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Is treatment necessary
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Is treatment necessary

I was diagnosed as hep B carrier in 1988 at the age of 24. I am 47 years old now. In the past 23 years I had regular check up once or twice a year. My liver profile blood works stayed in the normal range. The ALT mostly stayed close to the upper limit. The sonogram tests all ways showed a normal liver structure. My HBV DNA stayed around 300-600 copies/ml. Depending on this test results my doctors dismissed any treatment or further investigation of my liver by any other test unnecessary. Recently, I had a check up in May and the test results HBV DNA was 4,600 copies/ml my AST= 25 IU/L  ALT=50 IU/L. Looking at these results my doctor said it is time to have a liver biopsy and I have it done this week. He also mentioned that I will most probably be on a pill a day treatment for life. Right now I am waiting for my biopsy result and will see him in mid September. I am also Hep B E antigen (-), had HBV genotype A with 2.7 alpha - Feto tumor marker. Please advise on what your opinion of my situation is and what possible treatment if necessary is the best course to convert HBSAG +. I also feel a pain on my right side under the ribs which the doctors completely dismiss as unrelated to my liver and not to worry.

Thanks in advance for your input.
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26 Comments Post a Comment
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Avatar_m_tn

a doctor telling you will be on a life pill before seeing biopsy is just a drug maker seller, do change liver specialist right away

also the fact he never checked liver damage for all your life makes him very poor doctor, although most do not develop cirrhosis/severe liver damage some do even on normal alt/ast, not checking liver damage by fibroscan for a life time or making a biopsy earlier in ur life can be as heavy as being a murder......what about liver cancer checks?what if you developed liver cancer?such a doctor is a death sentence because in 6 months liver cancer is untreatable when develops

check these links so you might get enough knowledge to find a good and updated liver specialist
http://www.medhelp.org/health_pages/Hepatitis/HepB-Introduction--Welcome-Page/show/34?cid=153

"the general book of ignorance about hepatitis B" for doctors
http://www.medhelp.org/health_pages/Hepatitis/the-general-book-of-ignorance-about-hepatitis-B/show/1152?cid=153
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Avatar_m_tn

as to the pills....antivirals that can block liver damage but absolutely useless on virus infection, i'd go for them only if there is liver damage or HCC virus mutants, genotypes, hcc family history

interferon lambda will soon be out wait for it because it can have hi chances to clear the virus combo with alinia and tenofovir or entecavir

check ur hbsag level to know channces to clear hbv and check all other posts
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Avatar_m_tn
Thank you for the reply,

I do not think they have a fibroscan here in The USA. The fact that I lived for so many years after diagnosis and the numbers I listed above and the fact that I am hepb e antigen - say any thing about the long run out come of this disease.
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Avatar_m_tn
hey Macrold,
In New York Mount Sinai hospital has FIBROSCAN, Dr. DietRich does it...please go and visit the Mt. Sinai in New York for fibroscan and I agree with Stef (who has been on this board quite a long time and being very helpful to all of us).
I suggest you see Dr. Dietrich he is one of the respected Gasteroantologist and he will help you.

Regards
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Avatar_m_tn
say any thing about the long run out come of this disease.

absolutely nothing.i was like you with low hbvdna and kept without fibroscan monitoring despite it is available since 2004 in italy and i was at cirrhosis stage.the lesson here is never trust blood tests, hbvdna alone but use fibroscan to monitor the damage all other blood tests comes after
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Avatar_m_tn
Stef2011 and other experts of the forum,

Well I had the biopsy done and based on the result the doctor said no treatment is necessary right away we just need to do the blood work twice a year and monitor if any significant change happens to the viral load.
Here is the biopsy result and I do not know what to make of it and is not easy to believe every thing the doctor said. He said that based on the result no damage is done to the liver and the best option is to wait for better drug and monitor.

"The sections show benign hepatic parenchyma with mild chronic inflammation of the portal spaces. No granulomas or piecemeal necrosis are seen. The hepatic lobules show spotty lobulitis consisting of small aggregates of lympoid cells and rare neutrophils with associated cellular damage. No steatosis is identified. Variation in nuclear size is also observed. The trichrome strain shows no significant fibrosis or cirrhosis. PAS stains with and without diastase reveal abundant hepatocyte glycogen with no abnormal diastase - resistant inclusions. No increased iron deposits are noted with the iron stain.

The findings are nonspecific but may be associated with hepatitis B virus infection.

