Intro and Starting Viread Questions

[little_bear_09]

Hi,

I'm a 37-year-old female of Asian descent.  I was diagnosed with Hepatitis B during routine testing when I was pregnant with my oldest child - back in 2001 when I was 30.  Of course, this triggered everyone in my family to be tested and only my brother turned up positive.  The GI doctor I saw back then said we were probably infected as babies as we were born overseas and didn't move to the States until the mid-70s.  I think it's because we went to live in the Philippines during a short time and only my brother and I saw this dentist there.

Back in 2001, my test results were as follows:

Hep Be Antigen (-)
Hep B Surface Antibody (-)
Hep B Core AB (+)
Hep B Surface Antigen (+)

So from reading the past posts, this makes my type of Hep B the pre-core mutant type, right?

I started routine blood tests every 6 months.

Back in 2002, I was only tested for:

ALT: 15
AFP: 2.6
AST: 15

Fast forward to 2007 and Hep B Quantitation started showing up on my labs

Jan 2007

ALT: 20
AFP: 2.42
AST: 25

July 2007

Hep B Quantitation:  >38,000 IU
ALT: 29
AFP: <2
AST: 25

August 2008

Hep B Quantitation:  17,800 copies/mL
ALT: 13
AFP: 2
AST: 18

That August 2008 test got me referred to a GI Dr. again and they tested for

November 2008

ALT: 19
AST: 28

Hep Be Ag  (-)
Hep Be Ab  (+ abnormal)

I'm in pretty good health (lots of exercise and healthy eating) and all my prior ultrasounds were great.

But because I have the pre-core/mutant type of Hep B, the GI Dr. recommends that I start taking Viread.  We are trying to get the DNA to stay under 2000 copies and the almost 18,000 copies is too high.

Does this follow the normal course of action for my status?

I'm thinking about getting a 2nd opinion.

My Dr told me that once I started taking Viread, this would pretty much be a lifetime commitment.

Thanks in advance for any opinions and advice.  I've been trying to read past posts and various boards and I'm a bit on info overload at the moment.

Little Bear

[cajim]

Your ALT is normal, your DNA is not too high.  According to 2007 guideline, biopsy is needed to confirm the need for treatment.

[zellyf]

at 38,000 IU you are definitely in a range that suggests treatment should be initiated.  But at 17,800 copies you are close but not quite there.  Were these done at different labs?  Generally speaking 1 copy is the equivalent of 5 IUs.  I don't think a liver biopsy would be out of the question here.

[little_bear_09]

cajim

What 2007 guidelines are you referring to?  If I can point me in the right direction, I'll do a search for them.  Thanks.

Since I am e-antigen negative, I read once that treatment is considered when viral load is >10,000 copies/ml or >2,000 IU/mL.  But I'm annoyed at myself that I didn't credit that source because now I can't find it.
  
zellyf

I have had the same doctor for the last 5 years, but the lab in the office keeps changing.

When my brother was diagnosed, his doctor recommended a liver biopsy for him.  Mine did not, but I thought it was because I was pregnant or nursing or having more babies.

I'll call the GI to see why he doesn't want to do a biopsy first.  Thanks.

[zellyf]

Maybe it was Dr. Misra from the list.

[hurri]

hi, i just wanted to add some info ,i suggest u discuss with ur doctor, this is from Harrison's internal medicine 17th ed.

No treatment is recommended or available for inactive "nonreplicative" hepatitis B carriers (undetectable HBeAg with normal ALT and HBV DNA 2 x the upper limit of normal according to some authorities), and HBV DNA >104 (or 105 according to some authorities) copies/mL, antiviral therapy is recommended.

however, if HBV DNA is >104 copies/mL but ALT is normal or near normal, some would recommend considering liver biopsy and basing a decision to treat on the presence of substantial liver injury.

i meant 104 = 10 to the power 4, 105 = 10 to the power 5 etc..

[hurri]

oh i forgot to tell u, i'll be encouraging u, don't be upset, be in good health and mood, wishing for the best

hurri

[bram44]

Did you start the treatment ? How is going ?

As per latest guidelines it seems your profile is a candidate for treatment.

Please share your experience with this treatment.

[TO69]

I had very much similar (almost the same) situation as you ... my doc recommend me the same thing, take Viread now, however, I do have the other doctor recommend me to do biopsy.

Based on the current treatment guideline (2007 ASADL or what). We have to do biopsy and assess the fibrocis of the liver, the larger than grade 2 then treatment is admitted.

However, as I am close to 40, just saw one latest report showing if someone can try to minimize the viral load before 40 yrs old, the chance to get cirrocisis or HCC will be much lower ... based on this, i am thinking about getting treatment now and not to have the invasive biopsy test. I am still thinking now.