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Hepatitis B - Biopsy
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Hepatitis B - Biopsy

I am 31 year old Indian born male currently residing in US.
I have been diagnosed with Hepatitis B earlier this year (Feb 2013) by a screening test.
I had taken Hepatitis B vaccine back in 2007 before coming to use (3 shots), hence it looks like i got infected before that.

My results are as follows.
Date : March 4, 2013
HBV DNA - 1130 IU/ml
ALT - 30 ( Lab reference rage - 0 to 60)
AST- 24  ( 0 to 40)
HBeAg -Ve, Anti Hbe Positive
Date : April 8, 2013
AFP - Not detectable
Lever Ultrasound : Liver is unremarkable ( Normal result)

The HBV DNA and ALT, AST repated after 3 months.
Date : 3 June 2013
HBV DNA - 2590 IU
ALT - 41 ( lab Normal range 0 to 65)
AST - 26

I am really freaked out since my DNA is higher and ALT is also higher.

I met the doctor this week since I was concerned about elevated HBVDNA and ALT values. I requested doctor to have a liver biopsy. My doctor told me that he is not too much concerned with increased DNA and ALT values. He thinks to wait for next three months (for next set of HBVDNA and AST/ALT Tests) before biopsy, and told me if it remains persistently elevated, we may do biopsy. We do not have Fibroscan machines.

Can you please advise on waiting for biopsy for three months?

Also, My doctor told me that ALT seems normal, I have doubt on that as well. Any thoughts?

I really appreciate you insight.

Regards
Neil
44 Comments Post a Comment
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Avatar_m_tn
I agree with your doctor.. Viral load of 2,500 copies is low.. HBV tends to run high, like in the billions for some people. But viral loads of 100-200 million copies are not that uncommon. Then it is an emergency.

If you are up for it you can try interferon treatment, for six months. But you want be able to work taking that drug.. but it may help you clear HBV since your immune system is controlling it.

The key here is the immune system..

That is why I say we got it all wrong.. Not hepatologists/gastro guys should be treating us but virologists and molecular biologists. These people really study viruses and know more about them them all the MD's in general.. But then again if the world was perfect then we would have FibroScan here.. and surface antigen quant.
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Avatar_m_tn
but in your case I would not worry..  Viral load is of course bad, but it could be worse..

Just keep in mind that for us so far interferon is the best option if you are going to treat it..
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Avatar_m_tn
Thanks alot for your detailed response. One thing i would like to point out is, above values (1130 and 2600) shows viral load values in IU/ml and not in copies. Do you still think it is okay to wait for 3 months and see next set of test results before biopsy?
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Avatar_m_tn
if you dont test your hbsag quantity in iu/ml all the tests you did are useless.your hbvdna is low but again it is a very little meaning test out of antiviral treatment and without hbsag quant

you better wait for a fibroscan to be available, why damage your liver?
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Avatar_m_tn
So, looking at the test profile, do you think it is safe to wait for a while and check next set of results ( due in september 2013) before rushing for biopsy?
I found that fibroscan has been approved by FDA last month but we still dont have it in my region.
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Avatar_m_tn
blood tests do not reflect any liver damage,

it is impossible to know how the liver is from any blood test, but when you get to very advanced cirrhosis it becomes visible by the nodules on ultrasound and decompensation by out of range blood tests...so you are not at this point

i d check when fibroscan will be available or take a flight to canada/mexico to have it checked
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Avatar_m_tn
Is doctor has prescribe any drug to you as HBVDNA is >2000.
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Avatar_m_tn
Stef2011
If fibroscan may become available by the end of the year, should i wait till than ( while keep monitering HBVDNA and blood enzymes every 3 months)  or i am wasting my time by not having fibroscan/biopsy done right away?
Ashi2010,/ Stef2011
My doctor thinks hbv dna is not elevated enough to rush for treatment. he wants to wait for next set of bloodwork(sep 2013) to see if it is just a radom fluctuation or a pattern. If DNA stays elevated, he said he will order a biopsy in september.
He doesnt think there is much risk of waiting for 3 months based on my DNA levels.
Any comments on his opinion Stef?
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Avatar_m_tn
nor dna or alt have any correlation with liver damage, in the meantime you may change your diet and increase fresh vegetables.the liver damage is mainly due to inflammation and oxidative stress from immune response if you act on these parameters you can keep a healthy liver despite an active infection

if you take fibroguard, lipo ghs and lipo vit c you will block any fibrosis development and regress the one present, check that your bmi is less than 25 and doing this way you can wait until a fibroscan is available

you may also test your oxidative stress and vit d and keep d to 80-90ng/ml
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Avatar_m_tn
Stef2011
Thanks for your insight. Your comments are really helpful.