Any comment would be greatly appreciated

Thank you
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Avatar_m_tn
Well I had the biopsy done and based on the result the doctor said no treatment is necessary right away we just need to do the blood work twice a year and monitor if any significant change happens to the viral load.

this is very wrong and based on old assays and guidelines, hbvdna monitoring only doesnt help cure hbv.
you have to monitor the following:
hbsag quantity and if it ever reaches 1500iu/ml interferon must be used to clear hbv because this level of hbsag is the most accurate predictor of clerance by interferon

hbvdna monitoring, not useful to know when virus is weaker to try clerance by interferon combos.our goal is try to clear, not just contain hbv infection

fibroscan monitoring, in case fibrosis develops and in this case antivirals are necessary to reverse damage

meanwhile you can try cheap generics with no relevant sides like simvastatin, alinia, vitamin d to see if you can get hbsag to lower close to 1500-2000iu/ml, if so you add interferon in that moment

biopsy result....there are scales, the comment made are not professional, words can be interpreted differently by any doctor (so is biopsy too), so using scales we have less influence from the person doing biopsy.

in any case i assume you are f0, inflammation is less important, no fatty liver too

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Avatar_m_tn
Thank you for taking the time to educate me. I will talk to my doctors about hbsag quantity tests which I am not sure if I ever had one before and will also mention about making the priority on how to clear the virus not only contain it just like you mentioned. I will also try the fibro scan test.

One important question I have is that, what are the possible physical or other symptoms associated with being hep b chronic carrier. I tried to associate it with hep b any time I had any physical symptoms with out any proof. The doctors automatically dismiss it.

Thank you.
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Avatar_m_tn
the possible physical or other symptoms associated with being hep b chronic carrier.

none, most have no sympt until close to death with advanced cirrhosis from ears or liver cancer.
today i was with a friend with cirrhosis since teen.....platlets around 60K, PT bad, bilirubin bad, albumin bad, all tests bad, she feels just a little tired from time to time and lives normally.these tests results can be close to end stage but no tests can predict deaths while fibroscan can even predict serious complications when already on cirrhosis

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Avatar_m_tn
Thank you stef2011. I value your help very much.

Thank you
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Avatar_f_tn
I am sorry to hear about your friend.Can she be helped by HepTec products?
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Avatar_m_tn

i told her yesterday that now we are able to have heptech easily in italy too, we had customs charges were too high previously...heptech might save her life although she has autoimune hepatitis which can be due to unknown pathogenes (i dont believe in autoimmune diseases), anyway the development of cirrhosis is essentially the sme on fatty liver, alchool, viral pathogens

she wanted to talk with her doctor first because she doesn t believe it even though she can see all my tests....maybe i will give her some months free to try because with such bad blood tests her life is at risk and maybe doctors dont tell this to avoid scarring her, i also didn t tell her this but she has really nothing to lose
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Avatar_m_tn
"I also feel a pain on my right side under the ribs which the doctors completely dismiss as unrelated to my liver and not to worry. " - I'm in the same situation, I also fell something around the low part of the ribs, but all the doctors say that has nothing to do with the liver and maybe is something mechanic. I do 5 us for this problem on 5 different doctors and no one found any reason for this pain, is a small pain and I feel this pain when I sit-down for a wile and if I move after it start the pain it go way, so also my feeling ios that this is a mechanical one and no relation with liver.

Also my condition is similar to you, except the age, I'm 32 year old and low viral load (300 copies/ml), HBeAg negative, normal ALT / AST (22/18), 5.2 KPa on fibroscan ... , no medication;

Below you have my monitoring program (maybe you can discus it with your doctor):

every 3 mouth:
- test ALT and AST (at least)
- HBsAg (screening)

every 6 mounth:
- test HBV DNA
- test HBeAg, HBeAb, HBsAg, HbsAb
- test AgHBs quantitative
- test other liver related parameters (SPEP , GGT, ALKP , TBIL .... )
- US (ultrasound ecography)
- (Vitamin D) - this was added by my
- (Cholesterol / HDL / LDL / VHDL) - this was added by me also

every 12 mouth:
- test fibroscan
- test a normal scan blood (CBC, Serum Glucose, serum Urea, Serum iron, TAG, VSH ...)
- test fibromax (this was added by me)

This are the base test that I done, any one of this can be change in case that one is out of parameters . (also in case that you are under treatment this monitoring program have to be changed )

@stef2011 - do I miss something form the monitoring point of view ?




