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 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.

[stef2011]

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

[macrold]

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

[stef2011]

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

[bhagwankabanda]

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

[macrold]

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.