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HBV Conversion Possible?
Apr 11, 2001

Dear Doctor:

I have had Hep B for approximately 16 months. My doc put me on Interferon therapy 4 months ago (standard treatment is 4 months or 16 weeks, he says)and stopped it 2 days ago. He wanted to start me on Interferon FIRST and THEN start me on Epivir after a month to bring my viral load down (Interferon works better if viral load is low?)

After 4 mos. of Interferon treatment and 3 months of Epivir, my DNA is undetectable but my E-antigen is still positive (waiting for e-antibody results to come back). My liver enzymes went up to 300's and now are in the 40's range.

My doc is very happy with the way things are going. But I won't be happy until my E-antibody, E-antigen sero-convert and/or my surface antigen turns negative.

Questions:

1) From what I've told you, what do you feel are the odds that I will sero-convert?

2) My doc is encouraged because my DNA is undetectable and my liver enzymes are/were elevated. (they rose to 300's and now are in the 40's range) He says this happens when a sero-conversion is to take place. Do you agree?

3) Is it common for chronic HBV to go away (meaning, one develops antibodies)? I have had it for 16 months. My doc claims that I have a good chance of clearing it, especially since I haven't had it that long.

3) Now the emotional stuff. I feel like I'm NEVER going to have a relationship again because I'm contageous. They say to have safe sex but who on earth will come near me? Is it passed through saliva as well? What can I do?

Thank you!

Response from Dr. Rodriguez-Torres

We have much better results during treatment of HBV when there is a low DNA viral load and recent infection.It is also true that we see increases in ALT during treatment.This may be because an increase in the cytolytic responses(death of B infected cells).It is unclear if this is a good sign for sustained response. IFN therapy is assoc. to HBeAg loss in 30-40%.Around 10% also loss HBsAg.Patients that loss HBeAg during treatment, have a high chance of HBsAg clearance long term.Epivir has similar results,but long term seroconversion is rare. You should be happy if you can achieve HBeAg loss,as this is assoc. to a decrease in all hepatic complications.You may need to stay in Epivir for 18 months. Finally:There is a lot of research in progress.You seem to be an intelligent and sensitive person.You need to be honest about your disease, and this is going to help you measure and asses ,who is worthy of you.If you find the right person, this is not going to be a problem.Remember that any person that can be infected by you, can be vaccinated.Good luck!!!



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