Chronic hepatitis B

[asiafem722]

65 y.o. female, found positive for Hepatitis B in 1998. Her first LFT shown
AST (41/41), ALT 36/45. ordered by my primary care MD:

HB E Antibody POSITIVE, HB E Antigen negative, HB SAg (surface antigen) POSITIVE, HB Surface Antibody Negative
Hep A negative, Hep C negative

In Oct 11, 2000 under care of GI/hepatologist, LFT gave:
AST 399/36, ALT 583/39.
In Nov 06, 2000
HBV DNA Quantitative gave  HBV DNA 24200 copies/mL
HBV DNA (pg/mL)  0.085 pg/mL
Lamuvidine was mentioned but not started due to the fact that HBV DNA viral load less than 50000-100000 copies/mL

In Jan 12, 2001, LFT gave:
AST 26/36, ALT 21/39

In Dec 12, 2002 LFT gave:
AST 50/31, ALT 81/30.
US liver, all other test (EGD, Colonoscopy, MRI) normal.

In Jan 10, 2003
AST 32/30, ALT 34/30

In Jan 25, 2006
HBV DNA viral load 719 copies/mL
In Feb 09 2006
HBV DNA 3770 copies/mL
alpha-fetoprotein 6.7 IU/mL (limit 0-15 IU/mL)
In 2007: US liver, other tests: NORMAL

Recently  In June  07 2010 LFT gave:
AST 31/49
ALT 28/55
Alpha-fetoprotein 2.3 ng (limit 0-8.3) by Roche Eclia method
In June 22 2010, labs gave:
HBV Real-time PCR Quant :  HBV 7650 IU/mL
HBV DNA 44500 copies/mL (1 IU= 5.82 copies)
G.I specialist wants to put on VIREAD 300 mg once daily.
Ultra sound liver on June 29 2010 is normal
Hepatitis C and A negative


Since HBV DNA viral load is 44,500 copies which is still under the limitation to treat (< 50,000-100,000 copies/mL).
Should she hold and have another vival load count in December before making decision?

[asiafem722]

Thank you for the feeback.

The reason for posponing/hesitating because her hbe antigen negative she would have to take tenofovir for life.

She will talk to her specialist in December and will decide to start then.
by the way, do you have any update statistic shown the sides effects of tenofovir.

[stef2011]

also entecavir might be a good choice since it has no sides but there is 1,2% possibility of resistance, so entecavir can be used safely only after a virus mutation test has been made

tenofovir can have sides of decreased mineral bone density and kidneys, but these sides are very low rate less than 1% so only having hosteoporosis or kidneys problems might be an issue, on the other hand tenofovir has 0% resistance mutations so safer than etv

[stef2011]

there is no fibroscan or biopsy to check liver damage, his is the most important since cirrhosis and liver cancer risk increase with age and virus mutations, plus it looks like she is still hbe positive which is more correlated with both cirrhosis and HCC.ultrasound can only see HCC but not early cirrhosis (only advanced cirrhosis with nodules and nodules are dangerous for hcc development)

guidelines, at least euro guidelines which are updated more than yearly (US guidelines abolete not updated since 2008) consider hbvdna>2000iu/ml, alt>19, and liver damage higher than f2 for treatment

if she never had kidneys problems i'd start tenofovir right away since her age and quantity of virus even if liver dmage is f1, this is for cirrhosis prevention and hcc prevention since risk is very high after 40yo

by the way copies/ml is not used anymore because confusing, the WHO standard is iu/ml from many years, to change to iu/ml you have to multiply for 5.8