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Thank you
Sep 25, 2005

Hi Dr Barbara I have to thank you first and i know that every one is seeking for your help and i am sure that you understand my follow up. In my below last message i told you that i will start my medication and i did . after 03 months of the medication i had my Quan. DNA test and the result came undeductable.The doctor advised me to cont. and take my last shoot of twin vaccine on October 14 but he did not specify till when i should take the medicin ! He said that my anti hepbe is positive and there is no idea how long does it take. Also he is planning to make DNA test but this time is QUALIT. on Dec. 2005 and expect good news.My question is Ziffix is safe to be taken for long period? Also he is thinking to give me a forth (booster) shoot after the third twin vaccination! Do you advise me to do so ? thanks again and have a nice day.

Hi Dr Barbara

Sorry to bother you again but i am in deep trouble !!

As i have mentioned in my below last message that the doctor put me in zeffix because of my DNA level reading on the 22/02/05 (more than 85000 c/ml...but i have made onother dna test just before i start the zeffix on the 22/03/05 ..the result just came back and my readin level is 5000 c/ml !! is this possible in one month without treatment!!!?

What i shall do now stop the zeffix as it is no usfull with such low level??

I am so confused ..please help me with your opinio.

Regards,

Dr: Barbara 45 years old , Male , Chronic HEP B .The doctor decided to put me on Zeffix .He blieves that there will be a responce and the reason is for the treatment is my HBV DNA level >10000 IU/ML.I have started Zeffix with the vaccination of A&B HBV and the reason from the doctor to use the vaccination is to help my amune system and Zeffix treatment to deal with the virus.Shall I continue ? and if there is no responce and i stop taking the therapy shall my virus come back worse than it is now ?

1-test in 1996 showed HbsAg: Positive, HbeAg: Negative, Anti HBC total positive, Anti HBC IGM: Negative, Anti HBE: Positive, Anti HBS: Negative. Anti HCV total: Negative. With normal LFT test. 2- Abdomen ultra sound is NORMAL. 3-AFP TEST=1.38 (REF- 00-5.8) - HBV-DNA (qualitative) using COBAS TAQMAN HBV KIT IS POSITIVE.

-HBV-DNA (quantative) using COBAS TAQMAN HBV KIT IS POSITIVE and showed the following results:

A- 14693 IU/ML (Moderate Viraemna). B-85219 C/ML . C-4.17 Log IU/ML . D- Sens.threshold:6 IU/ML LFT's Results : ALP2S=79 U/L Albumin = 4.8 g/dl

Bilirubin Direct= 0.1 mg/dl

Bilirubin Total= 0.61 mg/dl

Gamma GT = 28 U/L

SGOT= 16 U/L

SGPT =24 U/L

Total Protein= 7.51 g/dl

Alk.Phos.=85 U/L Trigl=136 mg/dl

Response from Dr. McGovern

It is good news that your hepatitis B virus is suppressed on Zeffix (Epivir; lamivudine). You will need chronic therapy since you have hepatitis B e antigen negative infection. You will also need monitoring for the development of resistance which occurs over time with this particular drug.

The use of hepatitis B vaccine has not been studied with treatment, but your doctor has some rationale for using it to "boost" your immune system.

Dr. M



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