Please help!! Need information on the HBV Carrier

[marissa_79]

Hi There:

My husband was diagnosed as a HBV carrier last year during a volunteery blood donation.  We had no clue what it is until then.  He was immdiately sent to the Doc for more checkup.  I don't know the exact result of his LAb (As he is very upset on this topic, and I dont want to force him to show me his labs).  but what is Know is this -

1.  He is now 39 year old
2.  He is asymptomatic - no symptoms at all
3.  Continuous lab of ALT and AST level are normal (he is been checking every 6 months now for last 1 and1/2 years)
4.  Continuous lab of Liver ultrasound showed no damage/problem on the liver.
5.  He is following up with a GP, and not referred to a Specialist.
6. He recently mentioned that his doc has said that his results are pretty unchangeable/no flactuation.  So that is a good sign.
7.  His 2 other siters have it.

I am very very worried for my husband's health.  Eventhough he is fine at the moment, can i counter that he will be fine most of his life?  And one more question, he was told that he is a Carrier, but his doctor didnt mention anything like INACTIVE carrier... is there any difference between the two?  On the internet I see a lot of topics on Inactive Carriers... is that the same term as HBV cariiers?  We have 2 very young kids, and I am looking for some answers.  Please help!!

[stef2011]

then he doesn't need any medication right?

yes he doesn t need, just very close monitoring and hopefully drugs active on hbsag will come out in 5-10years, just drug makers choice since drugs are there and highly effective in a very short time

but if you find low hbsag it is better to make a try with interferon+nitazoxanide since iver cancer risk although very very low exsits

[Skyclimber]

better looking on his hbvdna, alt,hbsag quantity etc. every 3-6 month. if fluctuate, consult to a doctor.

[marissa_79]

Stefano-

Thanks for all the info you are providing!! It is giving me knowledge but on the other hand, I am getting more nrevous amd losing faith on my Doc.  Atleast from your analysis of the LAB result I posted, you mentioned that he is a inactive carrier.  If he maintain this kind of profile for rest of life, then he doesn't need any medication right? I am gonna hope that he will be part of that 75% group who live normal life without any complication!  GOD bless you all!!

[marissa_79]

a couple of years ago even patients with alt 20-40 with hbvdna within 100000copies/ml were considered inactive with mild liver damage while now we know it is not true at all


What is the latest guideline??  Please advise ...

[stef2011]

how can his Doctor tag him as an carrier vs a chronic patient.  

always double check in these last years new drugs and new tests have been discovered and these can make a very big difference, i think we are very close to the right combos to get rid of hbsag in many but being updated and aware is very important now more than in the future years

only researchers and expert doctors who go to the international conferences are aware of what i post, most of the others are so busy seeing patients that usually don' t get updated with evry study, so double you are very wise to double check
a couple of years ago even patients with alt 20-40 with hbvdna within 100000copies/ml were considered inactive with mild liver damage while now we know it is not true at all

does that prevent severe problems like Chirossis and Cancer?
absolutely yes, tenofovir and enetecavir are not very good boosting immune system and hbsag seroconversion but they make virus replication to almost zero and with no replication there is no liver damage and so no cirrhosis and no HCC

on the other hand immune modulators like nitazoxanide and interferon can boost immune system lowering antigens and seroconverting for those with low hbsag but these are not very good to make hbvdna und on all, so the combo of the two might lead to the best therapy for the future

[marissa_79]

Stefano/Skyclimber:

One more question -  Can someone please tell me when Doctors do the every 6 months followup in the USA, what are the standard LABS they are looking for?  I understand Fibroscan/US can be optional, but I am sure there is a minimum lab requirement they have to follow to check the blood test.. is the Quantitive test one of them?  If they dont do it, how can they reassure the patient that he/she is still in the same phase, correct?

[marissa_79]

Hi Skyclimber-

Thanks for your comments.  I am sure it came from his family...as his mother was a doctor!  Probably she was exposed to it ...

