Aa
Questions, more questions
Guys,
As much as i try to get my head around terms and different statistical facts there is a bunch of things i don't quite understand:
1). If ALT is 47 whilst the VL is 638U/l does that mean there is still liver damage. i noticed on a prev thread that someone mentioned the higher the DNA the higher the chance of liver damage...
2). What is the DNA? Is that the same as the VL indication.
3). When a hepitologist is looking at an inidividuals results, what prompts them to decide medication or not? I was immediately put on pega interferon but it obviously didn't do the job, hence, on combo med now.
4). What do you need from my post to show exactly how bad my liver was affected when it was still in undetected stage.
5). pls explain the seroconversion stage...
6). if one has positive e-antigen what does this mean? I'm also guessing if e-antigen is positive e-antibody is always going to be negative... and vice-versa?
7). From my biopsy i was told my liver was healthy yet there was slight scarring... Obviously that is a bad thing but as the liver tends to re-energise on its own could there be a possibility that scarring won't do me much harm in the future?
The worst thing is trying to understand everything needed to know in regards to HBV then after all results are gathered and explained i'm still sitting here even more confused.
As much as i try to get my head around terms and different statistical facts there is a bunch of things i don't quite understand:
1). If ALT is 47 whilst the VL is 638U/l does that mean there is still liver damage. i noticed on a prev thread that someone mentioned the higher the DNA the higher the chance of liver damage...
2). What is the DNA? Is that the same as the VL indication.
3). When a hepitologist is looking at an inidividuals results, what prompts them to decide medication or not? I was immediately put on pega interferon but it obviously didn't do the job, hence, on combo med now.
4). What do you need from my post to show exactly how bad my liver was affected when it was still in undetected stage.
5). pls explain the seroconversion stage...
6). if one has positive e-antigen what does this mean? I'm also guessing if e-antigen is positive e-antibody is always going to be negative... and vice-versa?
7). From my biopsy i was told my liver was healthy yet there was slight scarring... Obviously that is a bad thing but as the liver tends to re-energise on its own could there be a possibility that scarring won't do me much harm in the future?
The worst thing is trying to understand everything needed to know in regards to HBV then after all results are gathered and explained i'm still sitting here even more confused.
Don't get confused as a lot of new findings are coming out everyday due to complexity of HBV but the progress is pretty slow. That's why we still have to confront with treat/no-treat after 30+ years of knowing this monster existence. You have done all the right things :
i) done w/ Biopsy - know you liver condition / so find out more on the stage you are in.
ii) start medication - hope it speed up the sero-convert...need to think of resistance & ensure that the med won't interfere with yr plan to have baby.
Lastly....just keep monitoring your liver - this is what my Hepatologist told me - there is nothing we could do and there is no cure to it currently.
We are so lucky to have so much knowledge (I admit it makes me worry sometime) and what is the for us. But, think about those w/o choice - only LDV have full marketing right in China & 300M+ of people either no treatment or sub-optimal treatment or can't afford the medication.....
i) done w/ Biopsy - know you liver condition / so find out more on the stage you are in.
ii) start medication - hope it speed up the sero-convert...need to think of resistance & ensure that the med won't interfere with yr plan to have baby.
Lastly....just keep monitoring your liver - this is what my Hepatologist told me - there is nothing we could do and there is no cure to it currently.
We are so lucky to have so much knowledge (I admit it makes me worry sometime) and what is the for us. But, think about those w/o choice - only LDV have full marketing right in China & 300M+ of people either no treatment or sub-optimal treatment or can't afford the medication.....
As Zellyf suggested, the biopsy is the only real look into the health of your liver & you should have the grading & stage....
