High hbv concentration, normal fibroscan, should I get treatment?

[mdzlyz]

Hi everyone,
I'm a 50yo male living in Australia, of Chinese background. I got diagnosed with Hep B several years ago. I just got my most recent test results back. It says: 'hepatitis B concentration 42,000 IU/mL' (it has been this high for a while now). However, my fibroscan came back normal. But my doctor is recommending treatment with Entecavir or Tenofovir. Should I start treatment?
Thanks for your assistance!

[stef2011]

sorry i didn t notice age, 50yo is when statistically the liver gets more damaged and hcc increases but we are not all the same, as stephenCastlecrag suggested make all tests required and consider if tdf+interferon to clear hbv worths a try

another thing hbsag tends to get low by age, do check its quantity if low like 1500-2000iu/ml definitely try interferon+tdf because you have very high chances to clear by 96weeks combo, if also hbeag positive chances are even higher

[StephenCastlecrag]

Hard to discuss your situation based on so little information. Need history,ALT, eAg status. Also, a sequence of test results is better than just one set in making decision. Since you are in Australia, you should be referred to a liver specialist, do not rely on your GP.

[stef2011]

choice is not easy but since entecavir and tenofovir cannot stopped virus if used alone but can only cure a damaged liver, the use of antivirals is not indicated in your case

you may justify the use of those antivirals according to:

high liver cancer risk because of family history, or because having genotype c or precore/bcp mutants.keep inmind antivirals lower the risk but liver cnacer can happen anyway

you may try to clear the virus by interferon+tenofovir combo for 96weeks

i'd check hbsag quant in iu/ml, genotype, bcp/precore mutants and according to these results start tenofovir for one year and then add interferon+alinia and see if hbv can be cleared

absolutely avoid use of tdf or etv if you are young and you have low risk of hcc, use of antivirals monotherapy will not clear hbv