Please look at my case and I need some advices:

[MiddleAge67]

Hi. Everyone:

I am an asian male (Chinese). I am 44 year old. I was diagnose with chronic Hep B when I was 18 year

old. The year was 1984. At that time I  have a very high virus load (HBeAG?), but my liver function

was good (AST? or ALT? ). I had continued to monitor my health with 6 monthes blood test and my

condition stayed the same (high viral load? and normal liver function) until the fall of 1994. I came

to USA at 1994 and I stopped to monitor my condition, I was an internatinal student at that time and

I could not afford medical help and I thought I was fine. Some time in 2000 I checked my condition

again and it was the same as always (high viral load and normal liver function) that is when I first

got a job offer. Since then I tried to forget the Hep B, I tried to tell myself that I would be fine

as always.

Three weeks ago, I did my annaul check and I told my PCP about my Hep B. She was really concerned and

ordered some blood tests for me. Below are the test results:


albumin: 3.4 range 3.6-5.1 g/dL
globin: 4.2 range 2.1-3.7 g/dL(calc)
albumin/globulin ratio: 0.8 range 1.0-2.1 (calc)
bilirubin, total: 1.5 range 0.2-1.2 mg/dL
alkaline phosphatase: 87 range 40-115

ast: 163 range 10-40 U/L
alt: 186 range 9-60 U/L

hepatitis b virus dna: 82,100,000 range <29 IU/mL
hepatitis b virus dna: 478,000,000 range <169 copies/mL

cbc:
white blood cell count: 3.4 range 3.8-10.8 Thousand/uL
red blood cell count: 3.62 range 4.2-5.8 Million/uL
hemoglobin: 12.7 range 13.2-17.1 g/dL
hematocrit: 38.1 range 38.5-50.0%
mcv: 105.3 range 80-100 fL
mch: 35.2 range 27-33 pg
mchc: 33.4 range 32-36 g/dL
rdw: 15.2 range 11-15%
platelet count: 131 range 140-400 Thousand/uL


Hepatitis b surface antigen: reactive
Hepatitis b surface antibody ql: non-reactive
Hepatitis a ab total: reactive
Hepatitis c antibody: non-reactive

alpha petoprotein: 128 range <6.1 ng/mL

folate: 13.9 range 5.4-  ng/ml
vitamin b: 408 range 200-1100 pg/ml
ferritin: 364 range 20-380 ng/ml
prothrombin time: 11.8 range 9.0-11.5 sec
inr: 1.1

I also had the abdoman ultrasound. The finding is "the liver has grossly normal appearance. It is

free of masses or dilated ducts"

My PCP send me to a gastroenterologist (GI). Before I went to the GI, I have read as much about hep B

as possible. I was thinking taht I met all the conditions to start medication (entecavir or

tenofovir), I prefer tenofovir. However the GI has ordered more tests for me:

CT abdomen w con
hepatitis be ab
hepatitis be ag
hepatic function pnl livpnl

I guess they are hepatic function panel and liver panel.

Now my concerns and question:

I am really concerned with alpha petoprotein: 128 range <6.1 ng/mL. It is the tumor marker and it is

20 times the ULN. But my ultrasound record is fine.

Why the GI ordered CT scan, does it really help? It is very expansive (around 2000$). I have the

insurance but I need to pay the deductable and my out of pocket max is 2150$. It is really put me on

the border of the max out of pocket.

The GI said that he need more info (the tests he has ordered before he could make a desicion if I

could be on medication). The GI said that since my low white blood cell and red blood cell, there might  be other factors affect the liver function.

I have been living in a very healthy life style. I never drink alcohol. I can only remember that I

have not had alcohol more than 10 times in my life and they were all very long time ago. I do not

smoke. I have 7-8 hours sleep every night. I do not party. I eat healthy, enough rice or bread and a lot of veg and fruit, very little meat. I

occassionaly take half an hour nap(not every day). I am a computer programmer and I sit 6-8 hour a

day before the screen. I exercise 2-3 times every week. I play soccer 2-3 hours vigorously on

weekend. I was a college soccer team member when I was young.

Thanks for your time to read through the long list of my post. I will report back of my long journey

of the treatment.

Dan

  

[4est]

what is your HBV DNA ?

I've read that you had really high HBV DNA in Jun, but in that moment you don't knoe the HbeAg status. Now you know that HBeAg is negative, but you have to correlate this with the HBV DNA.

It is good to at least to correlate this in order to determin teh phase of the infection:
- if in from June to now the HBV DNA decrease (with more then 1log), and now we know that you are HBeAg negative - we can assume that in june you ware AgHbe positive and this is a indication that you are in the end part of Immune clearance phase.
- if we HBV DNA is still on the same level and now we know that HbeAg is negative we can assume that back in June was also negative and in this case you can be in immune escape phase.

