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Just found to be HBV carrier.. Pls advise
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Just found to be HBV carrier.. Pls advise

Dear all

I am an Asian man in my forties. I was recently diagnosed with HBV. These are the readings my test results show:
AST   40   ( 0 -40)
ALT   35   (3 - 40)
DNA  105,000 IU/mL
          255,000 copes/mL

Both my Liver ultrasound and Fibroscan results are clear, meaning no sign of any liver damage.

I have just chanced upon this website and am thankful to see the information being shared by fellow carriers as well as medical practitioners.

My doc has asked me to do a follow up in 5-6 months and nothing has been prescribed for now.

I would like to learn from you about what to expect in terms of treatment the doc may prescribe in the future and which drugs therapies I should consider more given your experiences.

To be honest, I am badly shaken by this diagnosis, and fear that I may just die in the next few years.

Thanks vm.

ND
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Avatar_m_tn
I am not a doctor, I will give you my opinions.
It does seem from your Fibroscan that you do not have severe fibrosis. This could be due to the fact that you may not have been chronic for long. Elevated ALT used to be an important criterium in deciding treatment, however because of uncertainty about the normal range of ALT and the fact that many patients still have disease progression even though their ALT is persistently normal. Now, hbvdna, viral load, is considered to be important in deciding treatment. Your viral load is considered to be on the high side. Finally, you are over 40, so treatment is a safety net. Having said all that, HBV is a slow moving disease and if you have not been chronic for long, there is no rush to treatment.

ALT flares occur when our immune system reacts against the virus. If the reaction is decisive and clears the virus, then of course it is good. But all too often, the reaction is not fully successful, the battle is lost and we incur damage to the liver. Over the years, many battles are fought and lost, that is why we have disease progression from fibrosis to cirrhosis.
14 Comments Post a Comment
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Avatar_m_tn
For us to make detailed comments, we need more information, such as HbeAg/HBeAb, HBcAb (igg and igm, to exclude acute infection) status. Fibroscan should provide a number in Kpa, not just "clear". It is important to know this number.

In terms of treatment, if needed, it will be either Entecavir/Tenofovir, a daily pill taken orally, or Peg Interferon, a course of 48 weekly injections, or a combination of the two.

Others will comment with their own ideas.
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Avatar_n_tn
5.4 KPA.

What is IGG/IGM?

Also, I cant find HbeAg/HBeAb etc on my report.

Thanks.
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Avatar_m_tn
Igg and Igm are types of antibodies - if HBcAb-Igm is positive, it may indicate a recent infection.

If you can't find HBeAg, HBeAb (anti-Hbe), you should include them in your test next time.

5.4 kpa indicates your liver is in reasonable shape, no severe fibrosis.
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Avatar_n_tn
Hi Stephen

Doc said mine is Chronic. I have not done any full health checkup in the past, so I cant tell when I got it.

Doc mentioned Barraclude as one of the options if I hv to start treatment. Is that effective?

Also, liver functions test normal... Was told since virus is not causing any damage yet (as well as from fibroscan and ultrasound), hence just monitor. Thought this is at least something positive in a negative situation. But reading this forum, I seem to get the idea having something like ALT flareups may be a better thing. Am I wrong to think that way?

Thanks vm.
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Avatar_m_tn
I am not a doctor, I will give you my opinions.
It does seem from your Fibroscan that you do not have severe fibrosis. This could be due to the fact that you may not have been chronic for long. Elevated ALT used to be an important criterium in deciding treatment, however because of uncertainty about the normal range of ALT and the fact that many patients still have disease progression even though their ALT is persistently normal. Now, hbvdna, viral load, is considered to be important in deciding treatment. Your viral load is considered to be on the high side. Finally, you are over 40, so treatment is a safety net. Having said all that, HBV is a slow moving disease and if you have not been chronic for long, there is no rush to treatment.

ALT flares occur when our immune system reacts against the virus. If the reaction is decisive and clears the virus, then of course it is good. But all too often, the reaction is not fully successful, the battle is lost and we incur damage to the liver. Over the years, many battles are fought and lost, that is why we have disease progression from fibrosis to cirrhosis.
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Avatar_n_tn
Stephen,

Thanks vm.

With regards to your last para, do you mean the disease progression without treatment, or even with treatment? I know of a carrier who has been treated for almost 20y, and has had no liver impairment despite a certain degree of fibrosis when he was diagnosed (ie the fibrosis was somehow reversed). So an older lady (abt 70y old) who has also been treated for a long time ], having a certain degree of cirrhosis.

Reading the posts in this forum, I have the impression that current therapies have been most effectively in arresting the progression, for most patients.

Thanks
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Avatar_m_tn
You are right, my discussion about many battles refers to those without treatment. Treatment by oral NAs inhibits viral replication, leading to undetectable virus in the blood - no virus in the blood means generally no immune reaction, thereby no inflammation and no damage to the liver. With peace, the liver can heal and fibrosis can be reversed.
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Avatar_n_tn
Thanks again.

I guess i will be doing 6-monthly followups and annual fibro/ultrasound scans from now on to manage the condition.

My liver doc says no cure yet (as we all know) but certain drugs are coming out over the next few years that may just nail it. Hence, "the future is bright".

So meanwhile, I have cut down on booze significantly, started exercising, tried to eat healthier. Hopefully a 'knight in shining armour' of a cure comes gallopiing  towards everyone.

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Avatar_n_tn
Hi Stephen

How does one relate the two DNA numbers?

DNA  105,000 IU/mL
          255,000 copes/mL

Thanks again.
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Avatar_m_tn
Actually, 1 iu/ml = 5 copies/ml. I suspect your 255,000 copies/ml figure is wrong.
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Avatar_n_tn
I just checked again.  To be precise, they look like this:

103   x10^3 IU/ml
256   x10^3 copies/ml (5.41 log)
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Avatar_m_tn
The conversion factor is well known. One of the two figures is wrong.
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Avatar_n_tn
On my test report, there is a footnote that says

"Lowest detection limit for hbv real-time PCR:  20 IU/ml  OR  50 copies/ml"

I called the doc to clarify. Was told this is the ratio for this particular lab. And in any case, was told to refer to the copies/ml As that is the commonly used reference.

Thanks
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Avatar_m_tn
Thanks. But this is confusing, I would have thought, iu/ml is the standard unit.
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