my hepb history. hbsag sero conversion

[fcar1]

Hello all,

I'm 32 and I was diagnosed with hepb in 2012 in Brasil.
In the first months I was not going under any treatment because my doctor didnt know if it was acute or chronic,
so we were just following it with exams.

Below you can see the first results:
05/2012
ALT - 184 U/L
AST - 102 U/L
HBsAg pos, HBeAg pos, A-Hbe neg
HBV Quant - 958.314.180 UI/mL

06/2012
ALT - 1244 U/L
AST - 398 U/L
HBsAg pos, HBeAg pos, A-Hbe neg

08/2012
ALT - 467 U/L
AST - 161 U/L
HBsAg pos, HBeAg pos, A-Hbe neg
HBV Quant - 60.975.743 UI/mL


I was supposed to start a treatment in the end of 2012, but I got a job offer from Czech republic and decided to move.

In the beginning of 2013 I found one doctor to help me here in Prague, she first prescribed Baraclude 1mg.

04/2013
AST 1.09 ukat/l
ALT 2.42 ukat/l
HBsAg pos, HBeAg pos, antiHBe neg
HBV DNA PCR quantity 4x 10/8

07/2013
AST 0.88 ukat/l
ALT 2.17 ukat/l
HBV-DNA-QPCR (IU/ml)..... 3,61e4 IU/ml

11/2013
AST 1.17
ALT 3.3
HBsAG pos, HBeAg pos
HBV-DNA-QPCR 8.6x10/3

In january 2014 I had another exam (dont have the values) and my doctor decided to change the treatment to Viread
(she tought Baraclude was not helping the way she wanted).

I did few exams after but I don't have all the details.

On March/2014, she told me that my liver tests were normal, viral load was low HBeAg was negative and A-HBe was positive.
June/2014 did another exam and got this email from her:
"HBV DNA viral load is still negative.
But the main thing ... :-) HBsAg is negative. So it looks like we could stop treatment for a year."

And from my last exam I have this info:

09/2014
AST 0.45 ukat/l
ALT 0.29 ukat/l
HBsAg neg, HBeAg neg, antiHBe pos, antiHBs neg
HBV-DNA-QPCR (IU/ml)..... 0


I would like to hear your opinion about this, what does really mean having HBsAg neg and viral load 0?
My doctor is czech and she always tells me few about the results.

What she told me now is that for her I'm healthy, but I should continue with Viread till June next year, or till I get antiHBs positive.

[sorte]

70-80iu in 3months is not even decrease yet, it's fluctuation

[fcar1]

don't know. it has some logic for me in your way of thinking hehe.. just don't know if our body behaves that way.....

also, not sure if dropping 70-80ui in 3months is a slow decrease...

[sorte]

I think if he has no contact with the virus antibodies will slowly decrease, correct ?

[fcar1]

Hey guys, here is an update on my exams:

06/03/2015
ALT - 15 U/L  
AST - 20 U/L  
HBsAg neg, HBeAg neg, A-Hbe neg
AntiHbs pos - 315 UI/L

06/06/2015
ALT - 13 U/L  
AST - 19 U/L  
HBsAg neg
AntiHbs pos - 239 UI/L

It shows a decrease on my antihbs, is that something abnormal? Or that is ok to happen?
I'm still on viread, but last time I visited my doctor she wanted to stop the treatment end of June. Not sure now with this antihbs drop if she will keep this decision to stop it.

[sorte]

I'm not sure but I think polish drug TFX is something similar http://www.ncbi.nlm.nih.gov/pubmed/2657248

[stef2011]

zadaxin doesn t work on hbv, maybe a little with pegintf combo.while studyforhope suggested it is very good to make hbsab antibodies when hbsag und

[fcar1]

beginning of 2012 I had unprotected sex with 2 girls, couple of months after I decided to go for std tests, that's when I found out about the hbv.

told them 2 about it. both said they didn't have it. actually one of them I dated for a while and I saw her tests, she had antiHbs + and all...

the other one I spoke just by phone...

I had a couple of symptoms I remember (on different stages) , mild itchy hives (a couple of days) and a bitter taste on my mouth.. thats all.

[sorte]

stef you mentioned something like this:

"So in my final question i got the answer to the best regimen when hbsag very low or und hbsab und
zadaxin plus hbv vaccine with aldara on skin on site of injection and vitd3"

Why zadaxin is not used in regular therapies ? not enough potential in compare to peginf ?

[SafiSifa]

My doctor told me that your Anti-Hbs should be positive more than 6-9 months.