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Avatar_m_tn
I forgot about yopur question regarding physical symptoms - as @stef2011 mentioned I don't think that any physical symptoms can be related to infection (this can appear in case of interferon treatment but are do to interferon and not do to infection )
On the other hand, the news that you have a disease (do not meter what kind of disease) is not a easy one and somehow stay in your mind and you try to correlate everything with this disease and this can be sometime dangerous because you can ignore some other signs. Is better to know exactly what can you correlate with the disease and to pay attention to any other sign and to report all the signs to your doctor / doctors. - easy to say hard to do :)
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Avatar_m_tn

sorry i can t check all tests now, about to go to sleep but as regards the pain in the lower part of the liver that is due to inflammation.me and my sister have noticed:

taking antioxidants like heptech or liposomal glutathione and making vitmin d level optimum range 60-70ng/ml this pain goes away so i think we can suggest the following:

lowering oxidative stress by antioxidants, possibly heptech will solve this.this pain is present also with normal fibroscan like 4-6kpa so i guess it is due to worsening of inflammation and not only by total inflammation

very low hbvdna and normal alt can make this pain go away too, but i notice that untreated on heptech can solve this despite hbvdna detactable and abnormal alt
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Avatar_m_tn

untreated on heptech....

sorry too tired now...,  i mean untreated for hbv but on heptech antioxidant/antifibrotic therapy
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Avatar_m_tn
" ... pain in the lower part of the liver that is due to inflammation" - how can we test this inflammation (blood test or fibromax or ....)?

I will made my vit D check in end of November and together with the other test (6 month tests) and this will be a base line for me and we cad discuss after that.
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Avatar_m_tn
how can we test this inflammation

the best way is biopsy because you can measure it separately but this is not very important to measure, the only thing with very strong influence on liver function is severe fibrosis, i d just check with fibroscan to stay lower than 7kpa at worst
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Avatar_m_tn

i think there is everything, some test can also be avoided, vit d better every 3 months at first

- HBsAg (screening) i'd skip this, better quantitative only

- test HBeAg, HBeAb,
you can also skip hbeag/hbeab this is very unlickly to change.hbeag can become positive again in case of hbv bad reactivation if you have wildtype hbv and not the eminus (core mutants)

HbsAb, this can be skipped too because unless hbsag becomes very low like 100-200iu/ml it is negative and even if little positive it cant have any influence

- (Vitamin D) -
if you supplement with 10000iu daily or even 5000iu it is safer to check every 3 months until a maintenance dose is found, serum calcium can also be a good test when vit d gets high

- test fibromax (this was added by me)
if you pay a lot for this you can skip it, i dont beleive in this.you can have cirrhosis and all normal blood tests so this is very unlickly to detect any damage on many patients or early damage
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Avatar_m_tn
Thank you for the comment and will take your advice and see if I can  benefit from it. I try not to think too much about hepb except that I like to be informed, but some time I think it does get in the way of thinking. The main complain I have is pain in the right side just below the ribs and I will see  if stef2011's suggestion can help me stop this pain.

Thanks.
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Avatar_m_tn
The last time I posted on the forum was back in October 2011.I was diagnosed in 1988 as being a chronic  carrier and my ALT & AST all the time and now is in the normal range. My Hep B dna had been around 600copies/ml but in Starting in 2011= 4600copies/ml and that is when I Had liver Biopsy for the first time and the result is as follows:

"The sections show benign hepatic parenchyma with mild chronic inflammation of the portal spaces. No granulomas or piecemeal necrosis are seen. The hepatic lobules show spotty lobulitis consisting of small aggregates of lympoid cells and rare neutrophils with associated cellular damage. No steatosis is identified. Variation in nuclear size is also observed. The trichrome strain shows no significant fibrosis or cirrhosis. PAS stains with and without diastase reveal abundant hepatocyte glycogen with no abnormal diastase - resistant inclusions. No increased iron deposits are noted with the iron stain.

The findings are nonspecific but may be associated with hepatitis B virus infection.


2/06/11 hbvdna 4300 copies/ml
ALT= 30 IU/L
AST = 24IU/L


8/9/12 HBVDNA=  8900 COPIES/ML
ALT= 21 IU/L
AST = 31 IU/L

2/15/13HBVDNA=  7000 COPIES/ML
ALT= 30 IU/L
AST = 20 IU/L

I had normal tumor markers always last one was done on 21/5/2013 and the hep bsag=+ ,hepbe ag=- , hepbeab=+  all the time and last test was on 2/15/2013.






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Avatar_m_tn
It seems that I clicked or some thing befor I finish or post my question. I had an abdominal ultrasound regularly and the last one on 2/15/13 and there are no abnormalities. My question is that why is that after for so many years staying low the hep b dna copies number is going up. The doctors are telling me not to worry and no need at this time for treatement. Today I called Mount Sinai in newb york and left a message to schedule an appointment to do fibroscan which was recommened to me back in 2011. Please look at my posts and advise. Does any body knows about a fibroscan in Dc area.