Anyway, medication have to be considered also in immune clearance phase and also in immune escape phase, especially in this last case, but usually more test are done before make a tratament decision. I don't know wht CT reveal to you doctor, but you have to check your liver status by Fibroscan or biopsy (if Fibroscan is not available in you area biopsy is one of the alternative) and also  HBsAg quantitative if is possible (this is a new test that is not in usual clinical practice, but also this can help to determine more exact if the treatment is needed or not)

[MiddleAge67]

Hi. Guys:

I have gone to my GI and he has ordered more test for me.

Previous test (09Jun2011):

AST: 163 10-40 U/L
ALT: 186 9-60 U/L

Current test:

CT (01Sep2011): shows that the liver looks good.

AST: 109 10-40 U/L
ALT:  123 9-60 U/L
hbeag: Non-reactive
Hepatitis BE antibody: Reactive:

Those liver tests were done on 15Jul2011.

Now I am on tenofovir (started on 19Sep2011).

Please advise if I should on the drug?

Thanks.

Dan

[OrientS]

Stef ..
You said: geno b, geno c, precore and bcp mutations ..

What are precore and bcp mutations?

[stef2011]

if you have no cancer it is good to check your hbv genotype and mutations to see if you are at increased risk, check your liver damage, and then according to results consider a therapy

geno b, geno c, precore and bcp mutations together with fibrosis higher than 8kpa on fibroscan are all signs of high cancer risk.....for example i had them all so i started antivirals immediately the only good thing i have is geno D

[stef2011]

afp can be elevated both in case of liver cancer or liver damage, it is very poor as liver cancer marker and i think it is not used anymore in europe because there are better markers and because more than 40% liver cancers show normal afp

in the case any cancer is found you must keep hbvdna undetactable by the most potent antivirals entecavir or tenofovir (the second is more potent) and i suggest you consider gcmaf treatment since liver cancer has no cure, the only possibility is live longer if it is possible to remove.
gcmaf has had small clinical trials but 100% of patients cleared cancers of any type.gcmaf cures immune system, not the diseases directly, so as you can see from other posts it is being used on hbv, hiv, CFS, cancers and many other diseases.to know if your immune system is damaged you need a tests called nagalase (check the gcmaf post in this case)

[stef2011]

Is it the CT my GI has ordered?

no it is not and it is useless to detect liver damage but if afp is high you need to check for cancer not liver damage and CT scans are the best tool for that


mhhh i see you are from US, the worst country in the world as to hbv tests, if you move to other countries, even canada which is close you will find fibroscans

as regards blood tests you can ship them to make hbsag quant, even third world countires have it.i guess india, china or europe accept blood sample to make the test.it is extremely cheap although i dont know what they might charge in ur case

[MiddleAge67]

Hi. stef2011:

Thanks for your post. I am not sure what the fibroscan is? Is it the CT my GI has ordered? I am in US and CT is very expansive. The cost is not that much since my insurance covers all the cost after $2150 max out of the pocket. I just do not want to get the expansive test which provide my GI very little info in my case.

Also could you explain to me my alpha petoprotein: 128 range <6.1 ng/mL. It is the tumor marker and it is 20 times ULN.

And my liver function tests:

ast: 163 range 10-40 U/L
alt: 186 range 9-60 U/L

Do they already show liver damage?

Thanks again.

Dan

[stef2011]

if there is no relevant liver damage by biopsy or fibroscan you can:
try interferon+alinia+tenofovir or entecavir and see if hbsag goes down or und and stop if hbsag stays the same by 24 weeks.if hbsag decreases by 24 weeks there is more than 30% pprobability to clear hbv by 2 years on this combo

wait for drugs active on hbv and that can clear it since if there is no liver damage it is not useful to treat because infection will go on anyway whatever drug

[stef2011]

first of all you have to know that hbv virus makes no damge, it is not a  cytopathogenic virus, on the contrary infected cells are more resistant to oxidative stress and work even better.the damage it is due to immune system response only so the quantity of virus is not correlated to any disease but your imune response is correlated to disease.

so no immune response is equal to maximum quantity of virus and no damage and no illness but perfect health, this is the situation of immune tollerant wneh infected at birth and lasts until 30-40yo for the most

what tests are needed:
first of all ultrasound is useless, it can only see cancer or end stage cirrhosis (when you are dying so no need of US)

- fibroscan, the most useful and first test needed
- hbsag quant in iu/ml (architect or roches quant)
- alt/ast
- hbcab igm quantitative

with these tests it is possible to understand your immune response, your liver damage, your response to try to clear hbv

useless drugs:
all antivirals (tenofovir and entecavir too), these drugs have no effect on virus, the only lower hbvdna to und in blood but the virus is not hbvdna and infection goes on and worsen even if hbvdna is und

the infection can be monitored by hbsag quant, cccdna, pgrna, hbvdna is very poor to monitor infection and infected cells