoked alot compare to women. So it's not too surprising that men are at a hiher risk than women based on those studies.
This is copied my a previous post of mine (edited for this thread): A bad outcome for is about 25% if unmonitored / untreated. If you are proactive, then it would be less than 25%, say 15%, don't drink and don't smoke, say 10%, healthy lifestyle to 8%...not too bad. Disclaimer: This is unscientific, stevenNYer logic ;)
Since you are 27, those lab markers Zelly indicated is very important.
In general, going mono LAM for long term treatment is usually not a good plan.
As for the 25%, I have good and bad news. First the bad news. Since you are a male, it's actually 35%. Female 15%. Average them, you get the 25%.
Now the good news: the % are based on earlier Asian studies, where Asian Men drank and smoked alot compare to women. So it's not too surprising that men are at a hiher risk than women based on those studies.
This is copied my a previous post of mine (edited for this thread): A bad outcome for is about 25% if unmonitored / untreated. If you are proactive, then it would be less than 25%, say 15%, don't drink and don't smoke, say 10%, healthy lifestyle to 8%...not too bad. Disclaimer: This is unscientific, stevenNYer logic ;)
If your wife is HBsAb positive, she is safe from HepB and you two can have children just like other couples. Because you carry HepB, it is good caution to have your children vaccinated as soon as the doctor advises.
Do the people who are taking meds and trying to control the VL still fall into this category? --I think so.
Do the people who are taking meds and trying to control the VL still fall into this category? --I think so.
Yes, the girlfriend is now safely vacinated. The weird thing is when i first met her (3 years ago) i had no idea i had Hep B.... We didn't use protection but yet she never caught Hep B.... She was told after investigating that she had done 2 courses of her vaccination at an early age but had not completed the third. She got tested which showed a negative then got the full vaccination again. (just wish i could do that huh lol).... Its not a definate for the switch but thats what been suggested or a lower dose or something. Hey not to dampen things but one of my main concerns with Hep B are the figures that show 25% of people will go on to have liver failure and liver cancer... Do the people who are taking meds and trying to control the VL still fall into this category?
Okay, read your profile...why does he want you to switch? Is the current regimen working to suppress your viral load?
Upper right quadrant refers to the area of the abdomen that houses your liver...along with lots of other stuff.
I'm not sure if there are any precautions against conceiving while on antivirals. Is your wife/partner vaccinated?
Upper right quadrant refers to the area of the abdomen that houses your liver...along with lots of other stuff.
I'm not sure if there are any precautions against conceiving while on antivirals. Is your wife/partner vaccinated?
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