By the way, when you said 1000 copies/ml (about 200 iu/ml), is it quivilant to 100,000 copies of viral replication?  is this measurement pretty standard for all Doctors in the USA?  Or does doctors range of decision varies from one to another?

[marissa_79]

Thanks Stefano.  I am sure that the HBSAG quantification test was done for him, otherwise how can his Doctor tag him as an carrier vs a chronic patient.  The only problem is I dont have the results with me, and my husband gets very upset talking about all these.  So, I will ask him to make sure that he is asking his doc about the Fibroscan and Quantificaiton test next time he goes which is about 3 months.  Again, I appreciate youe comments.  This site has made me more knowledgable in a positive way!!!

One last question -  I read online that most of the Carriers will spend normal life with no/minimum complications of liver.  And approximately 25% will go thru severe damage.  So, if we are monitoring from early stage, and if needed the therapy is used, does that prevent severe problems like Chirossis and Cancer?  May God keep all of us healthy, and happy...

[stef2011]

We are living in US,

fibroscan is expensive and in US it looks like nobody spends money for patients sake.they are more sensitive than biopsy and are the only mean to see liver damage, it is the most important and first test needed, it wasn t done because they don t have it at your doctor's
in germany there is a bus that goes around checking for free people liver on the road this is because liver damage is made by many things, even fats in the diet, and there is no other test to see it (exept biopsy)

on the other hand all tests are good so your husband looks inactive carrier but fibroscan must be done, i have cirrhosis but my blood tests about liver are better than your husband's so it is not possible to say 100% there is no liver damage by blood tests, at least now in 2010, maybe 10 years ago you might think blood tests could be enough

also hbsag quantification is missing, again because machine is expensive and in US they don t spend money.both fibroscan and hbsag quantification are available from 2005 or eralier.

[Skyclimber]

My personal question and points:
1. How long do you know your husbands' two sisters have these? It would suggest that your husband might be family transmited.
2. According to your husband situation, need to check his HBVDNA quantitive test. If the DNA quantity is less than 1000 copies/ml (about 200 iu/ml), the virus replication is not high.
3. Some doc suggest no antivirus therapy in this phase. Some doc will suggest fibroscan.

So pls check HBVDNA, and HBsAg quantification test.

[marissa_79]

Thanks  Stefano.

Here are Liver function LAB:

Serum Bilirubin .7
ALT 24
AST 18
Alkaline Phosphatase 66
Serum total Protein 7.5
Serum Albumin 4.5
Serum Globulim 3.0
A/G Ratio 1.5

Tell me what you think!!

He is going for Ultrasound in every 6 months, and so far THANK GOD!! ultra sound resluts are fine.  Doctor never told him about Fibroscan.  We are living in US, and I would think the Doc would have mentioned about it if he thought it was nessecary!!

[stef2011]

6. He recently mentioned that his doc has said that his results are pretty unchangeable/no flactuation.  So that is a good sign.

this is wrong according to the pahse, hbsag quantity there is possibility of eradication but only for those wth low hbsag less than 1000-1500iu/ml

7.  His 2 other siters have it.
should check liver damage by fibroscan as your husband, this is the only machine to tell you how liver damage is (biopsy too but absolete now)

  Eventhough he is fine at the moment, can i counter that he will be fine most of his life?
yes if you monitor closely, i was like your husband most of my life but since they didn t check me on fibroscan i ended up with cirrhosis, the period of developping cirrhosis is around 40yo and it is not due only to hbvdna and alt but also to type of virus mutations.
so having a specialized hospital for fibroscan, virus mutations tests can help a lot but even fibroscan. hbvdna and alt are enough

but his doctor didnt mention anything like INACTIVE carrier... is there any difference between the two?
truly inactive carrier hbsag<500iu/ml, hbvdna<2000iu/ml, alt2000iu/ml, alt>30, in order of importance

hbsag quantification and fibroscan are not widely available in countries with poor healthcare system