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Hepatits b - Low Virus with high ALT/AST
Hello everyone.
First of all, thank you for all your kindness. I've been reading all of your posts, particularly stef2011.
My mother and my 29 years old brother have hepatitis B. I'm younger, and I'm lucky I don't have it. Sadly, I believe that I suffer as much as they do with this situation and I'm having some problems dealing with all of this. Being a medicine student doens't help, I can't stop thinking about it. I'm depressed and I don't know what to do, and this forum really helps me.

My brother has been having some problems. He got the disease from my mother. I was looking at some older analysis, and I found out that, in his childhood years, his ALT and AST were sometimes kind of high (60s), even with the virus undetectable. He's HbeAg negative.

In 2011, due to an increase in ALT/AST and in HBV DNA, he  started to take tenofovir. After that, the enzymes went down  (but always in the upper limit) and so did the DNA. HbsAg remained always positive (but we don't have the numbers).

In 2014, he was still with tenofovir, and the enzymes started to increase again. He was doing some bodybuilding, working out everyday, and having some protein shakes (not more than that).  The virus remained undetectable, but the enzymes were always in the 100s level.  He did all the tests, celiac disease and all,and everything came negative. We noted that, after two weeks by the beach, the enzymes went to almost normal levels (vitamin D?).

In 2015, the doctor decided to switch to entecavir, which was a dumb thing to do in my opinion. She never cared to ask for a fibroscan, she said "it is only important for those with hepatitis C".  She doesn't care.

The medication change made no impact. The analysis remained the same. In October, with the enzymes being 100 and 50, the virus made an appearance: HBV dna: 140 (still low, but...)

Now we changed to another doctor. I talked to my hepatology teacher, I told him that my brother needs a fibroscan and maybe a biopsy, he agreed and he's going to be his doctor. He's starting the consultations next week.

I think vitamin D may play a important role in this situation. My brother has OCD. He is not medicated; he was once, but he says that it doens't like the feeling it gives him. He's never out of house, unless he's going to the gym (but he's not working out as much now, and he gave up on the protein shakes in 2014...). The only time he has some sun rays on his skin is like 14 days in the summer, and I noted that the enzymes are always higher in February (winter) and lower in August/September. He started taking 3000IU vitamind d3 a day last week, but we are going to ask the new doctor to test his values.

He also never ate any fruit at all and his sleeping schedule is a mess. He sleeps from 8am to 3pm, and like once in two weeks he doesnt sleep for a night because he has classes in the morning or something. It's all because of OCD, he's not a very easy guy as you can see. Now I convinced him to have orange juice, apples, carrots, nuts, everyday. He only ate bread, rice, pasta and chicken chest. He now has a more varied diet, but I think he is tired right now. He has lots of acne, herpes in his lips in this moment and he looks overall weak. I'm scared. He was never fat (he gained some weight before the enzymes started in 2014, but more like muscle weight) but he has cholestrol polyps in his gallbladder.  think this may be some type of autoimmune disease, although the markers were all negative. Was/is his weak diet and lifestyle making all of this?

I'm having a hard time with all of this. Sorry for bothering you, and I wish the best to all of you.
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Sorry for such a long boring post.
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- Weight-lifting can cause elevated liver enezimes (they stay elevated for about a week after the weight lifting) so that might have been a cause of elevation. Drinking can cause it too, as well as other liver diseases such as different kinds of hepatitis viruses etc.

- How is his mental/depression/anxious state?  I am asking this as stress can cause loss of weight and general weekness.

- No one knows what causes gallbladder polyps, but so long they are a small (not larger than 5mm) nothing to worry about them. My ultrasonographer find them 2 years ago on one examination...did 4 aditinal ultrasound tests after that and none showed them anymore. I think they could come from a number of things or a combination of them: hepatitis B, eating unhealthy, etc. Gallbladder is a "younger brother" of his sister "liver"...so when his sistem suffers, yournger brother "cries" producing the polyps...
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Thank you for your answer.
- He knows that and he never weight-lifts 10 days before being tested. He never drank, and he was tested for all the other diseases affecting the liver.

- He is in a state that he can't even grab food or his clothes, he can't touch the fridge, and he can't even touch me... But the question is, now he is more tired than anxious, he is sleepy all day and it makes e worried.
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A metabolic disorder due to a lack of micronutrients is a likely reason for these unusual high alts. The better diet might help, if consistently used.

one wonders why his vid d levels were never measured.  3000lu per day is not enough in this condition, but wait for the lab results.The beach day results are remarkable.it should have lead to analytical actions.

