Are you taking the conventional, Western-medicine route or some other route?
If the former, according to AASLD Hep-B Guideline 2009 Update,
If you are HBeAg+, HBV DNA (PCR) >20,000 IU/mL ALT 40 years, ALT persistently high normal-2x ULN, or with family history of HCC. Consider treatment if HBV DNA >20,000 IU/mL and biopsy shows moderate/severe inflammation or significant fibrosis.
If you are HBeAg+, HBV DNA (PCR) >20,000 IU/mL ALT >2 x ULN, then, observe for 3-6 months and treat if no spontaneous HBeAg loss. Consider liver biopsy prior to treatment if compensated. Immediate treatment if icteric or clinical decompensation. IFNa/pegIFNa, LAM, ADV, ETV, TDF or LdT may be used as initial therapy. ADV not preferred due to weak antiviral activity and high rate of resistance after 1st year. LAM and LdT not preferred due to high rate of drug resistance. End-point of treatment – Seroconversion from HBeAg to anti-HBe. Duration of therapy: IFN-a: 16 weeks; PegIFN-a: 48 weeks; LAM/ADV/ETV/LdT/TDF: minimum 1 year, continue for at least 6 months after HBeAg seroconversion; IFNa non-responders / contraindications to IFNa -> TDF/ETV.
If you are HBeAg-, HBV DNA (PCR) >20,000 IU/mL ALT >2 x ULN, then, IFN-a/peg IFN-a, LAM, ADV, ETV, TDF or LdT may be used as initial therapy. LAM and LdT not preferred due to high rate of drug resistance ADV not preferred due to weak antiviral activity and high risk of resistance after 1st year. End-point of treatment – not defined. Duration of therapy: IFN-a/pegIFN-a: 1 year; LAM/ADV/ETV/LdT/TDF: >1 year; IFNa non-responders / contraindications to IFN-a -> TDF/ETV.
If you are HBeAg-, HBV DNA (PCR) >2,000 IU/mL ALT 1- >2 x ULN, then, consider liver biopsy and treat if liver biopsy shows moderate/severe necroinflammation or significant fibrosis.
If you are HBeAg-, HBV DNA (PCR) <=2,000 IU/mL ALT 2,000 IU/mL—Treat, LAM/ADV/ETV/LdT/TDF may be used as initial therapy. LAM and LdT not preferred due to high rate of drug resistance; ADV not preferred due to weak antiviral activity and high risk of resistance after 1st year. HBV DNA6 months; 2. Serum HBV DNA >20,000 IU/mL (105copies/mL), lower values 2,000- 20,000 IU/mL (104-105 copies/mL) are often seen in HBeAg-negative chronic hepatitis B; 3. Persistent or intermittent elevation in ALT/AST levels; 4. Liver biopsy showing chronic hepatitis with moderate or severe necroinflammation.
Inactive HBsAg carrier state: 1. HBsAg-positive >6 months; 2. HBeAg-, anti-HBe+; 3. Serum HBV DNA 20,000 IU/mL after a 3-6 month period of elevated ALT levels between 1-2 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. Patients who remain HBeAg positive with HBVDNA levels>20,000 IU/mL after a 3-6 month period of elevated ALT levels >2 ULN should be considered for treatment.
● HBeAg-negative patients with normal ALT and HBV DNA <2,000 IU/mL should be tested for ALT every 3 months during the first year to verify that they are truly in the “inactive carrier state” and then every 6-12 months.
● Tests for HBV DNA and more frequent monitoring should be performed if ALT or AST increases above the normal limit.
IFN-a and PegIFN-a: initial influenza-like illness: fever, chills, headache, malaise and myalgia. Other common side effects include fatigue, anorexia, weight loss and mild increase in hair loss. The most troublesome side effect of IFN-a is emotional lability: anxiety, irritability, depression and even suicidal tendency.
Lamivudine: very well tolerated.
Adefovir Dipivoxil (bis-POM PMEA, Hepsera): Nephrotoxicity has been reported in 3% of patients with compensated liver disease after 4-5 years of continued adefovir therapy.
Entecavir: a similar safety profile as lamivudine in clinical trials. Studies in rodents exposed to doses 3 to 40 times that in humans found an increased incidence of lung adenomas, brain gliomas and HCCs.
L-deoxythymidine (Telbivudine/LdT, Tyzeka): well tolerated when used as monotherapy and has a safety profile comparable to lamivudine. However, cases of myopathy and peripheral neuropathy have been reported.
Tenofovir: has been reported to cause Fanconi syndrome, renal insufficiency as well as osteomalacia and decrease in bone density.
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