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Doctor Comments
I was diagnosed with hep b in March 2008. I had my first tests then. The result was HbsAg +ve, HbeAg -ve, Hbeab +ve
HBV DNA load - 4000 copies/ml
Now I went to see my doctor this week and he advised me to go for only Hbsag Test. he says there is no point in looking at other markers because they won't change so frequently.
Also, he wants to do a biopsy on me to establish a baseline and determine if I need treatment.
My questions are: does it really make sense to go for biopsy if my hbv dna count is 4000? Also, he is not even testing that. I am of the opinion that if I can avoid biposy, I should avoid it. Are there any other options apart from biopsy like ultrasound etc which can give some idea about health of liver?
HBV DNA load - 4000 copies/ml
Now I went to see my doctor this week and he advised me to go for only Hbsag Test. he says there is no point in looking at other markers because they won't change so frequently.
Also, he wants to do a biopsy on me to establish a baseline and determine if I need treatment.
My questions are: does it really make sense to go for biopsy if my hbv dna count is 4000? Also, he is not even testing that. I am of the opinion that if I can avoid biposy, I should avoid it. Are there any other options apart from biopsy like ultrasound etc which can give some idea about health of liver?
HBsag +ve, HBe _ve , AntiHBe +ve. If your ALT and AST are also persistently normal then you are considered an inactive carrier and no treatment is recommended. Do you know your ALT and AST?
Helo sir,
I am HBsag +ve, HBe _ve , AntiHBe +ve. As per my physician no need for HBVDNA,Is there any treatment for such case.I have done these test during March 08 and again in Nov08 both time same result obtained.kindly suggest some treatment to cleare HBV.if possible.
I am HBsag +ve, HBe _ve , AntiHBe +ve. As per my physician no need for HBVDNA,Is there any treatment for such case.I have done these test during March 08 and again in Nov08 both time same result obtained.kindly suggest some treatment to cleare HBV.if possible.
Do the doctors push for biopsy if patient says no?
--The patient makes the decision. On the other hand, your doctor is on your side even if your views may be different.
What if my liver panel results are bad? Can he start me on pills without doing biopsy?
--Yes, if your liver panel results show you need treatment, your doctor can make the recommendation without biopsy.
also, what are the possible alternatives to biopsy which the doctor can use to decide if I need to start treatment?
--Depends on what your doctor wants to find out. Biopsy is the most direct assessment of your liver.
Hope this helps.
--The patient makes the decision. On the other hand, your doctor is on your side even if your views may be different.
What if my liver panel results are bad? Can he start me on pills without doing biopsy?
--Yes, if your liver panel results show you need treatment, your doctor can make the recommendation without biopsy.
also, what are the possible alternatives to biopsy which the doctor can use to decide if I need to start treatment?
--Depends on what your doctor wants to find out. Biopsy is the most direct assessment of your liver.
Hope this helps.
also, what are the possible alternatives to biopsy which the doctor can use to decide if I need to start treatment?
I have given this a thought last week and I guess I am not ready for a biopsy as of now.
If my Liver Panel results are not bad enough - I don;t know about HBV DNA count as doctor dod not test it, so if liver panel is not bad , I guess I am going to say No to biopsy.
Do the doctors push for biopsy if patient says no?
What if my liver panel results are bad? Can he start me on pills without doing biopsy?
If my Liver Panel results are not bad enough - I don;t know about HBV DNA count as doctor dod not test it, so if liver panel is not bad , I guess I am going to say No to biopsy.
Do the doctors push for biopsy if patient says no?
What if my liver panel results are bad? Can he start me on pills without doing biopsy?
