Deciding when to start treatment

@ThomasTu Appreciate the info. I will probably start the treatment if the doctor recommend it given almost zero “medical” downside from autivirus.

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Hi, so I decided to take TAF since Apr 14. And now(May 14) my GPT dropped from 92 to 82; and DNA dropped form 2.5e8 to 9.0e4. Would you consider the treatment result good or bad, or normal? Thanks.

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Hi Steve,

I assume GPT was a type for ALT?

The reduction in HBV DNA over the first month is excellent. You are experiencing a good response.

Yeah, that is ALT from 92 to 82. Thanks @availlant

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Hi Steve,

ALT decline should continue and should eventually become normal given the speed of your HBV DNA decline.

Keep us posted!

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I am CNN seeking opinions or views.
Am 42 yrs old male. 8 months ago by chance I tested positive for Hepatitis B surface antigen S/CO B value of 4984.21 . I suspect it’s from child hood since I remember someone close who had symptoms similar to acute HBV but still not sure where I got it from. My family know and have been vaccinated. Below are the following additional results same time or 8 months ago:

  1. Anti HBc IgG positive

  2. Anti HBs 2.7 mIU/ml

  3. Hep A negative

4.Hep C negative

  1. HBV viral load 121 IU/ML

  2. Anti HBc IgM negative

  3. S/CO CM value 0.07

  4. HBe antibody (anti HBe) positive

  5. HBeAG Hep B e antigen negative

  6. Hep C antibody HCV 3 at 0.05

  7. HIV negative

  8. Alanine Transaminase 25 U/L

  9. Total bilirubin 16.4 umol/L high range being 20.5

Two days ago or 8 months later .the following are the results

  1. Alanine Transaminase 29U/L

  2. Viral load 390 from 120 8 months ago

  3. No DTV from Doppler test

  4. High AFP 6.6ng/ml with or using a ref range of 0 to 5.8

  5. 3.9 kpa on fibroscan meaning absent or mild fibrosis. No mass or nodules seen

  6. CAP 270 dB/m grade 2 steatosis

Question for @ThomasTu and any anyone else in this good platform:

A. I Visited two top gastro specialists in Nairobi and one prescribed tenefovir and the other requested for review in three months. Why the difference? Something to worry me? Not sure who to listen to. One said treatment ensures I reduce to almost zero the possibility of progression then wait for drug advances in the next 5 or 10 yrs.

B. Should AFP worry me. What else should worry me? Or should I monitor closer

C. I have shortness of breath and painful legs always. Worse when I exert yet pressure is ok, no diabetes markers, ok reumatoid factor test

D. Any other or additional view based on my results above are welcome?

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Dear CNN,

Your test results indicate that you have chronic HBV infection with evidence of increasing viral replication. Although there is no evidence of fibrosis, some studies have suggested that the progression of HBV infection is faster in individuals with steatosis.

According to some international guidelines, antivirals like tenofovir disoproxil fumarate (TDF) are not indicated until evidence of fibrosis and or abnormal liver function (elevated ALT) is present. On the other hand, your HBV titer is increasing (perhaps as a result of your steatosis).

So I suspect one doctor is following the standard guidelines (request review in 6 months) while the other doctor is looking at your steatosis and increased HBV titers as justification to initiate early TDF therapy as a preventative measure. The difference between these two approached should not raise any concerns on your part but reflect the reality of differing approaches with different doctors.

Its important to note that how to proceed with your own therapy is a decision between you and your doctor in concert. However, it is true that early introduction of TDF has a very high chance to prevent any progression of liver disease from HBV infection.

Best of luck…

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Thank you for your balanced feedback.

Hi CNN
I am happy hear from your concerns. I may not answer you directly but probably as a person experiencednin hep b and many doctors in Kenya, I can refer to the best honest gastro if you don’t mind.
Kinoti

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Hi @Kinoti Thank you pls suggest. Will appreciate

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At Agha Khan hospital, book Dr M.V Shah(endescopy department)once a week. Consultation fee is ksh4000,but I use my NHIF cover as a civil servant.
M.V.Shah is the senior most gastroenterologist in Kenya with now over 35years experience.
Wish you well.
Kinoti

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Thank you @Kinoti . Once a week to mean he is only available once every week?

Hi CNN.
Yes. Dr. Mahesh V. Shah is available one a week.
I have been to KNH doctors plaza, Ruai Family Hospital (Hospital of speciality)MP Shah and the handling has always been divastating.
Kinoti

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hello,
may I ask what you mean by “cure” drug by 2030?

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Hello,
what do you mean by “upcoming cure”?
upcoming cure used in combination with antivirals …
Do you know where I can read more about this upcoming cure?

Dear @catcher.007,

This is a prediction based on the number of agents that are out there being tested at the moment (https://www.hepb.org/treatment-and-management/drug-watch/). From this, we expect at least one of these or ones still in pre-clinical development to contribute towards a cure in the future.

Most of these have been tested in combination with current antivirals (tenofovir or entecavir).

Hope this clarifies things.
Thomas

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Ah, I see. I misunderstood your previous post. I thought the “upcoming cure” as in the one that is going to cure HBV completey for current chronic patients. One magic pill. I misunderstood.
I should be hopeful seeing so so many list of companies working on different drugs. But I’m also feeling worried that there are so many working separately on separate paths. Wouldn’t it be more effective if they all work together and share information? Covid vaccine came out pretty quickly because all the countries worked on it together.
My other worry is that HBV is more of disease of outside of USA. I worry that it won’t get the funding it needs because it’s not a priority for America.
Anyway, I’m still grateful that we have many drugs being developed and really hope that we will find a “cure” very soon for hep B just as they did for hep C.

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Just want to share my status of my treatment.

2022-04-14: Start taking anti-virus; DNA: 2.5e8; GPT: 92
2022-05-16: One month after aiti-virus; DNA: 9.0e4; GPT: 82
2022-07-12: Three months after anti-virus: DNA: 1.8e4; GPT: 123

Is the GPT jump normal? Based on my data, is everything going all right? great? normal?

Appreciate any comments.

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Hi Steve,

Which antiviral medication are you taking?
You need to share with us other liver function data such as bilirubin, albumin, INR and platelets if you have them.

In the interim…

You are experiencing a good antiviral response to therapy (4 log decline in HBV DNA within 3 months). How are you feeling?
You are also experiencing a mild transaminase flare (GPT/ALT is 123). Normally when an ALT flare is occurring in the presence of a good antiviral response, this signals the immune mediated clearing of infected hepatocytes from your liver (which is a good thing).

Best regards,

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Thanks. I am taking TAF.

I did a liver ultrasound 3 months ago, all looks good.
At this point, I am feeling good.
I was a little bit concerned about the GPT/ALT being 123, but good to know that it is a good thing for now.

Thanks so much!

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