[sorte]

how did you found that you had hep b ? did you had some sympthoms or it was just some regular checkup ?

[fcar1]

Thanks you guys.

I know this is not over, and I guess I was just lucky with this treatment.

Never had any sort of special diet, don't take any kind of supplement and to be honest, for the last 1 year and a half I've been drinking beers at least 4 times in a month -  and yes, I asked my doctor in Prague and she said it was ok (probably I was not drinking the amount she said was ok) :)...

Lets see, I hope I keep getting good results like this...

[sorte]

Why are you still on baraclude if you are HBsAg- ? Not enough antibodies ?

[SafiSifa]

Congratulations.

I am also cured with Baraclude in only 12 months.

Although I am totally cured, I am still on Baraclude treatment.

See my results: http://www.medhelp.org/posts/Hepatitis-B/My-All-Test-Result-After-12-Months-Treatment-of-Entecavir-I-am-cured/show/2355051

See my story: http://www.medhelp.org/posts/Hepatitis-B/Urgent-Advise-for-Entecavir-Usage/show/2044528
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[mustthinkpositive]

Congratulations. You have developed surface antibodies.

Your HBV Quant will be undetectable/negative so there will be no numbers. Your Dr will decide on whether to stop treatment which I would suggest pretty soon.

[fcar1]

@stef
Can't say, my previous exam was on 09/2014 and antiHBs was negative.

@sorte
chronic and I have no idea for how many years...

[sorte]

Do you know if it was accute or chronic and how many years you had it ? Did you had ever tested AntyHBc - Total ? I think it would help to differ those types of infection cuz for chronic it may stay positive for years.
Not sure what happens with those antibodies after serovonversion or recovering after accute, anyone ?

[stef2011]

is it 6months since hbsab>10miu/ml?

if so it is safe to stop antiviral but to be on the safe side test hbsab every month and if it declines too much restart tdf

[fcar1]

Hey guys,

I just wanted to update you with my last exams (I still don't have the HBV quant. results).

06/03/2015
ALT - 15 U/L 
AST - 20 U/L 
HBsAg neg, HBeAg neg, A-Hbe neg
AntiHbs pos - 315 UI/L

It seems quite good results, do you think I can ask my doctor to stop taking medicine with this level of anti-HBS?

[stef2011]

His comment is under immunotherapy peg or zadaxin when hbsag is very low/und and you need to develop hbsab, not a general rule

when you stop peg and you cleared hbsag to develop stable hbsab and no relapse you need additional immune therapy with no antivirals....it is not to stop antivirals and wait because relapse risk is highest

So in my final question i got the answer to the best regimen when hbsag very low or und hbsab und
zadaxin plus hbv vaccine with aldara on skin on site of injection and vitd3

or keep pegintf if no zadaxin or hbv vaccine

Antivirals are better not to be used because some low virion production is needed to stimulate immune therapy like a vaccine

[andrey19]

It is worth mentioning we have two forum members who cleared hbs antigen on intf+nuc combo and continued taking NUCs. They both relapsed shortly. According to recent Studyforhope post it maybe better to stop taking nucs once hsbag is cleared.  

"Re the continued use of antivirals in this window phase of low antigenemia i tend to think that antivirals are more harmful than helpful, since a certain degree of antigen presentation and availibility, particularly of the core antigen, will be need to drive the maturation process on the dendritic cells for new hbv specific Tcell clones. With nothing to encounter, these dendritic cells will have nothing to present to docking Tcells and no clone stimulation will take place. Consider it an internal vaccination of moderate dosage."

[stef2011]

Hbsag negative means you have some immune control but not that you are free fromthe virus.the virus is and will be present in low quantity inside cells as cccdna for years

so what to do, keep tenofovir until hbsab becomes detactable very high then youcan stop tenofovir and see if hbsab remains stable.zadaxin and hbv vaccine can help develop hbsab

do not stop antiviral now, you need hbsab stable and even when you get hbsab wait 6months before stopping

[melcul]

Yes, but the wierd thing is that you became hbsag negative after 2 years without treatment, you are very lucky, your doctor didnt said anything about trying a vaccine or aome treatment untill you make hbsab ?

[fcar1]

yes, that's what I think from what I've read in this forum. If I don't have the antibodies anything can happen.

I believe I do have chronic because first exam showing I had hbv it was on February or March 2012 ( I did this exam for all stds)... and after, only in June 2014 HBsAg became negative, so more than 2 years

[melcul]

anyway, if antibodies still dont show up i think this is wierd ,maybe stef or someone more experienced can give you an advice, because if you do not have antibodies, you are not imune and hbsag can start to grow again