1st appointment

[makimak]

Hello,

I live in the UK. I've had my first appointment with the infectious disease department at the hospital on Monday and the doctor has given me some information on Hep B and listened to my chest and back..I did a load of blood test to verify my viral load. She said in the UK, we no longer do liver biopsy, they will flip the liver to check whether it is sore or not then we can determine whether I need medication. Does anyone know what flipping the liver means and how it is performed? I know I should have asked the doctor but I had to take in so much, I simply forgot. As I am 28 weeks pregnant at the moment,the can't check my liver until I have given birth. I am due back at the hospital in 3 weeks to discuss my blood test results.

[makimak]

I didn't mean I was 56 years old, I meant my liver status is 56. I'm only 30 year old. I don't think i can imagine myself being pregnant when i'm 56. Besides treatment, is there any further recommendation you have for me in terms of lifestyle and diet?

[stef2011]

after 40yo it is always better to treat if hbvdna is detactable because liver cancer risk increases very much due to the precore and core mutations

[makimak]

Ok Thanks for your advice. I will speak to my doctor again when I go back. From your experience, if i'm at 56, does that mean my condition is bad and my liver is quite damaged?

[stef2011]

said for a woman the average was about 30

wrong these are 5 years ago data.this has been update from years: woman 19 men 30

good fibroscans are now available in UK too but i guess hbsag quant assays are still missing.members from UK had to move to europe for updated tests on hbv as hbsag quant by architect

viral load has no meaning in terms of infection but the higher the viral load, the higher liver damage ususally.hbsag quant correlates better with infected cells in the liver and hbvdna is used to measure if antiviral is working together with hbsag quant

you should start tenofovir to make hbvdna und and avoid any possibility of the baby getting infected.is hbeag positive?

vaccine/HBIG to prevent cronic hbv in the baby can fail with hbeag pos and high hbvdna, i'd go with tenofovir as guidelines indicate and as many members here did

[makimak]

Just an update, been back to the hospital to see the specialist regarding the blood test I had 3 weeks ago, I was told my viral load was slightly high and my liver ALT is slightly high too. He said for a woman the average was about 30 but my results is showing 56 (if that makes sense). Some terms i didn't fully understand but I suppose what he was saying is my liver has become sore and I may need to go on treatment to control this. We did some more blood test today as he wanted to make sure that he double checked everything before giving me treatment especially now that i'm 7 months pregnant. I am due to go back again in 3 weeks to see him and discuss the results. He did say I will have to have a fibroscan after I give birth.

He mentioned that the viral load can go up and down, therefore, it is important to re-check everything before prescribing treatment as this will be on-going. Does anyone know what causes the viral load to increase?  

[stef2011]

http://www.medhelp.org/health_pages/Hepatitis/HepB-Introduction--Welcome-Page/show/34?cid=153

http://www.medhelp.org/health_pages/Hepatitis/the-general-book-of-ignorance-about-hepatitis-B/show/1152?cid=153

there are many ignorant doctors so it is better to studies the guides linked above so that you can prevent dealing with one of them and are able to understand who is ignorant or who is expert

[stef2011]

if the doctor means just feeling the liver by hands that's a century ago way to feel if liver is stiff or normal....an expert doctor could not feel my cirrhosis by hands so if that is the case tell the doctor he is crazy if he thinks he can feel liver damage by hands, a witch might be more helpful

As I am 28 weeks pregnant at the moment

you have to take antivirals to prevent your baby being nfected in case hbvdna is high and hbeag positive, but antiviral has no effect on hbv so it is used only in case there is liver damage or to prevent babies infection.
your baby needs vaccine too but in case hbsag is positive it can fail so tenofovir is given, tenofovir is the only safe in your case, do not use others because they can make virus mutations and get disease worst especially lamivudine, adefovir or telbivudine, latest international guidelines consider only tenofovir for pregnancy

[stef2011]

they will flip the liver to check whether it is sore or not

only fibroscan is used to determine if liver is damaged, be careful UK healthcare system is not updated and they save money on people health, ask for a fibroscan and if UK has no fibroscan (what a shame even third world countires have) go to germany, italy, spain or france and try to charge the costs to UK healthcare system

i know i have free healthcare in UK so probably you have the same in italy, ryanair are extremely cheap and other members had to travel outside UK because tests are obsolete for hbv and there are no fibroscans