Taking back my recent advices regarding the criteria for treatment.

[Aduiski]

I am taking back my recent advices regarding the early treatment based on UK/British guidelines....

[Mrr49]

So as I said to twinboys1girl for me, it appears the longer you are in e.ant + phase is where the damage is done to the liver & hcc risk. I was told by my doc as long as your immune system keeps virus under control (inactive) no problem. By the way I am 66yrs old & hope I die with it not from it as my doc says.

[Mrr49]

I was diagnosed over 22 yrs ago as e.ant-,anti hbe+, low dna, highest 500.
What I am trying to say is what aduiski said that during e.ant + phase is where the damage is done to the liver which increases hcc risk.
If I am wrong will somebody correct me please.
Good luck.

[FingHb]

I think being a woman (female) also tips the favor to you.  Like you posted before twinboys, monitoring is more important then the guild line on paper, since all cases are individual.  Having a good specialist and the abilities to monitor our hbv status should be why we should get into treatment rather than guild lines available from dr Google.

[twinboys1girl4me]

Mmr49...My specialist, who works with Dr. Gish is on the same page as what your doctor says.  She would not treat me, and my ALT and DNA is almost identical to you, sometimes lower like you experience.  I hope I am still inactive in 20 more years, like you have remained.  

[Mrr49]

Aduiski
I forgot to mention I was told my hcc/cirrhosis risk was 0.3%

[Aduiski]

Corrected:

Population here on this website tends to be on treatment, with above average severity of hepatitis...for those these numbers are slightly higher....however they also tend to know other things which help reducing the risk of hcc so that then balances out and the above estimated numbers 1 / 2.5 % I believe are still very good approximates for lifetime risk of hcc.

[Aduiski]

Sorry for my spelling autocomplete...typing from a small device

[Aduiski]

I ment if they monitor it...but I gave my maximal estimates of 2% and 4%, my best estimates would be 1% for females and 2.5% for males, for average Caucasians that monitor it and treat it if required.
For some people these will be higher for some lower...depending on other factors some of which are diabetes, obesity, diet, etc.
Population here on this website tends to be on treatment, with above average severity of hepatitis...for those these numbers are slightly higher....hive we they also tend to know other things which help reducing the risk do this balances out and the above estimated numbers I believe are still very good approximates for lifetime risk of hcc.

1 or 2.5% is virtually nothing...so Should worry more about a heart disease from which much greater percentage of us here will die...

[Aduiski]

It is really hard to be smart and give others advice.

[Aduiski]

Accidentally selected your comment as the best answer.

Those infected at later age have their chances for hcc usually somewhat reduced.
However, they need to be very careful during their hbeag positive phase, as this is where their liver can get damaged/hcc.

[maica111]

I dot no understand.

[Aduiski]

Probably LESS than 4% of Caucasian males  and less than 2% of Caucasian females with CHB will die from it if they monitor it regularily and treat it when required.

word less was missing

[Mrr49]

Aduiski
Did you mean if  they DO NOT monitor it.

[Aduiski]

Probably than 4% of Caucasian males  and less than 2% of Caucasian females with CHB will die from it if they monitor it regularily and treat it when required.

[Aduiski]

Yes that's the case

[Aduiski]

I am 40.
Yes, some people stay "inactive" their whole lives. Even for those people virus is not 100% inactive, but for the people that are classified as truly "inactive" their immune system suppress very efectively the virus, their DNA most of the time either undetected or bellow 2000 IU, their ALT is normal almost always and their hbsag is almost always bellow 1000 IU/ml.
For people who are truly "inactive" medication isn't usually prescribed, both to save government money and because medication can for some people have side effects.

[Liverpatient]

Thanks, Aduiski, for the generous reply.
I've read the folllowing: Persistent HBV infection is sometimes associated with histologically normal liver and normal liver function, but about one third of chronic HBV infections are associated with cirrhosis and HCC.

[Aduiski]

hcc chances are very much correlated with older age. Virtually no one gets hcc before 35, chances for hcc start to raise sharply after 40-45, and after 50 it becomes an issue for us CHB carriers.

[Liverpatient]

Aduiski, how old are you, if you care to answer. Also, are there hbv carriers who stay inactive throughout their entire life, without treatment and without any hbv related issues? If so how many percent, roughly, of chb carriers do they make up?

[Hope_88]

Why is age a factor?

[Liverpatient]

The longer time the virus is in the liver, the more damge it does ( of course in those with active chb).

[Mrr49]

Aduiski
That comment you made about hcc could explain why my doc says I have nothing to worry about. I am not true inactive but my risk of hcc & cirrhosis in both groups remains minimal with all my tests overall.  No fibrosis or cirrhosis. Does that make sense.
Thanks

[Mrr49]

Aduiski
Sorry always been inactive & no liver damage so doc will not start meds unless my alt rises (now33) but doc not concerned & dna always been low ( max. in 22yrs 500).
What do you think.

[cure4life]

That was a very thorough answer. Thank you Aduiski.

[Aduiski]

As well as the factor of not being over 40

[Aduiski]

The person could undergo a close 3-monthly monitoring, rather then being put immediately on the potentially life-long treatment.

[Aduiski]

One might be in the state of a long term mild hepatitis, but have his hepatitis  worsened for lets say 6 months due to immunity drop caused by stress, other sickness or something else.
For example, his DNA and ALT values like this:

January 2013
DNA undetected
ALT 25

January 2014
DNA 10000
ALT 40

July 2014
DNA undetected
ALT 30

January 2015
DNA 1000
ALT 35

July 2015
DNA 10000
ALT 40

January 2016
DNA 50000
ALT 60

With all other factors favouring mild hepatitis and reduced risk for hcc, like for example:
- hbeag negative
- low hbsag quant., like 1500
- genotype A or D
- healthy lifestile (doen't drink, doesn't smoke, not overweight, exercises)
- normal fibroscan and ultrasound
- no family history of hcc

The person could rather a close 3-monthly monitoring, rather then being put immediately on the potentially life-long treatment.

[Liverpatient]

I think you are right; it all should depend on the state of the liver: if the liver is doing fine in terms of cirrhosis and hcc; then there should not be a rush to treatment. It is not wise to commit oneself to treatments that are lifelong in in most cases, as well that come with various sides and viral resistances that could even lead to worse hbv flares and liver damage.

[cure4life]

?May I ask,  Would you elaborate?