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Avatar universal

Recently diagnosed with CHB-Fatty Liver-Fibroscan 6.2-HBe negative-Low DNA

-Recently Diagnosed CHB Patient, age 38 years, living in US.
-Must have aquired in childhood since Mother doesn't have it and I got vaccinated twice for HepB in last 15 years. My brother was diagnosed with CHB recently and therefore I also took the HBsAg test and found I am also positive.
-Also diagnosed with hypothyroidism 2 years back, started the medication 2 months back-started Livothyroxine 0.1 mg daily.

Baseline Tests :
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HBsAg : Reactive
HBsAb : Non Reactive
HBe Antigen : Non Reactive
HBe Antibody : Reactive
HepB Core Antibody, IgM : Non Reactive
HepB Core Antibody Total : Reactive
HepB DNA 70 IU/ml(1.85 Log IU/ml)

ALT 27
AST 18

Abdominal Ultrasound(02/27/2015) : Fatty Liver
"The liver appears hyperechoic diffusely suggesting fatty infilteration or hepatocellular disease."

Fibroscan(03/31/2015) : 6.2 (Average of 3 values 6.0,6.5 and 6.2)
Abdominal Ultrasound accompanying Fibroscan says "Minimal homogenous hepatic echogenicity. Findings may reflect infilterative process, including hepatosteatosis"

Some questions( I am trying not to ask questions which are probably answered elsewhere in the forums, but still could be some duplicates...please bear with me) :
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1.The doctor adviced to reduce wait by 10% to reverse Fatty Liver. I am already on leaner side weighing 150 lbs with 5'7" height. Anyhow, I tried to control my fat intake and started doing some excercise which reduced the weight to 140 lbs now.
Do we know if the fatty liver is caused by fat alone ? I mean I am lean, still have fatty liver, could it be CHB which might have indicated fatty liver on ultrasound ?

2.Fibroscan reading of 6.2 seems little higher. Could fatty liver be behind it or its minimal fibrosis ? Should I go for biopsy at this stage ?

3.I am CHB patient with HBe negative and low DNA count. How to know if I am in inactive stage and don't have bad mutations. I think I have read somewhere if DNA < 2000 and qHBsAg < 1000 then you could be in inactive stage. But we don't have qHBsAg in US. I am visiting india in May and will get qHBsAg test done. Are there any tests to find mutations ?

4.I haven't got yet tested for vitamin D and pth. I have an appointment with doc next week, so will get those tests ordered. Do we also test T-Cell counts ? Is this helpful in any way ?

5.Stef and others have mentioned to not touch dairy for helping liver. I am a vegetarian(with dairy products), and milk is a significant part of my diet(for protein). I drink organic milk and now I have switched to non fat version as well. Is it still harmful, if yes, would you please explain why ?

6.Does hypothyroidism have any link with CHB. Is this medicine(Livothyroxine) ok for CHB patients ?

7.Looks like I am not a candidate for antivirals at this stage. Should I be considering any medications at this stage ? I am thinking to wait till I get my qHBsAg results in July.

8.HCC Risk : I have read in this forum(Stef's post) that coffee would reduce HCC risk as well as good amount of vitamin D. Any other help to significantly reduce HCC risk ?

Thanks a lot for fellow members for taking time to respond to questions and helping to understand the disease/treatments/management better. Very much appreciated.
22 Responses
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Avatar universal
No, I am not on any medication.

Started the supplement Vit D 5000 IU per day(a month back) after it came very low at 12.
Helpful - 0
Avatar universal
Where you on medication? 3.4iu/ml it is like nothing like you almost cleared the virus. Hope you will get some useful information from our experts here in this form. Wish you a good luck!
Helpful - 0
Avatar universal
I am visiting India and just got my qHbsAg test done as well as part of the visit.

It came very low at 3.44 IU/mL

Can the body naturally get rid of the virus, since the number is so low ? Any recommendations in light of this new finding ?

I will also try to get an opinion from indian doctor while I am here and maybe get the test done from a different lab, just to be sure(since this test is not available in US).

thanks
Helpful - 0
Avatar universal
Thanks for the explanation stef, I will try to reduce my dairy intake.
Helpful - 0
Avatar universal
Regarding "vit k2 mk7 200mcg daily, magnesium chelate 400mg daily" , how to they help ?

these are vit d cofactors, if they are deficient vit d works badly
Helpful - 0
Avatar universal
Also, on dairy, I take organic non fat milk, is that also a problem ?

as a healthy point of view it is a bad food, no mammal is genetically designed to drink milk all life and from other animals.milk has many grow factors that promote cancer

in your case it is not strictly needed but if you do less milk will turn in less calcium, and calcium is not needed at all when you have norml vit d levels because you will absorb it from all foods and milk has too much calcium

also being vegetarian is not very healthy if you have access to "grass feed animals" (clean grass i mean, fresh, no pesticides and so on).but if being vegetarian is a choice because you dont want to eat animals it is ok but hard to balance all nutrients
Helpful - 0
Avatar universal
Thanks for the response Stef.

I will talk to my doc regarding Vit D Shot.

Regarding "vit k2 mk7 200mcg daily, magnesium chelate 400mg daily" , how to they help ?

