Need treatment or not

[MegFaq]

My viral load is ~ 4000 iu/ml with normal alt & ast.
Do I need treatment. My hbeag is - ve. Doc says they need to monitor at least 6 months ( blood test every 3 months) before starting treatment . What kinda of treatment is best in my case?

[MegFaq]

is hbsab less than 10 iu is considered negative?

[MegFaq]

My main concern is how can it be negative &  less than 5 iu at the same time?

[flyinsky]

if it rises at each time, yes

[MegFaq]

I got my blood work tested in two diff labs. One says my hbsab is negative with < 5 iu and other one says hbsab < 3 iu. What does that mean? How can it be negative and less than 5 iu at same time ? Is my immune system trying to work against the virus ?  Will these values improve?

[flyinsky]

high viral load+high transaminases(alat/asat)+high biliburine +fibrotst f2 or more = the hepatit is active eed treatement
the quantity here of hbsag is needed at the begining of treatement  to compare if there is a clearence or not
for me there is no relation i have an increase of hbsag at te same time my viral load is less than 20copies
i can eplain thi in simple word we can say that dnaviral is the son of hbsag when there is a replication hbsag live its chldren in the liver cell where they multipling transform the genitic form of the liver cell

[MegFaq]

Thank you all for the responses. Is there a correlation Btn hbsag  value to hbv load? Is it linear or not ?

[Aduiski]

There are 3 major Hepatitis B guidelines, 2 out of which are written after 2010:

- Asian-Pacific one:
http://apasl.info/apasl/wp-content/uploads/2014/02/Guideline-HBV-2012-update.pdf

- European one:
http://www.easl.eu/assets/application/files/ef520780b91cf4f_file.pdf

If you are white you are more likely to benefit from the European one. If you are asian you are more likely to benefit from the Asian-Pacific guideline.
European one is much easier to read.

[Aduiski]

yes but only if your ALT is frequently > 40 OR you have fibrosis F2 or bigger

[MegFaq]

Based on few posts earlier  looks like I need treatment with > 2000 iu/ml  if hbeag is -ve.  

[Aduiski]

just don't get scared of this...I am confident you'll be OK as you have very low viral load and normal ALT/AST on your last measurment....

[Aduiski]

and yes...you should repeat your viral load test 6 months from the time you measured it lastly.

I am also recommending people to do 1 ultrasound (or even better MRI) every 6 months to scan for early liver cancer, if you do belong in one of the risky groups for HCC cancer (like being asian male over 40years, having family history of HCC, having cirhosis, being african over 20 years ...)
The best strategy here might be an interchangable MRI and Ultrasound every 6-months (so in one year you get scanned with both, as MRI is able to pick early cancers much better)

Don't let this scare you, however, this is just a precautionary measure for those being in risk groups

[Aduiski]

Yes the most important missing information is the state of your liver (fibrosis) which can be evaluated by Fibroscan (or Fibrotest).
If you have F0 or F1 fibrosis then there is no need for threatment at this stage, provided you take 3-6 monthly measures of ALT/AST and they stay normal.

I would advise therefore the following:
1. take Fibroscan test and see what the results are.
2  If the results are F0 or F1 then no need for threatment at this point, in which case take another measure of your ALT/AST 3 months after you measured it last time to see whether it is still in normal range or not.
3. depending on the above results....

I wish you the best...

[MegFaq]

The dr didnt do any other tests other than liver enzymes. Should I ask for more tests ?

[flyinsky]

you have to be sure that your liver is not dommaging,if every thing is ok no treatment

[andrey19]

you are missing qHbsag and fibroscan to know if you have fibrosis or not.