I got an appointment of a doctor (hepatologist) who has Fibroscan at his place (A University hospital). I got appointment of middle of July. I will have to convince him to order a Fibroscan in the first appointment.

Thanks for doing wonderful job at helping people.
God bless you!
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Avatar_m_tn
I had fibroscan done yesterday. I was the second patient to have fibroscan done. median stiffness was 5.5 kpa and my doctor told that it is in normal range. Any comments on results?
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Avatar_m_tn
perfect liver
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Avatar_m_tn
Had fibroscan yesterday. Got liver stiffness of 5.5
Doc told me it is normal. Any thougts?
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Avatar_m_tn
Stef
With normal fibroscan results, my doctors are suggesting that I may be an inactive career and not a candidate for tratment at this point of time. In US we dont have HBSAG quant test available. Based on my test results, and present test limitations, do you agree with their opinion? What should i do at this point of time?
Thanks
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Avatar_m_tn
Based on my test results, and present test limitations, do you agree with their opinion? What should i do at this point of time?

no without hbsag quantity we dont know if you are inactive, we dont know cccdna quantity and number of infected cells in the liver, we also dont know if pegintf can clear your hbv and if you have active immune response.since this test is the most important, which is logic even for the most stupids...the goal is hbsag negative...., you better send your samples to india or europe to check hbsag
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Avatar_m_tn
Doctors are telling me that they will observe by doing LFT & Hbvdna every six months and fibroscan every year.
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Avatar_m_tn
And again AFP and US every 6 months
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Avatar_m_tn
yes that means you wont be cured for hbv
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Avatar_m_tn
I know that I wont be cured. But, based on the test data, do you think it will be a correct approach for me now? Should I seek treatment from other country or can I wait for few years by just observing HB?  It is really frustrating to be in US since there is little i can do towards getting rid of my hbv. They dont even have hbsag quant test inUS.
Any suggestions?
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Avatar_m_tn
I started taking 2000 iu/ day of D3 and 1000 iu/ day of vitamin c.
I dont have my vitamin D level checked but am planning to have it checked next month at my next appoinment.
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Avatar_m_tn
Stef
Hypothetically, Suppose i somehow get hbsag quant test done and it comes back with higher value suggesting that i am an active career with dormant HBV( low dna, normal alt and normal liver stiffness), what would be my treatment options?
Will it stil be peg or will i need to be on antiviral?
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Avatar_m_tn
antiviral is useless as long as hbvdna is very low, alt normal and liver with no damage

pegintf is useless on hbeag neg if hbsag is very high like more tna 10.000iu/ml.....

so we do need hbsag quant and genotype to know if you have high chances to respond to pegintf, anyway inactive carriers with hbvdna und and normal alt showed about 30% hbsag clearance so you have a good starting poitn anyway but without hbsag quan *** makes non sense to go for pegintf in such a bad position as yours, i mean you ll have to pay pegintf yourself and only india/vietnam have very low prices
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Avatar_m_tn
I will try to see if i can get hbsag quant test done somewhere. But based on your response it looks like I might have limited options since i am hbeag-ve with low but detectable hbv dna and normal alt with low liver stiffness.  
Another question: what suppliments do you recommend to make sure that the HB is in check considering my position? I have reduced 11 lbs since i was diagnosed in feb 13. BmI of 23 now. eating lots of fruits and veggies and taking vit c and D as explained above.
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Avatar_m_tn
Neil, stef can sometimes be a bit confusing with his lapidary replies but hes telling you the right things. I suggest you read a few threads here and you will have a good picture on why is HBsAg so important in regards to treatment strategy.