Also, on dairy, I take organic non fat milk, is that also a problem ? I really want to know the reason since I am a vegetarian and milk does make significant part of my diet.

thanks
Helpful - 0
Avatar universal
Yep, I made vit D 25-OH total test 2 times.
Helpful - 0
Avatar universal
they re available anywhere, even online by a spill of dry blood but actually not so important because we are 99,9% deficient and 100% less than 60ng/ml without supplements

it is useless to check d2 and d3, just total 25ohd is ok
Helpful - 0
Avatar universal
is there any sense to make those tests:

Vitamin D, 25-OH, D2   < 4ng/mL
Vitamin D, 25-OH  D3   12ng/mL

?
I'm not sure if they are even available in my country
Helpful - 0
Avatar universal
you are very severely deficient, this rise to max risk of death on any human being when getting a disease

5000iu is nothing you can t go on this low, italian guidelines indicate a loading dose of 350.000-1.000.000iu once and then about 2000iu daily as maintenance on healthy subjects, probably 5000iu would be the minimum as maintenance

i d go with at least 350.000iu once and then 10.000iu daily with vit k2 mk7 200mcg daily, magnesium chelate 400mg daily, then retest by 1 month

if you go with 10.000iu daily it may take many many months

cut all dairies from your diet and increase water to 2l daily
Helpful - 0
Avatar universal
Just got my Vit D/Calcium/PTH test done, and seems I am deficient on Vit D.

Here are numbers :
Vitamin D, 25-OH, Total :12ng/mL
Vitamin D, 25-OH, D2   < 4ng/mL
Vitamin D, 25-OH  D3   12ng/mL

Intact PTH : 33 pg/mL
Calcium 9.4 mg/dL

I am thinking I need to go on vit D supplement. Thinking of 5000 IU daily, which is available OTC in US.

Is that ok ?
When should I do the test again ?

thanks a lot.
Helpful - 0
Avatar universal
thanks Stef.
Helpful - 0
Avatar universal
i mean hbv activity is very low

it is just a matter of food quality and supplements to clear fatty liver but most people can t eat those type of foods

start with everything with sugar is poison, zero sugar in your diet then add everything you see in my post

fatty liver is not always correlated to overweight.for italian type of looks bmi 25-26 can be already overweight and i was that bmi, by the diet i moved to bmi 21-22 (around 22 is ideal for health and look).

also hdl must be high to stay away from fatty liver and ldl possibly very low.there are bio statins to lower ldl and in my post you ll find supplements for hdl too, i remember i was low on hdl and i moved it up
Helpful - 0
Avatar universal
I have low HDL at 33mg/dL.

Total Chol is normal though at 157 mg/dL

Here are relevant numbers :
LDL 101 mg/dL
HDL 33mg/dL
Chol 157 mg/dL
Trig 115mg/dL
Helpful - 0
Avatar universal
do u have cholesterol?
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Avatar universal
150 lbs is very slim and not fat. Im 167 lbs 5'8 and my bmi is 25. So nofat in my case. You might have signs of fibrosis due to hbv but probably mild.
Helpful - 0
Avatar universal
Thanks for your comment Stephen,

I found a study where it says
"Indeed, it is the combination of serum HBsAg and HBV DNA levels that shows most promise as a single-point measurement for differentiating active CHB versus inactive carriers. A single-point measurement of serum HBsAg (cut-off <1000 IU/mL) and HBV DNA (cut-off ≤2000 IU/mL) in the abovementioned Italian population achieved even better discriminatory power between these two stages of chronic HBV infection (94% diagnostic accuracy, 91% sensitivity, 95% specificity, 88% PPV, 97% NPV)"

Link : http://www.ncbi.nlm.nih.gov/pubmed/20451520


I will have my qHBsAg done in July and will know.
Helpful - 0
Avatar universal
Thanks Stef.
What do you mean by "very low" when you say
"hbv has nothing to do with your fatty liver because very low, food quality is the most probable reason and low vit d..."

Is the fattiness in liver is very low ? How do we know ?

Also, whenever you get a chance, if you could take a look at other questions I have, and if you have any thoughts on them.

Helpful - 0
Avatar universal
I see my reply has been mangled by the use of angle brackets, sigh.

Inactive or immune control phase patients are characterized by HBeAg negative, very low or undetectable hbvdna (less than 2,000 iu/ml) and persistently normal ALT. Many patients will stay in this phase for a very long time and some may even lose their HbsAg as they get older. However, for some, they will transition to the next phase - Immune Escape Phase - aka, chronic HbeAg negative Hepatitis B. In this phase, both hbvdna and ALT will be elevated and fluctuate ( 2 x ULN and hbvdna > 20,000 iu/ml. Obviously a lot of patients would like to know their chances for staying in the inactive phase for ever - this is where qHBsAg is being used to predict the risks. It has been shown that a qHbsAg < 100 iu/ml may indicate a very high chance of losing HBsAg naturally in the next few years.
Helpful - 0
Avatar universal
http://www.medhelp.org/posts/Hepatitis-B/update-on-my-fatty-liver/show/1500346


try to copy what i did, diet and supplements must be a religion for you for 6 to 12 months,
food must be fresh organic (not processed or with chemicals in it), and all supplements natural of the highest quality (not synthetic)

hbv has nothing to do with your fatty liver because very low, food quality is the most probable reason and low vit d
Helpful - 0
Avatar universal
I don't know the answers to all your questions, so I will just make a few comments, others will give you theirs.

Fibroscan is usually the medium of 10 successful readings, so I am not sure about this "average of 3 readings". You don't seem to be over-weight, so I am not sure whether a special probe for obese patients is needed in your case.

Inactive or immune control phase patients are characterized by HBeAg negative, very low or undetectable hbvdna ( 2 x ULN and hbvdna > 20,000 iu/ml. Obviously a lot of patients would like to know their chances for staying in the inactive phase for ever - this is where qHBsAg is being used to predict the risks. It has been shown that a qHbsAg < 100 iu/ml may indicate a very high chance of losing HBsAg naturally in the next few years.
Helpful - 0
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