Is treatment necessary

[macrold]

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.

[macrold]

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.

[stef2011]

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

[stef2011]

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

[4est]

" ... 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.

[stef2011]

untreated on heptech....

sorry too tired now...,  i mean untreated for hbv but on heptech antioxidant/antifibrotic therapy

[stef2011]

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