PS. Why is interferon not refunded for you in US ?
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Avatar_m_tn
The problem is, hbsag quant lab test is not available in US. My doctor thinks that i am not a good candidate for either antiviral or peg treatment as my hbvdna is not superhigh, alt is in normal range and liver stiffness is in normal range( see above posts) Doctor is following AASLD guideline for hepb. He will keep testing me for   every 3 months for first year and if everything is normal he will designate me as inactive career. I consulted another doctor and he is also saying prettymuch the same thing. Peg cost $25000+ here and insurance wont pay in full evenif doc is prescribing it. in my case doc is not considering me for peg.
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Avatar_m_tn
wow and I was thinking our public care is crap.
you need hbsag quant to have a full picture and then make a decision.
contact a faculty that does clinical trials and they will hook you up for that test and maybe some trial where you get IFN for free (like i did).

heres a link to my trial with locations:
clinicaltrials.gov/ct2/show/study/NCT01277601?term=GS-US-174-0149&rank=1&show_locs=Y#locn

if hbsag is low + your other results it might be worth a try IFN to full cure despite statistical odds regarding response.
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Avatar_m_tn
12/12/12 was tested
HBV positive
HBe neg / anti HBe pos
ALT/AST Normal range
HBV DNA 150 ul/ml
Fresh vegy including: black radish/no red meat/ just chicken breast/ no shell fish fried food/ just barbequed or steamed food.

2 months lated :
HBV DNA 29 ul/ml

Took it easy and tried some of the forbiden staff mentioned above
2 months later:
HBV DNA 95ul/ml

Still took it easy and kept on taking some of forbiden staff

2 month later:
150 ul/ ml.   879 copies/ ml
2 months later  27th June 2013
200 ul/ml.    1170 copies/ ml

So as you can see Neil we are on the same boat
Now i am trying a restricted diet as in no fried nor red meat no shell food instead bio food and grilled chicken breast or white fish. Black radish / milk thistle supplement my next test is on the 30 august and i will keep you posted on the result.
I agree with your doctor and stef after my deep research on the net we are in a very early stage for any medicine intake or biopsy . We are called
Chronic Hbv since we passed six months and virus still present but it deosn t mean we can not fall in category of being Acute HBV and virus clear and if the case we will be HBV negative in my case HBC positive since never had vaccination and with god' will if you clear the virus you will be HBV and HBC negative. Also we are called e-antigen negative and this is a good sign when to concider medicine treatment in our case DNA more than 10000 ul/ml
Or ALT 150
I read we can do Alpha - fetoprotein test not clear to me what is it i need to get feedback from my docter probably to see if our liver is devoloping cirrhosis dont know what is the difference to fibrocis need to do research or ask doctor or stef.

Hope this ease your pain. Also i suspect that i got the virus from dentist on march 2012 when i had thoot filling and resulted in an infection.
I am 40 years old by the way.

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Avatar_m_tn
12/12/12 was tested
HBV positive
HBe neg / anti HBe pos
ALT/AST Normal range
HBV DNA 150 ul/ml
Fresh vegy including: black radish/no red meat/ just chicken breast/ no shell fish fried food/ just barbequed or steamed food.

2 months lated :
HBV DNA 29 ul/ml

Took it easy and tried some of the forbiden staff mentioned above
2 months later:
HBV DNA 95ul/ml

Still took it easy and kept on taking some of forbiden staff

2 month later:
150 ul/ ml.   879 copies/ ml
2 months later  27th June 2013
200 ul/ml.    1170 copies/ ml

So as you can see Neil we are on the same boat
Now i am trying a restricted diet as in no fried nor red meat no shell food instead bio food and grilled chicken breast or white fish. Black radish / milk thistle supplement my next test is on the 30 august and i will keep you posted on the result.
I agree with your doctor and stef after my deep research on the net we are in a very early stage for any medicine intake or biopsy . We are called
Chronic Hbv since we passed six months and virus still present but it deosn t mean we can not fall in category of being Acute HBV and virus clear and if the case we will be HBV negative in my case HBC positive since never had vaccination and with god' will if you clear the virus you will be HBV and HBC negative. Also we are called e-antigen negative and this is a good sign when to concider medicine treatment in our case DNA more than 10000 ul/ml
Or ALT 150
I read we can do Alpha - fetoprotein test not clear to me what is it i need to get feedback from my docter probably to see if our liver is devoloping cirrhosis dont know what is the difference to fibrocis need to do research or ask doctor or stef.

Hope this ease your pain. Also i suspect that i got the virus from dentist on march 2012 when i had thoot filling and resulted in an infection.
I am 40 years old by the way.