As you know, there is always the other side with its reasons too. The best option is to discuss your case with a doctor in the know familiar with your liver. That way your decision is most likely to be the most appropriate one.
as usual, you are the best source for info
i spontaneously seroconvered God knows how long ago.
so i guess i am gonna take my changes and do away with liver biopsy
i think the first argument by William Balistreri was convincing enough
thank again Cajim
best of luck
i spontaneously seroconvered God knows how long ago.
so i guess i am gonna take my changes and do away with liver biopsy
i think the first argument by William Balistreri was convincing enough
thank again Cajim
best of luck
Notes on “The Facts About Liver Biopsy,” Katie West,
If you will be having a liver biopsy it is important that you thoroughly discuss with your doctor both the procedure and purpose of the biopsy and get all of your questions answered before it is scheduled. These points will help to inform you of biopsy procedure and in guiding your questions.
What is a liver biopsy?
A liver biopsy is a procedure in which a small sample of liver tissue is removed from the liver in order to more closely analyze the liver and diagnose liver conditions. Before a biopsy is performed, other less intrusive tests such as x-rays and blood tests are usually issued. It is only after those tests come back and your doctor decides she/he needs more information that a biopsy is scheduled.
Why is a liver biopsy performed?
A liver biopsy can be especially helpful in diagnosing liver abnormalities and diseases, especially hepatitis and liver cancer, when other tests are inconclusive.
Biopsies can also help to predict treatment outcomes for chronic Hepatitis C patients and in the management of Hepatitis C.
How is a live biopsy performed?
There are several kinds of biopsy procedures, however the most common is a percutaneous biopsy. In this type of biopsy the procedure is performed at the hospital. The patient will lie on her/his back, placing their right hand above their head. The patient is given a local anesthetic starting at the skin level and continuing through the chest wall, into the liver to numb the biopsy area.
After the patient is fully numb, a biopsy needle is quickly inserted and removed while the patient holds her/his breathe. Ultrasound is sometimes used in guiding the biopsy needle. This needle is used to remove a small section of the liver. Because the area is numbed, the patient should only feel a small amount of dull pain and pressure during the biopsy.
The entire procedure typically takes about 20 minutes, with approximately 5 to 10 seconds where the patient will have to remain completely still, holding her/his breath.
What to expect before the biopsy
Before the biopsy is performed, a doctor will run a series of blood tests and take a complete medical history. In most instances, patients are instructed to stop taking aspirin, ibuprofren, anticoagulants, and possibly other medications for one week leading up to the biopsy and to not eat and drink for the 8 hours directly before the procedure.
After the biopsy
Most patients feel a minimal amount of pain after the biopsy procedure. A bandage is placed over the incision and the patient is instructed to lie on her/his right side for up to 2 hours to help stop the bleeding. In most cases, patients are sent home the same day. Patients must have a ride home from the hospital and will need to be on bed rest for 8 to 12 hours.
The most common complaints after a liver biopsy is soreness around the incision and pain in the right shoulder. Similar to before the procedure, it is essential that patients do not take aspirin, ibuprofren, or other blood thinning medications for one week after the procedure to ensure the incision and biopsy site heals properly.
What are possible complications of a liver biopsy?
Bleeding from the liver (at the site of the biopsy) is the most common complication of a liver biopsy. It is reported that this occurs in 1 out of every 100 patients. In most cases the bleeding is not severe enough to require a blood transfusion, however in some cases a transfusion and/or surgery is required to stop the bleeding. Other less common complications include puncture of the lung or gallbladder and infection. It is your right as a patient to be informed of and your doctor’s responsibility to inform you of these complications, however it is also important to remember that any surgery has the risk of complications, and that often those complications are rare.
If you will be having a liver biopsy it is important that you thoroughly discuss with your doctor both the procedure and purpose of the biopsy and get all of your questions answered before it is scheduled. These points will help to inform you of biopsy procedure and in guiding your questions.
What is a liver biopsy?
A liver biopsy is a procedure in which a small sample of liver tissue is removed from the liver in order to more closely analyze the liver and diagnose liver conditions. Before a biopsy is performed, other less intrusive tests such as x-rays and blood tests are usually issued. It is only after those tests come back and your doctor decides she/he needs more information that a biopsy is scheduled.
Why is a liver biopsy performed?