This from Dr. Keeffe answers some of your questions:
"Now what about if we do nothing? If we don’t have any therapy at all for hepatitis B, is there a natural clearance rate? Well there is, but it’s very low. And I have to say that I only rarely see this in my practice, but there are some very nice reports in the literature, particularly from Taiwan and China, showing that if you follow a large number of carriers, particularly older individuals, that they will actually lose the surface antigen. The surface antigen, that we abbreviate HBsAg, is really the marker of infection. When that goes away, the antibody of recovery is called the surface antibody, abbreviated Anti-HBs, occurs. But more importantly, as it relates to therapy, is there is an antigen called the “e-antigen”, which is a marker of activity of the virus. And so, it along with DNA indicates an active virus. This particularly applies to what is called the “Wild type” virus. Now the e-antigen will spontaneously convert in about 4%- 12% of carriers per year, even if we do nothing. That means the disease shuts down spontaneously. In over 5 years it’s 40%-50%, over 10 years it’s 70%-80%. These studies come from Asian countries, and also from Brian McMahon, who’s been very carefully studying Native Americans in Alaska and has published some very nice papers. This occurs more often in older individuals and those with elevated liver enzymes. The ALT, that patients sometimes called the “alt”, is the abbreviation for the alanine aminotransferase, it’s a liver enzyme. It’s simply a protein in the liver cell. When the liver is inflamed, that protein gets out of the liver cell into the blood stream, so it’s a marker of inflammation of the liver. The ALT tends to be higher in people who are converting. So some doctors, and you’ll see some guidelines that are conservative will say that if we see a new patient, and the ALT level is up to 200- 400, and the patient is e-antigen positive, that patient may be going into a spontaneous sero-conversion, they’re going to lose the e-antigen and develop the e-antibody, and they’re going to become quiet without therapy, so wait, don’t treat right away. My own philosophy, I would rather initiate therapy and accelerate sero-conversion because when the ALT is elevated, there is liver damage taking place. I would rather accelerate the process if I can. Now up to 20% who lose the e-antigen may revert back and become active, but that’s the high figure, it’s more like 5% over a lifetime. Now the one thing we’ve learned, for those of you who have hepatitis B, if you ever have a malignancy, and have to have chemotherapy, like breast cancer or colon cancer, you need to be protected with an oral agent, like lamivudine or adefovir, because while you’re having chemotherapy, there’s a high likelihood your hepatitis B will reactivate again. Now, oncologists are starting to get that message out, but it’s still not there across the community, so you should be aware of that, that’s one of the issues that will lead to the reactivation of hepatitis B."
"Now what about if we do nothing? If we don’t have any therapy at all for hepatitis B, is there a natural clearance rate? Well there is, but it’s very low. And I have to say that I only rarely see this in my practice, but there are some very nice reports in the literature, particularly from Taiwan and China, showing that if you follow a large number of carriers, particularly older individuals, that they will actually lose the surface antigen. The surface antigen, that we abbreviate HBsAg, is really the marker of infection. When that goes away, the antibody of recovery is called the surface antibody, abbreviated Anti-HBs, occurs. But more importantly, as it relates to therapy, is there is an antigen called the “e-antigen”, which is a marker of activity of the virus. And so, it along with DNA indicates an active virus. This particularly applies to what is called the “Wild type” virus. Now the e-antigen will spontaneously convert in about 4%- 12% of carriers per year, even if we do nothing. That means the disease shuts down spontaneously. In over 5 years it’s 40%-50%, over 10 years it’s 70%-80%. These studies come from Asian countries, and also from Brian McMahon, who’s been very carefully studying Native Americans in Alaska and has published some very nice papers. This occurs more often in older individuals and those with elevated liver enzymes. The ALT, that patients sometimes called the “alt”, is the abbreviation for the alanine aminotransferase, it’s a liver enzyme. It’s simply a protein in the liver cell. When the liver is inflamed, that protein gets out of the liver cell into the blood stream, so it’s a marker of inflammation of the liver. The ALT tends to be higher in people who are converting. So some doctors, and you’ll see some guidelines that are conservative will say that if we see a new patient, and the ALT level is up to 200- 400, and the patient is e-antigen positive, that patient may be going into a spontaneous sero-conversion, they’re going to lose the e-antigen and develop the e-antibody, and they’re going to become quiet without therapy, so wait, don’t treat right away. My own philosophy, I would rather initiate therapy and accelerate sero-conversion because when the ALT is elevated, there is liver damage taking place. I would rather accelerate the process if I can. Now up to 20% who lose the e-antigen may revert back and become active, but that’s the high figure, it’s more like 5% over a lifetime. Now the one thing we’ve learned, for those of you who have hepatitis B, if you ever have a malignancy, and have to have chemotherapy, like breast cancer or colon cancer, you need to be protected with an oral agent, like lamivudine or adefovir, because while you’re having chemotherapy, there’s a high likelihood your hepatitis B will reactivate again. Now, oncologists are starting to get that message out, but it’s still not there across the community, so you should be aware of that, that’s one of the issues that will lead to the reactivation of hepatitis B."
All your questions are quite valid.
Before there were antiviral drugs, pega interferon was the only tool in the hepitologist's tool bag, could this be the reason? Could it be that your ALT was active enough and your VL was low enough and your genotype was A such that your hepitologist tried to cure you once for all?
