Introduction and a few questions

[benski486]

Hello, long time listener first time caller.  

It's been a little over a year since I was diagnosed HBsAG positive.
Since then I've tried to educate myself as much as possible.  Thankfully
I found this board which has not only been extremely informational, but
also reassuring at times.

Ever since the diagnosis I have been seeing a Gastroenterologist and doing
both blood work and ultrasounds.  I've had two ultrasounds done since the diagnosis
and both reported no issues.

Here are all the tests done since April of 2014

4/24/14
---------------------------------
HBsAG +
HBeAG -
HBV IU/mL 480
Log 10 HBV IU/mL 2.681
HBV Copies/mL 2800

7/8/14 (genotype, and liver tests)
---------------------------------
ALT 27
ALPHA-FETOPROTEIN 2.9

HBV GENOTYPE C
POLYMERASE MUTATIONS NOT DETECTED
PRECORE MUTATION DETECTED
BCP MUTATIONS NOT DETECTED

Antiviral drugs Resistance Predictions (none)

Precore and BCP Mutations
Precore (TAG) G1896A
BCP Not Detected

OTHER MUTATIONS:
POLYMERASE: Not Detected
PRECORE: C1858T
BCP: Not Detected

HEPATITIS B VIRUS DNA, QN, R-T PCR
HEPATITIS B VIRUS DNA 1222 H < 20 IU/mL
HEPATITIS B VIRUS DNA 3.08 H < 1.30 LogIU/mL

11/25/14
---------------------------------
AST 36
ALT 31
ALPHA FETO-PROTEIN 4.7

HEPATITIS B VIRUS DNA, QN, PCR W/RF
HEPATITIS B VIRUS DNA 470 H  IU/mL
HEPATITIS B VIRUS DNA 2.67 H LogIU/mL

5/20/15
---------------------------------
AST 32
ALT 25
ALPHA FETO-PROTEIN 4.4

HEPATITIS B VIRUS DNA, QN, R-T PCR
HEPATITIS B VIRUS DNA 2996 H < 20 IU/mL
HEPATITIS B VIRUS DNA 3.47 H < 1.30 LogIU/mL

As I understand things, the chronic condition and HBeAG negative would indicate a precore mutation which was confirmed with the
genotype test done last year.  I've also read that it isn't the nicest mutation either.  

So just a few questions based on the test data.

1) Should I be concerned with the viral count fluctuation? I'm assuming I shouldn't as my guess is fluctuations are normal?

2) With my genotype and mutation is that low of a viral count considered abnormal?  A lot of stuff I read on that combination tended to
show viral load at much higher levels and typically much more damage to the liver.

2) Lastly, in my leisure time, I train regularly in a grappling martial art, which at times involves very close contact with someone else.  
There is no striking, but accidents do happen.  Personally I am extremely cautious, and will absolutely not train if I have any open cuts
even if bandaged.   Heck I won't train with a common cold either.

My doctor assures me that my risk of transmitting the virus to someone in this case is very low based on my current status.  I trust her
judgement, but at the same time I don't want to knowingly put people at risk, thoughts?

Any advice is appreciated.

Regards,
B

[benski486]

Thanks stef2011,

At my next visit I will ask about the intact parathormone testing and in the meantime will increase D3 daily intake to 5000 IU.

[stef2011]

1000iu is nothing but probably you dont have receptors resistance and you got a minimum increase, use 5000iu at least because we are not healthy persons, the range 30-100ng/ml is for healthy persons...while for us the optimum range for liver cancer prevention is 90-100ng/ml

also test intact parathormone because if there is vit d receptors resistance vitd25oh will not tell you how your vit d sufficiency is.when you reach vitd25oh 90-100ng/ml pth must be lowest normal range (if not there is resistance).anyway you probably have almost no resistance, 1000iu daily is nothing for most of us, note that sun can make 20.000iu per day by total body exposure on white skin

[benski486]

Thank you both for your replies, very helpful.

I should have mentioned at the time of diagnosis I was extremely Vitamin D deficient.  A 10.2 L value, I believe 30.0 - 100.0 ng/mL is the reference range?
I started taking d3 supplements and now my numbers are as follows:

VITAMIN D, 25-OH, D3 57 Not established ng/mL
VITAMIN D, 25-OH, D2 < 4 Not established ng/mL

Continuing to take D3 1000iu daily.

[stef2011]

genotype C has a very high risk of HCC and having low hbvdna in the blood is not always predictive of low intrahepatic hbvdna (hbvdna in the liver), after checking fibroscan i would consider tenofovir

hbvdna is not that low last test is around 2000iu/ml....also conider checing vit d3 and intact parathormone so you can supplements vit d3 the dose needed and prevent hcc, it is possible that vit d3 correct supplementation will lower hbvdna too

[StephenCastlecrag]

Your numbers look very good.
1. Viral count should be kept as low as possible, even undetectable. It is normal to have minor fluctuations, both due naturally and to the lab procedures.
2. Genotype C is not as good as A, B, with regards to treatment by Interferon.As regards to precore mutations, I am not an expert, but I believe all HbeAg negative will have the mutations, but its importance depends on how widespread is the mutation: less than 10% or over 50% of all the virus in the liver etc.

3. With such a low viral load (very little virus circulating in your blood), you are very much less infectious. However, it is always good to practise universal precaution, by everyone. Also over 95% of adults can fight off a HBV infection.

I notice your AST is always slight higher than your ALT, which indicates to me that you do exercise a lot.

Cheers and happy fighting.

Stephen