A liver biopsy can be especially helpful in diagnosing liver abnormalities and diseases, especially hepatitis and liver cancer, when other tests are inconclusive.
Biopsies can also help to predict treatment outcomes for chronic Hepatitis C patients and in the management of Hepatitis C.
How is a live biopsy performed?
There are several kinds of biopsy procedures, however the most common is a percutaneous biopsy. In this type of biopsy the procedure is performed at the hospital. The patient will lie on her/his back, placing their right hand above their head. The patient is given a local anesthetic starting at the skin level and continuing through the chest wall, into the liver to numb the biopsy area.
After the patient is fully numb, a biopsy needle is quickly inserted and removed while the patient holds her/his breathe. Ultrasound is sometimes used in guiding the biopsy needle. This needle is used to remove a small section of the liver. Because the area is numbed, the patient should only feel a small amount of dull pain and pressure during the biopsy.
The entire procedure typically takes about 20 minutes, with approximately 5 to 10 seconds where the patient will have to remain completely still, holding her/his breath.
What to expect before the biopsy
Before the biopsy is performed, a doctor will run a series of blood tests and take a complete medical history. In most instances, patients are instructed to stop taking aspirin, ibuprofren, anticoagulants, and possibly other medications for one week leading up to the biopsy and to not eat and drink for the 8 hours directly before the procedure.
After the biopsy
Most patients feel a minimal amount of pain after the biopsy procedure. A bandage is placed over the incision and the patient is instructed to lie on her/his right side for up to 2 hours to help stop the bleeding. In most cases, patients are sent home the same day. Patients must have a ride home from the hospital and will need to be on bed rest for 8 to 12 hours.
The most common complaints after a liver biopsy is soreness around the incision and pain in the right shoulder. Similar to before the procedure, it is essential that patients do not take aspirin, ibuprofren, or other blood thinning medications for one week after the procedure to ensure the incision and biopsy site heals properly.
What are possible complications of a liver biopsy?
Bleeding from the liver (at the site of the biopsy) is the most common complication of a liver biopsy. It is reported that this occurs in 1 out of every 100 patients. In most cases the bleeding is not severe enough to require a blood transfusion, however in some cases a transfusion and/or surgery is required to stop the bleeding. Other less common complications include puncture of the lung or gallbladder and infection. It is your right as a patient to be informed of and your doctor’s responsibility to inform you of these complications, however it is also important to remember that any surgery has the risk of complications, and that often those complications are rare.
HepB Foundation Expert Speaker:
11. Who needs a liver biopsy and who doesn't?
There is an old school of liver specialists who believe in biopsying everything. And there is a new school who feels that we have enough data now, so why do we need to biopsy, because it is not going to change our treatment? I subscribe to the new school - unless you are going to enroll in a clinical trial, where you are required to have a biopsy.
11. Who needs a liver biopsy and who doesn't?
There is an old school of liver specialists who believe in biopsying everything. And there is a new school who feels that we have enough data now, so why do we need to biopsy, because it is not going to change our treatment? I subscribe to the new school - unless you are going to enroll in a clinical trial, where you are required to have a biopsy.
Notes on "Role of Liver Biopsy in Chronic Hepatitis B," by Balistreri, William F.
1. The major value of a liver biopsy in a patient with chronic hepatitis B infection is to rule out other causes of liver disease, assess the degree of liver damage, and provide information regarding disease progression. The issue is not always clearcut -- liver histology can improve significantly in patients who have spontaneous hepatitis B e antigen (HBeAg) seroconversion or sustained response to antiviral therapy. Likewise, liver histology can worsen rapidly in patients who have recurrent exacerbations or reactivation of hepatitis B.
