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Advice to start treatment or not for HBV
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Advice to start treatment or not for HBV

I am having chronic HBV, detected in 2009 .  Tests showed HbsAg - Positive, HBeAg- negative, anti HBe-Positive , Alpha-Fetoprotein- 10.64 in 2010, 11.80 in 2011, 8.83 in 2012  and now 8.22 in March, 2013. The viral load count was 53,000 to 1,10,000 IU/ML in 2010, 2,08,000 to 2,36,000 in  2011, 2,42,000 in 2012 and now in March,2013 it was 4,12,000 IU/ML. All my blood test , ultrasonography test of liver are normal.  The ALT was 33 & 46 - 2009, 23 & 17 - 2010, 24 - 2011, 30 - 2012 and 34 - March, 2013.  The AST was 28 & 37- 2009, 26 & 27 - 2010, 26 - 2011, 30 - 2012 and 32 - March, 2013. Do I need the treatment,  when my ALT, AST are in limit . My doctor has advised Tenofovir, one tablet daily.  Should I start taking treatment, and  is so is Tenofovir best option.
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Avatar_m_tn
Personally, I would start treatment and Tenofovir is an excellent choice. The reasons being you already have stage 2 fibrosis and your viral load is high.

I am still puzzled by your fairly normal ALT, but that should not stop you from getting treatment.
17 Comments Post a Comment
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Avatar_m_tn
age? hbsag?
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Avatar_m_tn
I find your results very puzzling. Can you please clarify your viral load counts- why are they expressed as x,xx,xxx?
If x,xx,xxx means simply xxx,xxx then you are HBeAg. Negative with a very high viral load, yet your ALT is persistently normal. This is most unusual.
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Avatar_m_tn
One more thing, you said you were diagnosed in 2009, but do you know how long you were infected? I may be wrong, but I understand when one has cirrhosis, the ALT levels tend to be lower.
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Avatar_m_tn
The viral load count was 53,000 & 1,10,000 IU/ML  in two tests in 2010, 2,08,000 & 2,36,000 IU/ML in two tests in  2011, 2,42,000 IU/ML in 2012 and now in March,2013 it was 4,12,000 IU/ML.

Liver biopsy report, done in 2010 , is as under:

"H&E section through liver biopsy tissue shows liver parenchymal cells. There is evidence of ground glass hepatocytes with sanded nucleus.There is mild periportal interface hepatitis . There is no confluent necrisis, and focal inflammation. One portal area shows mild inflammation. Fibrous expansion of most portal areas with short fibrous septa. No e/o cirrhosis seen.
Impression : Mild chronic hepatitis.
HAI scor (3/18).
Stage 2. "

Please advise me further to start treatment/Tenofovir or not. I am non-alcoholic with strict diet regime. My wife  children tested negative and got vaccinated.
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Avatar_m_tn
The viral load count was 53,000 & 1,10,000 IU/ML  in two tests in 2010, 2,08,000 & 2,36,000 IU/ML in two tests in  2011, 2,42,000 IU/ML in 2012 and now in March,2013 it was 4,12,000 IU/ML.

Liver biopsy report, done in 2010 , is as under:

"H&E section through liver biopsy tissue shows liver parenchymal cells. There is evidence of ground glass hepatocytes with sanded nucleus.There is mild periportal interface hepatitis . There is no confluent necrisis, and focal inflammation. One portal area shows mild inflammation. Fibrous expansion of most portal areas with short fibrous septa. No e/o cirrhosis seen.
Impression : Mild chronic hepatitis.
HAI scor (3/18).
Stage 2. "

Please advise me further to start treatment/Tenofovir or not. I am non-alcoholic with strict diet regime. My wife  children tested negative and got vaccinated.
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Avatar_m_tn
Personally, I would start treatment and Tenofovir is an excellent choice. The reasons being you already have stage 2 fibrosis and your viral load is high.