Combo treatment must have resistance and sustained viral suppression in mind. We would understand the reasons behind your hepitologist's decisions better if we have your labs prior to the treatments and as Zellyf indicated, as detailed as possible.
You are right: higher VL is associated with disease progression. But exactly how much ALT value and how much VL load are hard to say.
DNA in this context I think means the DNAs of the HepB virus.
Hope this helps.
Before there were antiviral drugs, pega interferon was the only tool in the hepitologist's tool bag, could this be the reason? Could it be that your ALT was active enough and your VL was low enough and your genotype was A such that your hepitologist tried to cure you once for all?
Combo treatment must have resistance and sustained viral suppression in mind. We would understand the reasons behind your hepitologist's decisions better if we have your labs prior to the treatments and as Zellyf indicated, as detailed as possible.
You are right: higher VL is associated with disease progression. But exactly how much ALT value and how much VL load are hard to say.
DNA in this context I think means the DNAs of the HepB virus.
Hope this helps.
1). If ALT is 47 whilst the VL is 638U/l does that mean there is still liver damage. i noticed on a prev thread that someone mentioned the higher the DNA the higher the chance of liver damage...
ALT and HBV DNA (which is the same as viral load cannot measure how much damage or scarring the liver is experiencing. That can be best determined by biopsy. ALT *is* a measure of cell death and a high viral load has been shown to be related to liver damage but it is not a measure of the current state of the liver.
2). What is the DNA? Is that the same as the VL indication.
Yes.
3). When a hepitologist is looking at an inidividuals results, what prompts them to decide medication or not? I was immediately put on pega interferon but it obviously didn't do the job, hence, on combo med now.
Ideally one would look at a series of ALTs and VLs as well as a recent biopsy. Sometimes, in the presence of very elevated VL and ALT you might initiate treatment without a biopsy. Do some more reading on the different stages in the typical progression of Hep B and review the current flow chart for treatment.
4). What do you need from my post to show exactly how bad my liver was affected when it was still in undetected stage.
Do you mean before diagnosis? Because undetected refers to a viral load that is too low to be counted by currently available tests.
5). pls explain the seroconversion stage...
Best to go to the Welcome page and read it again.
6). if one has positive e-antigen what does this mean? I'm also guessing if e-antigen is positive e-antibody is always going to be negative... and vice-versa?
Again, this is explained on the Welcome page as well as I could do it here. If you still have questions after that come back and post.
7). From my biopsy i was told my liver was healthy yet there was slight scarring... Obviously that is a bad thing but as the liver tends to re-energise on its own could there be a possibility that scarring won't do me much harm in the future?
Some scarring is to be expected with Hep B that you've had since birth. How it will progress from here is impossible to say. I would focus on the fact that your liver seems to have sustained little damage so far and do what you can to keep it that way. Did they give you your staging in numbers? That would better...slight scarring is awfully vague. I'd ask to see the report.
ALT and HBV DNA (which is the same as viral load cannot measure how much damage or scarring the liver is experiencing. That can be best determined by biopsy. ALT *is* a measure of cell death and a high viral load has been shown to be related to liver damage but it is not a measure of the current state of the liver.
2). What is the DNA? Is that the same as the VL indication.
Yes.
3). When a hepitologist is looking at an inidividuals results, what prompts them to decide medication or not? I was immediately put on pega interferon but it obviously didn't do the job, hence, on combo med now.
Ideally one would look at a series of ALTs and VLs as well as a recent biopsy. Sometimes, in the presence of very elevated VL and ALT you might initiate treatment without a biopsy. Do some more reading on the different stages in the typical progression of Hep B and review the current flow chart for treatment.
4). What do you need from my post to show exactly how bad my liver was affected when it was still in undetected stage.
Do you mean before diagnosis? Because undetected refers to a viral load that is too low to be counted by currently available tests.
5). pls explain the seroconversion stage...
Best to go to the Welcome page and read it again.
6). if one has positive e-antigen what does this mean? I'm also guessing if e-antigen is positive e-antibody is always going to be negative... and vice-versa?
Again, this is explained on the Welcome page as well as I could do it here. If you still have questions after that come back and post.
7). From my biopsy i was told my liver was healthy yet there was slight scarring... Obviously that is a bad thing but as the liver tends to re-energise on its own could there be a possibility that scarring won't do me much harm in the future?
Some scarring is to be expected with Hep B that you've had since birth. How it will progress from here is impossible to say. I would focus on the fact that your liver seems to have sustained little damage so far and do what you can to keep it that way. Did they give you your staging in numbers? That would better...slight scarring is awfully vague. I'd ask to see the report.
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