Better to switch back from entecavir to tenofovir .

Temporarily high alts can also  result from intense muscle training with weights.Check cpk at the same time. How high was the ast?

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I don't think it's because of the muscle training. The time they reached the biggest values till now: 170 ALT, 65 AST
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Also, do you know if vitamin D can make people even more tired? He seems worse after he started taking it.
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Do he drink alcohol or smoke ? ''He also never ate any fruit at all'' WHY? If he turns back to tenofovir , controls his Diet, takes fruit and much vegetable ,check the dosage of vid d, there will be a great change . In case he has been drinking alcool all this years then .....its normal tenofovir had that failure .
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No, he never drank or smoke. As I said, he is a difficult guy...
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let him also test for hepatitis D , You also did well asking for fibroscan, you may be surprise with the results .
Take much courage and be strong .
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It was negative. Thank you so much nicofelor.
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Try following on the suggestion of studyforhope as he is the most knowledgeable member of this forum.

One thing is clear...you should make a plan with your parents on convincing your brother to see an (or two) experienced psychiatrist(s). OCD (maybe combined with some other psychological issue) is hampering him hard, and because of the constant stress and lack of sleep his immune system is probably greatly weekend which negatively impacts his Hep B as well.
His previous medications for OCD were probably not spot on (or maybe he just sees it negatively as he is depressed at the moment). Mental conditions take time to accurately pinpoint and it usually takes some "trial and error" with different combinations of medicines to find the most appropriate medicine for a particular person. Once an appropriate medication is find you'll see him change drastically.
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How much muscle training can affect ALT results and how much it may be rised and for how long ? Is it a question of 10 or 20 IU or maybe 100 ?
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http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2125.2007.03001.x/full
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p.s. for your convenience my hep b virus blood brother...
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does this mean weightlifting is bad for hepatitis b chronic carriers. i have been lifting weights on and off for about 12 years.
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I don't think it hurts the liver, it just makes the enzymes higher so people shouldn't exercice 1 week prior to blood analysis.
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Test also intact pth with vitd25oh

I think nutritional deficiencies and low vit d are present 100% in this lifestyle and this makes immune system very weak and ther is an open door for chronic hidden patogens

Try to improve his diet by juices, neuro\psyco conditions can be improved a lot by vit d3, high dose epa or dha now i dont remember which of the two but yiu can google studies and see doses,also nicotinamide may help and absolutely work on the gut too,problems in the gut may reflect on psyco diseases.make live yogurts with fresh organic milk dont remember which bacteria can be best maybe bifidus and lets see if these simple changes can help

Also remeber to avoid processed foods with chemicals,gmo and if possible use fresh organic
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He says vitamin D3 makes him (a lot more) sleepy. I found some people in the internet saying the same, I'm not sure about why that happens. We're going to test it next week.

I'm going to do all of that. Thank you.
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Be careful with the distinction between nicotinamide and nicotinamide riboside. Nicotinamide can actually have negative effects on the availability of  NAD+ in the cells nucleus.It is NOT RECOMMENDED to take, but nicotinamide riboside has appropriate processing pathways and is currently one of the most promising supplements to take, after the seminal paper by David Sinclair in the journal CELL, where a dramatic reversal of mitochondrial aging was achieved using nicotinamide mononucleotid, to which nicotinamide riboside is an immediate precursor.
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I'm going to search more about nicotinamide riboside. Thank  you!
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"Fifteen healthy men, used to moderate physical activity not including weightlifting, performed an 1 h long weightlifting programme" - so included people do not used to train hard regulary. I used to train since many years and my liver is F1 and low chronic hepatitis from biospy. So I guess positive aspects of exercise are more important that some temp alt increase.
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http://www.ox.ac.uk/news/2014-05-23-many-mental-illnesses-reduce-life-expectancy-more-heavy-smoking

http://www.nimh.nih.gov/about/director/2011/no-health-without-mental-health.shtml

Mental illness reduces life more then hep B does...and not that it just reduces the life-span....it makes one live his life in a misery-state...

Most people don't take the depression and/or similar mental issues seriously enough...it gets overlooked...people think the person will get better after a while, that he/she is just momentarily in a bed state...well if it goes for more then a year chances are that it won't get better without the medication....

In fact it is one of the worst diseases as it affects the mind itself...
You should seek the treatment for your brother...when he gets prescribed the right medicines for it you'll see alive and healthier again....
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The new doctor is doing a fibroscan and he is planning to add tenofovir to entecavir. What do you think?
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