Thanks
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Avatar_m_tn
1. Fibroscan testing: checkout Liver Scan Direct in Canada. This is where I will be heading to. They charge $150

2. Increase in DNA: these numbers do fluctuate. Your reporting in copies ML, should be reporting in iu/ml. So divide your numbers by 5 or a the number that was given on your report. But looks like there is a battle going on between the virus and your immune system.

3. Has your pain resolved? This pain could be associated with inflammation due to viral load/immune system battle.

4. Have you tested for mutants?
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Avatar_m_tn

1. Fibroscan testing: checkout Liver Scan Direct in Canada. This is where I will be heading to. They charge $150

I just made an appointment for the end of March at Mt. Sinai hopital in New york city to do Fibroscan for the 1st time. I hear a lot on this forum about it even though I did Biopsy not long time ago.

2. Increase in DNA: these numbers do fluctuate. Your reporting in copies ML, should be reporting in iu/ml. So divide your numbers by 5 or a the number that was given on your report. But looks like there is a battle going on between the virus and your immune system.

I do not know what is going on but a battle is going on. I feel fatigued with less energy, Pain on the upper quarter on the right sied and at the back. Last time Stef2011 mentioned about taking antioxidants like hepatech or liposmal glutathione. I really need to get this but can some onewho took this supplement can tell me the effectivness of this in stopping the pain. The doctor checked for many other things and saying that not associated with Hep b. I feel it is associated. I also had mild, muslce and joint pain kind of burning sensation, Please comment if it is associated and what can I do. The pain comes and goes, when it comes it lasts for a while.
Steef2011 what do you think and please tell me about the supplements more, where to get it here in the US and if therte is any side effect.

3. Has your pain resolved? This pain could be associated with inflammation due to viral load/immune system battle.

The pain right now is bad. Last time I checked my vitamin D is 35.3 ng/ml. Do I need to make it higher and how many IU  supplement I need to take daily. This test was done in 2011.

4. Have you tested for mutants?  iN 2011 a test was done and Genotype A detected  Part of the report say as follows:
HBV drug resistance not detected. No mutuations detected
3TC(lamivudine , epvir) sensitive
ADV (adefoir, hepsera)  sensitive
TEB ( Telbivudine, tyzeka) sensitive
ETV (entecavir, baraclude) sensitive
TNF ( tenofovir, viread) sensitive

The doctor never discussed these with me, next time I go I discuss with him. please if any body is knowledgeable about what it means please advise.

ThANKS.



.

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Avatar_m_tn
1. Fibroscan testing: how did you manage to schedule one at Mt. Sanai, I tried but they didn't return my call. I am guessing its not covered by insurance so any idea on the cost? I'd much rather to go NY then Canada.

2. I've searched from one end of the internet to the other end of the internet. My wife has been having this pain as well which has gotten me really concerned. It definitely started after she had a flare. The best answer I got was from HepatitisResearcher who posted that its from inflammation of some sort putting pressure on the capsule that surrounds the liver.

3. I've seen members following HepatitisResearchers protocol and / or the Heptech supplements (anti-fibrotic and anti-oxidant) able to resolve this in a period of few months look up user ALMAJA or user GAUF.

4. The mutations you posted are drug resistant mutations. You should check for the precore and core promoter mutations.
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Avatar_m_tn

1. Fibroscan testing: how did you manage to schedule one at Mt. Sanai, I tried but they didn't return my call. I am guessing its not covered by insurance so any idea on the cost? I'd much rather to go NY then Canada.

I called mt sinai hospital in newyork city and told them that I wont to be seen by Dr. Dietrich and a fibro scan, Actually I called twice I left a message for the secreatary and second time left a message with the receptionist. Call and tell them what happened they will call you back.

2. I've searched from one end of the internet to the other end of the internet. My wife has been having this pain as well which has gotten me really concerned. It definitely started after she had a flare. The best answer I got was from HepatitisResearcher who posted that its from inflammation of some sort putting pressure on the capsule that surrounds the liver.

What is a flare is it when a  viral activity high?


3. I've seen members following HepatitisResearchers protocol and / or the Heptech supplements (anti-fibrotic and anti-oxidant) able to resolve this in a period of few months look up user ALMAJA or user GAUF.

I will check

4. The mutations you posted are drug resistant mutations. You should check for the precore and core promoter mutations.

next time I visit the doctor will talk to him about it. What is the purpose of this test.

THANKS
.

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