2. In practice, the issue of whether to initiate treatment in a patient with chronic hepatitis B does not depend on histologic findings, such as the grade of inflammation. The liver biopsy is of limited value in predicting response to interferon therapy and the data are limited regarding the value in predicting response to any of the oral antiviral agents. The best candidates for treatment are those individuals with positive predictors of response -- these patients can be identified on the basis of serum HBV DNA levels, hepatic biochemical tests, and serologic studies. The best indicators of sustained virologic response are low pre-treatment serum HBV DNA titers and elevated alanine aminotransferase (ALT) levels. The decision as to whether to obtain a liver biopsy should take into consideration age, the upper limits of normal (ULN) for serum ALT level, HBeAg status, HBV DNA levels, and other clinical features suggestive of chronic liver disease. The American Association for the Study of Liver Diseases (AASLD) guidelines suggest that "patients who remain HBeAg positive with HBV DNA levels> 20,000 IU/mL after a 3-6 month period of elevated ALT levels between 1-2x ULN, or who remain HBeAg positive with HBV DNA levels> 20,000 IU/mL and are>40 years old, should be considered for liver biopsy, and treatment should be considered if biopsy shows moderate/severe inflammation or significant fibrosis." Therefore, liver biopsy is most useful in persons who do not meet clearcut guidelines for treatment.
3. One could argue that a biopsy could indicate cirrhosis and that the presence of cirrhosis increases the risk for hepatocellular carcinoma (HCC). However, periodic screening for HCC should be performed in all patients with chronic HBV infection, even in the absence of cirrhosis.
1. The major value of a liver biopsy in a patient with chronic hepatitis B infection is to rule out other causes of liver disease, assess the degree of liver damage, and provide information regarding disease progression. The issue is not always clearcut -- liver histology can improve significantly in patients who have spontaneous hepatitis B e antigen (HBeAg) seroconversion or sustained response to antiviral therapy. Likewise, liver histology can worsen rapidly in patients who have recurrent exacerbations or reactivation of hepatitis B.
2. In practice, the issue of whether to initiate treatment in a patient with chronic hepatitis B does not depend on histologic findings, such as the grade of inflammation. The liver biopsy is of limited value in predicting response to interferon therapy and the data are limited regarding the value in predicting response to any of the oral antiviral agents. The best candidates for treatment are those individuals with positive predictors of response -- these patients can be identified on the basis of serum HBV DNA levels, hepatic biochemical tests, and serologic studies. The best indicators of sustained virologic response are low pre-treatment serum HBV DNA titers and elevated alanine aminotransferase (ALT) levels. The decision as to whether to obtain a liver biopsy should take into consideration age, the upper limits of normal (ULN) for serum ALT level, HBeAg status, HBV DNA levels, and other clinical features suggestive of chronic liver disease. The American Association for the Study of Liver Diseases (AASLD) guidelines suggest that "patients who remain HBeAg positive with HBV DNA levels> 20,000 IU/mL after a 3-6 month period of elevated ALT levels between 1-2x ULN, or who remain HBeAg positive with HBV DNA levels> 20,000 IU/mL and are>40 years old, should be considered for liver biopsy, and treatment should be considered if biopsy shows moderate/severe inflammation or significant fibrosis." Therefore, liver biopsy is most useful in persons who do not meet clearcut guidelines for treatment.
3. One could argue that a biopsy could indicate cirrhosis and that the presence of cirrhosis increases the risk for hepatocellular carcinoma (HCC). However, periodic screening for HCC should be performed in all patients with chronic HBV infection, even in the absence of cirrhosis.
well i am almost in the same status as you are.
i was sitting at 3470 copies/ml with normal ALT and AST
Doctor gave me an option at the time and said he liked to treat no matter spcially that i was hgeag (-ve) but didnt know how long ago i had serocnverted.
we did an ultra sound which also came back normal
last visit two weeks ago - it had been two months since i started treatment - my DNA was UND, ALT and AST were normal.
he wants to see me in 4 months but said he wanted to do a biopsy when i go back. at least discuss a biopby.
not sure wanna do a biopsy. i feel like its the best way to really know where your live stands but in the mean time ultra sound is ok, ALT and AST are normal.
i was diagnosed back in April this year but did manage to get blood results from regualr physical checks up going back to 2004 and ALT /AST showed normal readings back then.
