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Suggestion required Important

Hi ,

I need to understand when is the need for Liver Biopsy,, and is it safe ?

My lab result :

Feb 2009 :

ALT  :10
AST : 8
Else normal

July :
ALT : 52
AST : 37
HBV DNA : 1194 IU /ml


Oct :
ALT : 51
AST :24
HBV DNA : 4949

Iam HBEag negative and Anti HBeAG  positive ..

My question is How  long should be monitor the value ( sets of three months ) to determine if they are consistent ? I mean I have monitored them thrice Feb , July and OCt ( do not have HBV DNA for feb ) ... just because my HBV DNA has gone up from 1194 to 4949 shall I start treatment ? Or shall I wait for about and two more tests for next 6 months to think about treatment ?

My doc has advised that after two months  no need for HBV DNA just do ALT . and if it is consistent at the same level or go up we will go for Liver biopsy and and then will decide about the treatment ..

What do u guys say ? In my opinion this elevated HBV DNA can be temporary should we wait more in order to start treatment .. as once the treatmetn starts its a life time game ..

PLease give me expert opinion on the same .. iam very scared looking at 4949 figure ..

Iam Indian age 22 .. was diagnosed almost 4 yrs back ..when had jaundice .. but even my doc had little knowledge and he literally asked me to do nothing then .. only when i came in contact with you wonderful guys i came to know that this needs to be taken seriously and then i visite my current doctor who is a gastroenrologist .. neways .. please guide me

Thanks in advance
Jhakas

Related Discussions
10 Comments Post a Comment
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948882_tn?1270557407
Since you are only 22, I would suggest monitoring until DNA load is over 100,000 copies/ml.

As long as you feel good (no symptoms) and AST/ALT are < 1.5 times normal limit, you may simply monitor and be liver friendly (good diet, staying away from alcohol and avoiding any anti-liver medications).

Did your doctor suggest testing so often ?
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Avatar_m_tn
Bramm I really appreciate your comments ..

did u say 100000 copies / ml i,e 20000 iU/ml ?

Steven will appreciate if u can comment ?
Both of u please ans all my question
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Avatar_m_tn
it seems your doctor is following the proper procedure with your case.. yes i would monitor for at least anotger two rounds of tests.. also DNA is very important so that i do disagree with your doctor.. you need to lern about changes in both DNA level and ALT so that the right decision is taken.
in your cse, going for treatment is a pretty serious decision since if you go with it then you're most likely on it for life.

wat out a little and see what happens by next summer
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181575_tn?1250202386
I think you should continue to monitor.  Treatment is to hinder viral replication, your replication is already low.  What could be happening is that despite your "e" status, you are still in the immuno-clearance phase and your are still not in the "inactive phase" yet, so your ALT will be at times elevated since there is still activity between your immune system and the virus.

DNA is important to see which has the upper hand, your immune system or the virus.  Once that is established (and it could be another year or two), you could have a clearer picture if you need treatment or not.  But if your ALT persistently stays high, in the 50s or 60s, then treatment may help, and it may be for short term, depending and guessing on when you actually enter the "inactive" phase.
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Avatar_m_tn
Bramm I really appreciate your comments ..

did u say 100000 copies / ml i,e 20000 iU/ml ?

Steven will appreciate if u can comment ?
Both of u please ans all my question
Blank
948882_tn?1270557407
Yes - because of your age. Once you start medication, you may have to stay on them for life.

Also see if you try alternative treatment methods (good diet, herbal medicines) - if that makes a difference please keep us updated.

Monitor your AST/ALT,viral load every 3-6 months. If ALT is more than 40, and viral load is constantly increasing, you should think of treatment. Otherwise just relax and try to eat/drink healthy :)
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Avatar_m_tn
Hi Steve and others ,

I have been following what Iam being told ... here are my latest results :

Hi ,

I need to understand when is the need for Liver Biopsy,, and is it safe ?

My lab result :

Feb 2009 :

ALT  :10
AST : 8
Else normal

July :
ALT : 52
AST : 37
HBV DNA : 1194 IU /ml


Oct :
ALT : 51
AST :24
HBV DNA : 4949


Jan :
SGPT :88
SGOT : 39
HBV DNA : 28304 IU/ML

Iam HBEag negative and Anti HBeAG  positive


In our last discussion you have suggested to monitor and not go for treatment as Im quite young ...
Now the after these results do you still think the same ??
I just dont wana start the treatment which is for lifetime ... shall I wait and do all liver friendly things for another 3 months and check ??
Please suggest iam very depressed
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Avatar_m_tn
How do you feel?  Any symptoms?  On any medications?  Drink alcohol?
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Avatar_m_tn
biopsy is not needed, if alt/ast are not over 300ui/ml for about 6months you can check liver by fibroscan and see if any damage is present

you can try interferon and stop it anytime if you get too heavy sides, interferon has about 30% virus eradication at 5-10 years after end of tx

you can also check for alinia and wait for more data on hbv
it is not approved yet for hbv (although antiviral effect is well known from 2004....), it has the highest rate of virus eradication amoung hbv tx, no resistance and active against all resistant hbv strains, no sides.
it is used on hcv combinations but it is much less potent on hcv than hbv and doesn't work as monotherapy like it does on hbv
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Avatar_m_tn
No Symptoms, no alcohal (alcohol),

One imp thing is I have gained a lot og weight in last couple of months ... could it be because of that ( high ALT? )

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