What is best course of action for HBV HBeAg -ve & Anti HBe +ve ?

[Aakash]

Hello,
MY aunt (age 58) is suffering with HBV which was detected 4 years back, recently in 2007 liver biopsy done which has following results.

1. HBeAg -ve
2. Anti HBe +ve
3. HBV - DNA 157,216 1U/ml
4. Fatty liver INR 1.07 AFP 9.7, Chronic hepatitis Stage 2.

Now as we have been told there are two different routes that can be followed one is interferon & other are antivirals. Considering the less side-effects we are more inclined towards antivirals. She has been suggested for Entecavir (Baraclude) amoung others. What would be our best course of action? Since HBV is known to have ability to develop resistance to antivirals accross time, what could be alternate course action after say 1 or 2 years.

Thank you.
INDIA

[stevenNYer]

First off thanks to jboyhk for all the support for those with HepB.  I agree with jboyhk in thinking that your aunt have one of the HepB mutants.  It's more common than you think.  My MD explained it that when your body's immune system tries to fight off the virus during seroconversion, the virus could mutate to ensure its surival.  The mutant know as the pre-core happens at about 20% of chonic Hep B individals. The other more common mutant core-promoter is 40%.  In the past, when a MD see e-Antigen 1 and e-Antibody positive, they tell pts that they are safe but now they know about possible mutants.  You could ask your specialist to do a genotyping test to be sure.  Baraclude is a newer meds and is said to be quite good.  Highest anti-viral strength and lowest resistance rate I think.  My MD recommend combo anit-viral therapy though to minimize meds resistance.  As your MD about that.  Good luck.  

[jboyhk]

If what you wrote is accurate Eantigen negative and E antibody Positive with DNA count above 100,000 she may have whats called the pre-core mutant. I am not a dr. but from I know that is more difficult to treat.

You really need to find  a specialist who has expertise in treating these kinds of patients.