point is, i dont know how bad it is gonna be on your body to do a bipsy. my understanding is that liver regenerates ( correct me if i am wrong on this) , so maybe ONE and ONLY ONE biopsy to know where you stand isnt the worst of all things that happen to your body. it just sets the base line info on your liver and gives an idea to your doctor how treat you if you need one.
maybe i am just saying it is ok now and maybe i will get scared when it is time to do a biopsy and back out of it. i dont know
best of luck. please update me with what you do as we seem to be almost exactly in the same boat.
i was sitting at 3470 copies/ml with normal ALT and AST
Doctor gave me an option at the time and said he liked to treat no matter spcially that i was hgeag (-ve) but didnt know how long ago i had serocnverted.
we did an ultra sound which also came back normal
last visit two weeks ago - it had been two months since i started treatment - my DNA was UND, ALT and AST were normal.
he wants to see me in 4 months but said he wanted to do a biopsy when i go back. at least discuss a biopby.
not sure wanna do a biopsy. i feel like its the best way to really know where your live stands but in the mean time ultra sound is ok, ALT and AST are normal.
i was diagnosed back in April this year but did manage to get blood results from regualr physical checks up going back to 2004 and ALT /AST showed normal readings back then.
point is, i dont know how bad it is gonna be on your body to do a bipsy. my understanding is that liver regenerates ( correct me if i am wrong on this) , so maybe ONE and ONLY ONE biopsy to know where you stand isnt the worst of all things that happen to your body. it just sets the base line info on your liver and gives an idea to your doctor how treat you if you need one.
maybe i am just saying it is ok now and maybe i will get scared when it is time to do a biopsy and back out of it. i dont know
best of luck. please update me with what you do as we seem to be almost exactly in the same boat.
yes - he is going to do CBC and liver profile but he is only testing for surafec antigen, not for antibody or HBV DNA count.
My ALT in march was 39 , AST 25
I am not sure if I should go for Biopsy if I CBC and liver profile is not bad and also he is not checking for HBV DNA which primarly decides biposy and whether treatment is required!!!
My ALT in march was 39 , AST 25
I am not sure if I should go for Biopsy if I CBC and liver profile is not bad and also he is not checking for HBV DNA which primarly decides biposy and whether treatment is required!!!
According to the 2007 guideline:
HBeAg-negative, anti-HBe Positive Patients with Normal ALT Levels and HBV DNA <2,000IU/ml (Inactive HBsAg Carriers). These patients should be monitored with ALT determination every 3 months during the first year to verify that they are truly in the “inactive carrier state” and then every 6-12 months. If the ALT level is subsequently found to be elevated, more frequent monitoring is needed. In addition, an evaluation into the cause of ALT elevation, including HBV DNA tests, should be initiated if it persists or recurs.
Do you know your ALT? Biopsy provides useful information when you are not sure if you need treatment.
HBeAg-negative, anti-HBe Positive Patients with Normal ALT Levels and HBV DNA <2,000IU/ml (Inactive HBsAg Carriers). These patients should be monitored with ALT determination every 3 months during the first year to verify that they are truly in the “inactive carrier state” and then every 6-12 months. If the ALT level is subsequently found to be elevated, more frequent monitoring is needed. In addition, an evaluation into the cause of ALT elevation, including HBV DNA tests, should be initiated if it persists or recurs.
Do you know your ALT? Biopsy provides useful information when you are not sure if you need treatment.
Are you sure you heard him correctly? A surface antigen test is pointless if you're chronic. That's not going to change at all. Your liver panel and DNA are what need to be done about every 6 months.
How old are you again? Gender?
Biopsy is the gold standard for determining the state of the liver. If I were you I would try to get a full liver panel, a CBC and then depending on those you might decide to treat no matter what the biopsy says in which case you might not need one.
How old are you again? Gender?
Biopsy is the gold standard for determining the state of the liver. If I were you I would try to get a full liver panel, a CBC and then depending on those you might decide to treat no matter what the biopsy says in which case you might not need one.
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