Important---for HeAg negative patients

[xxriver]

It is commonly believed that for HeAg negative patients if the viral load is less than 10,000, antiviral treatment is unnecessary.

This belief could be wrong.

For these type of patients the liver is receiving sustained damage even when the viral load is at a low level (eg. less than 10,000 but above 1,000) and even when the ALT is normal.

Most hepb-cirrhosis results from this long but sustained liver damage concealed by low viral load and normal ALT.

[zellyf]

Can you cite some studies?

[bram44]

What I have read there are 2 categories of HBeAg -ve patients :

1. Hep B which is not mutated (starts of HBeAg +ve and seo converted)
2. Hep B which is mutated (which does not produce HBeAg)

Second one is more common in Asia.

Treatment path is suggested by doctors based on age, length of infection and viral load.
There are cases where the viral load is high, but doctors suggest not to treat because the age is too low (and liver fibrosis is none).

So in essense viral-load alone should not (and is not) a factor in treatment.

[zellyf]

More often, I read that using ALT as a treatment parameter is not as accurate b/c it doesn't reflect the state of the liver...just cell death at that blood draw.  However, consistently low viral load and consistently low ALT  the chances of a good outcome are high.

[bram44]

makes sense.

My doctor handed me about 20 different cases (he got it part of his professional website). I am surprised to see even for people into 50s with higher viral loads, the suggestion was not to treat.

The selection of treatment in them is more based on symptoms/general health of patient, liver fibrosis (either through blood tests or through biopsy), age, viral load.

As you said various parameters are taken into consideration, before placing patient on treatment path. As some of the forum members pointed out in the past - there are many doctors who do not update themselves :)