Re: Hepatites B

Posted By Dudley on October 01, 1998 at 02:47:12:

In Reply to: Re: Hepatites B posted by HFHSM.D.-ym on September 27, 1998 at 12:09:53:






: : : : : : : : ]
: : : : : : : : I was diagnosed with Hep. B 10 years ago. I have never been sick with it since, but I am curiouse,...Does this mean my liver has permanent necrosis,..or is that only with Hep. chronic?
: : : : : Dear Wendy,
: : : : : Most cases of acute hepatitis B viral infection do not progress to chronic liver injury. To determine whether or not you have chronic hepatitis B infection you should have a series of blood tests. Liver enzymes (aminotransferases- AST and ALT) are often elevated in chronic hepatitis. You can also be tested to see if you are a chronic carrier (hepatitis B surface antigen positive), infective (hepatitis B e antigen positive) or immune (hepatitis B surface antibody positive). I hope you find this information helpful.
: : : : : This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
: : : : : If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians' Office and make an appointment to see Dr. Muszkat one of our experts in Gastroenterology.
: : : : : HFHSM.D.-ym
: : : : : : : *Keywords: hepatitis B
: : : : I am also a Hepatitis B carrier and my doctor told me recently that there is a hepatitis B DNA test which can tell the risk level of one's hepatitis B.  Can you tell me more about this and whether this is effective.  My doctor also said that if one is identified to have high risk, there is a new medicine ,which has been invented for treating HIV, can also be used to suppress the hepatitis B virus to reduce its risk to a very low level.  Please explain more on this.
: : : : Please also advise where I can get expert advice on hepatitis B queries?
: : : : Regards
: : : : Dudley
: : : : :


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: : : : : : : Dear Dudley:
: : : When someone has evidence of hepatitis B in their body, we then try to figure out if the infection is active and specifically we try to determine if the virus is actively replicating or making new virus.  One of the most important tests to determine this is to look for pieces of the viruss DNA in the blood.  So I agree that it would be important to see if you have detectable hepatitis B DNA in your blood.  Sometimes the level of the hepatitis B DNA also gives us useful information.  If you have hepatitis B DNA in your blood, you are potentially a candidate for therapy for hepatitis B.
: : : The new medicine to which you are referring is lamivudine (it is also called epivir of 3TC).  It is an oral pill with few side effects that is an effective inhibitor of enzymes (proteins) made by both the HIV virus and hepatitis B virus.  It is approved for the treatment of HIV disease and is commonly used to treat HIV infections.  It is still being studied for hepatitis B, however.  Part of the problem with lamivudine when it is used alone for hepatitis B is that it is effective in supressing the virus but typically does not eradicate the virus or cure the disease.  In addition, over time the hepatitis B virus can mutate so that lamivudine no longer surpresses it.  As a result lamivudine is an exciting new drug in treating hepatitis B, but its exact role is still a little unclear.
: : : As a liver specialist, I find the evaluation and treatment of patients with hepatitis B to very challenging.  Several drugs are available for treatment of hepatitis B and more are on the way.  I advise you see someone with a lot of experience with this entity and it sounds like you may already being doing so.  
: : : I hope this information is helpful to you.   I would invite you to contact us again with additional information or questions.   If you are near Detroit,  we would be happy to see you here at Henry Ford.   We have an active group of liver specialists with extensive experience with hepatitis B.   You can always contact us directly at [phone].
: : : This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question pertaining to your health.  
: : Dear Sir,
: : I had the HBV DNA test and result is negative, i.e. less than 5 pg/ml and my test of HBe antibody is positive.  Can you tell me whether this is sufficient to tell that I am alright.
: : Dudley
: Dear y.m.,
: Please answer my above question and tell me if it tells that I have no liver disease?
: Dudley
: : Dear Dudley,
The fact that your Hepatitis B viral DNA level is very low and that your Hepatitis B e antibody is positive means that you are a chronic carrier (hepatitis B surface antigen positive) but are not highly infective to others. Most gastroenterologists would not treat with medication at this time. Although, you probably have little or no damage to your liver at this point, the best way to determine this is with a liver biopsy. However, since doing a liver biopsy at this time would not change the management, I would not recommend that you undergo this invasive test at this time. Some chronic carriers of hepatitis B will become hepatitis B surface antigen negative with time and even develop hepatitis B surface antibody (become immune). You should have regular follow-up visits to monitor your liver function tests and see if you show signs of progression of liver disease. I hope you find this information helpful.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
HFHSM.D.-ym
: : *Keywords: hepatitis B, chronic carrier

: Dear y.m.
Your explaination has been very helpful, thank you
Dear Y.M,
Hope you can also explain to me if I have a slight elevation of AFP of 10.7 iu/ml (normal range 1-10 iu/ml), does this matter?  Last year, my AFP was 5.9 iu/ml but this year, I took some herbal medicine which showed the AFP increased to 16.8 but after I stopped, for 3 weeks, it went down to 9.3, but four weeks later it went to 11 and another five weeks later it went to 10.7.  I had the above HBV DNA test, it was negative, I had ct scan when I had the 16.8 reading but everything was fine.  I am very puzzled and hope that the HBV DNA negative result means that my liver is o.k. and the slight elevation of AFP is not a problem which was what my doctor told me.  Can you help me to understand this?
Your kind assistance is very much appreciated.
Dear Dudley,
Thank you for your recent message. I'm glad to hear that you are hepatitis B viral DNA negative and that your recent CT scan was negative for focal liver lesions. Marked elevations in alphafetoprotein (more than 500) are associated with hepatocellular carcinoma (liver cancer) and testicular cancer. Mild elevations may be associated with benign liver tumors, cirrhosis or hepatitis. I would continue to follow-up with your physician and have periodic repeat blood tests to monitor the alphafetoprotein level. An annual ultrasound may also be indicated. If any lesions are noted, an MRI of the abdomen may help differentiate benign from malignant lesions. I hope you find this information helpful.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568 our Referring Physicians' Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
HFHSM.D.-ym
*Keywords: chronic hepatitis, alphafetoprotein level
Dear y.m.
thank you for the above explanation. I forgot to tell you that I also have HbeAg negative and Hbe antibody positive. Does it mean that my risk of having liver disease is low in addition to HBV DNA negative.  I read that if one takes 3TC, the purpose is to get rid of HBV DNA by 98% and if one has HBe antibody, there is no need to have interferon.  In my case, I have already achieved what the above two medicines would like to achieve, this should mean that I have a rather low risk of liver disease. Can you enlighten me. Thank you.