HBV DNA low positive

Male 27 HbsAg positive for probably 8 years.
Had a serious illness then with ALT and AST around 2800.
Then ALT back to normal for 5 years but in last 2 years its fluctuating from 40 to 60 while once it was 140 and back to 40
within 2 weeks. My AFP stable around 11.
US always was normal.
My Hbeag is negative for years and Hbeab and HbcAg is positive.
My viral load is 1400 cop/ml 3 months ago.
Does it mean I have a mutant virus?
If everything is slow why I keep get abnormal liver tests?
Can I start the treatment and will it has a chance to success?
Is there the chance my viral load will jump to millions again ?
Thank you!

[Kevin Pho, MD]

Your case shows positive HBsAg, positive HBeAb, negative HBeAg and a fluctuating ALT.  If the ALT is elevated, it may be worth considering treatment - one possibility may indeed be a mutation where there is a stop-codon precluding production of HBeAg.  A prolonged course of therapy may produce a more sustained response.  I would also obtain a Hep B DNA level - which would also help guide treatment decisions.

You may also want to consider a liver biopsy should also be considered to give clues to liver damage and disease activity.  

It may certainly be possible that the treatment may be successful, and also possible that the viral load could jump.  Discussion with a hepatologist should answer these questions in your individual case.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[dizel]

Forgot to add that I had ANA test positive for 1:100

[dizel]

And last question in case the virus not a mutant, can it become a mutant starting from this stage?
Thank you so much!

[dizel]

I just got an answer from medlab and they tell me that I have increased the virus load to around 100.000 cop/ml.
With ALT and AST at normal range. I lost myself here, does it mean I have mutant virus?

I never got any hep b treatment.