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Avatar_m_tn
all the tests you did are almost useless without hbsag quantity in iu/ml and fibroscan, especially hbvdna is useless off therapy, it can go from und to billions without real meaning without hbsag quant and fibroscan

have hbsag quant checked so you will know if you can clear hbsag by peginterferon
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Avatar_m_tn
To add to the above realy don t know if i had it from the dentist or way before coz just remember tha in 2008 i had skin issue and my dermato prescribed skin otopsy results were Jessner and Kanof . Would any body know if these two Hepatitis B & Jessner and Kanof are related if the case i might be carrying HBV since 2008 and just knew about it in 2012.
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Avatar_m_tn
Thanks stef for the prompt reply.

Is there any relation between Jesner &Kanof and Hbv infection bearing in mind that i never accepted to take medicine in 2008 for jessner and kanoff after my research that there is no direct medicine for this latter and doctors are prescribing Plaquenil and this latter impare vission and not a direct medicine to this sikness. 2008&2009 had skin erruption normaly around May and they clear after 3 months. But after taking some herbs  only for 1 week my body skin was clear of erruption and they stopped appearing in 2010/2011/2012. However, after 12/12/12 was shoked and stress again and all over then the jessner and kanof skin erruption showed up on June 2013.
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Avatar_m_tn
hbv has no symthoms at all on chronic carriers, just tireness from time to time and little pain around liver area, all this is not relevant, again you just have to check hbsag quantity and fibroscan and according to results go for hbv genotype test and start peginterferon

infection is from borth, it is too rare to get it as adult
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Avatar_m_tn
Understood stef so i should concider both jessner and kanof and Hbv as 2 defferent sickness unrelated one. My question now doing the hbsag quant and fibro and there result will clarify the gynotype or this latter is a third test and if so how is it configured. By having all the three result this help prescribe the right dosage for peginterferon dose and if not shall i just start the peginterferon with no harm or sideeffect  until i will be able to perform the fibroscan and hbsag quant. Also if there is anything else meanwhile that can help clearing hbv until i be able to do these tests.
Thanks
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Avatar_m_tn
Here is a question for you stef when can i or a person should say that i or he is carying a non active or dormant HBV / Chronic HBe negative.
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Avatar_m_tn
when HBSAG is <1500iu. DNA UND or <200iu ALT/AST normal and no fibrosisis
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Avatar_m_tn
there is a study just posted look for it on the board

hbsag level depends on genotye for genotype D hbsag around 1000iu/ml but genotypes a,b,c require much lower hbsag.

hbvdna less than 2000iu/ml, alt less than 30 men 19 women, fibroscan less than 6kpa
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Avatar_m_tn
My hbasg is 410.9
my anti hbe is 700+
i th this is chornic is this posible to be non reactive?im aplying aboard.the doctor unfited me.
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Avatar_m_tn
May God bless and cure you stef for the effort you put researching all the info.
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Avatar_m_tn
Alya look at your post i am a seaman as well and just compare your readings with mine. I was hired  even with HBV virus.
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Avatar_m_tn
Stef according to your findings above i need to wait to get the HBSag quant and other tests fibroscan and gynotype in order HBv or HBSag can be classified as active or dormant. As i am a seaman and on board right now i will be able to get those test done by end of august, but as red in one of the post here talks about HBC Test pos= acute and neg = chronic do i have to do this or can i be concidered chronic since i am over 6 months period and HBV didn t clear since 12/12/12therefore i can be concidered chronic carrier.
-Is it correct when we say active = either chronic or acute that it clears itself depends on tests result.
-dormant: means only chronic
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Avatar_m_tn
Neil any result for your genotype, fibroscan, HBSag Quant.
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Avatar_m_tn
I dont have hbsag quant results as they are not available on my country. Also, i dont have grnotype test done. I do have fibroscan results though. Median liver stiffness is 5.5 kPa. My other test results are at in the initial few posts of this thread.
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Avatar_m_tn
Try to get in touch with this lab in france lyon my lab in casablanca use this latter for tests not available in morocco and he charged me 350 dirhams so the french lab must be charging cheaper like 25 euros for the Hbs ag quant so i would suggest droping them an email en how to send the blood sample to them and ask them to email you the result.

http://www.biomnis.com/
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Avatar_m_tn
Update:---- Started taking Vit D - 2000 iu, Vit C 1000 iu daily since July 2013

Latest blood Test date : 9/6/2013
HBV DNA : 694 iu/ml
AFP - Non Detectable
ALT - 36 (Range 0 - 65)
Liver function test normal.

Have Doctor's appointment tomorrow
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