I am still puzzled by your fairly normal ALT, but that should not stop you from getting treatment.
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Avatar_m_tn
Thanks, Sir, I am overwhelmed with your kind advcice at this critical juncture. I am starting taking Tenofovir and will be in your touch.
Regards,

Sincerely,
Veme1.
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Avatar_m_tn
as a antiviral, tenofovir is best choice agree. but before starting tenofovir you can try daily 10000(ten thousand) iu dose of vit d and check its value bi-weekly, and check your other parameters dna and hbsag monthly. you can do this for 2-3 month and check the progress , you may get good results with vit d only and in future  dont need to start tenofovir. even if you get partial response from vit d, u will be clear that vit d is helpfull for you, then after 2-3 months u can start tenofovir with vit d.
you may proceed this way  because 2-3 month wating for starting tenofovir, is not going to harm anything. but if you are successful in controlling hvb by vit d , you may stay away from tenofovir.....so what i suggest you is try just vit d 10000iu/daily dose for 2-3 month then we will think.
may be other members put more light.
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Avatar_m_tn
Thanks Sir,
for the deep insight in the matter. I just want to share that though I was detected with hbv only in 2009 but the fact that hbeag turned negative shows it may be for some time.

Prior to 2009 my exposure to sunrays was enormous, sometimes 8 to 9 hours daily. Now after 2009 it is almost Nil for the nature of job. The viral load data of 2009/2010 at 53,000 IU/Ml  (might be under check by vit. ' D' ) and steady increase thereafter to present load of 4,12,000 IU/Ml (in absence of vit.' D') are also indicating like that  In any case I will try this option as well with the hope for the best.

If any other valuable suggestion is there, kindly let me know.
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Avatar_m_tn
please go for 'hbsag quantative test with dilution' and start vit d,c,zink  then check hbsag quat, vit d level, blood count  and dna (monthly dna only if you can easily afford) monthly to see the advantage. vit d,fish oil are effective against fibrosis. try this for 3 month.update us.

one very valueable suggestion, try whatever option you can try or you want to try before starting antiviral, because once u start antiviral there are only two truths:
first, very difficult to stop.
second ,you can not detect advantage of any other medicine/suppliment on hep b  as viral load will be null after antiviral.
offcourse dont worry  antiviral option is always there to choose.
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Avatar_m_tn
You are 47, Hbeag negative and stage 2 fibrosis was detected 4 years ago, stage 4 is cirrhosis. Since then your viral loads have been above 2,000 iu/ml. I forgot to ask you the ULN for your ALT, but the new upper limit is 30 iu/l for men. The inverse relationship between Vitamin D levels and hbvdna levels has not yet proven to be causal. So, it is my personal opinion that you should start treatment. If you respond well to Tenofovir, as most patients do, your fibrosis should regress and risks of developing HCC reduced. As for stopping antivirals, stopping rules are being refined that will guide you to stop with better then the 50% success rate under the present rules.

I am not a doctor.
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Avatar_m_tn
take care but no need to worry.
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Avatar_m_tn
Kindly keep me advising. Will see doctor with above options.
Thanks.
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Avatar_m_tn
I was unaware of the fact that stage 4 is cirrhosis. Now will see the doctor with above facts.
Thanks.
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Avatar_m_tn
Dear StephenCastlecrag,
Thanks a lot,
As advised I have started taking Tenofovir Disoproxil Fumarate 300 mg Tablet once a day after night meal since Sept.,2013. The tests on 16.12.2013 showed  viral load < 20 IU/ML, Alphafetoprotein serum :  8.90 ng/mL, Hep. Be Antibodies serum : 0.010 (reactive), Hep. Be Antigen : 0.42 (non-reactive). I took vitamin "D'  and it rose from 7.48 ng/mL on 16.08.2013 to 23.07 on 27.12.2013.  
Any further guidance may kindly be advised.

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Avatar_m_tn
I am glad you have responded well to treatment. I would suggest that you just continue treatment and keep monitoring every 6 months. In the future, there are several options you may consider, but they will be dependent on the state of fibrosis of your liver(you can determine this by doing a Fibroscan) and the serum level of HbsAg (by doing a quantitative HbsAg assay). Depending on the results, you may stop treatment or try Interferon add on to see if you can clear the HbsAg.
All the best.
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Avatar_m_tn
increase vitamin d3 dose because 23 is still very deficient, when liver is cirrhotic it is needed much higher dose to increase vitd25oh.best levels are around 50-60ng/ml for you

also be sure your BMI is less than 25, both low bmi and optimum levels of d3 are mandatory for cirrhosis regression
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