Treatment or not?

[TO69]

I think I got Hep B vertically or early in childhood. 39 yrs old now, starting routine check up 6 yrs ago, for the past 2 yrs, my VL load fluctuates from about 1k to 45k copies/ml. All my ALT are under 30. Also, I am e Ag (-), e Ab (+). One of my doctore recommend me to start treatment with Viread. The other recommend me to do biopsy. Saw one reseach showing for Hep B carrier, if one can minimize the VL load before reaching 40, the possibility to get Cirrocisis or HCC will be much lower. I am thinking about getting treatment now, however, also got concerned about the resistance as we are not sure how long (probably very long) we need to be on the anti-viral.

Hope to seek any other thoughts. Thank you.

[stevenNYer]

"If one is going to treat in this type of circumstance (eAg -), why not treat with INF for a year instead of antivirals forever ?"

Because when you stop, you still likely need antivirals to hold down HBV DNA.  Unless your goal is for the "S" seroconversion, which like you said is a mere 3%.  For most, it's not worth it since antivirals are much more patient friendly.

[bberry]

INF, like you said works best with C heppers.
not sure why doctors dont recommend it much to B heppers bit i am sure they have a point there as it seems to be the norm amongst them.

i read somewhere , not sure where, a while back that even with those starting meds after seroconversion to hbeag negative that their chances ro resolving hbv is still there and may be of a higher percentage..not that it would exceed the 2% yearly rate but it is there nonetheless.

[apache1]

quote from bberry:
at these readings i wouldnt really start meds. keep in mind TO69, that after you've acheived hebeg negative if you start treatment that you will be on it for life. there's no coming off of it.
==============================================================

I have a question.
If one is going to treat in this type of circumstance, why not treat with INF for a year instead of antivirals forever ?
From what I have read, No chance of drug resistance and a chance of getting the VL low or UND, maybe permanently. Also, although very low (3%), the chance still exists with INF to go HBV surface antigen negative.

http://www.ahrq.gov/downloads/pub/evidence/pdf/hepb/hepb.pdf

I know many are skeptical of the sx from inf therapy, but in reality most of these bad sx come from the Ribavirin not the Interferon. Since most reports on INF therapy comes from the HCV inf tx, riba is always used. With HBV riba is not used, so the sx should be a lot less. When I reduced riba dose and then finely stopped taking Riba but continued with peg interferon, the sx were almost non existent for me.

jmo
apache

[stevenNYer]

More frequent DNA testing would be helpful.  
I think the lack of a trend, the fluctuation could be in itself indicate a degree active hepatitis.  I think a biopsy before starting treatment makes a whole lot of sense to determine the status of your liver.

If your biopsy result is good, then you may want not to treat and monitor more frequently with HBV DNA and ALT labs.

[TO69]

usually between 6 mos to a year ; it fluctuates over time .. can not see a definite trend here though.

Dec'05 - 2920 copies/ml
Jul'06 - 1590 copeis/ml
Aug'07 - 45000 copies/ml
Feb'08 - 39600 copies/ml
Sep'08 - 1210 copies/ml
Jun'09 - 35500 copes/ml

[stevenNYer]

How often do you check your HBV DNA?
What are the actual DNA numbers over time?

Looking at the trend will give you a better guess at what's going on?

[TO69]

thank you, my doctor said he would like to bring the VL down as early as possible. BTW, I am a Asian American. I am now more toward following the std treatment guidline to take biopsy and go from there ...

[bberry]

at these readings i wouldnt really start meds. keep in mind TO69, that after you've acheived hebeg negative if you start treatment that you will be on it for life. there's no coming off of it.
a good diet and liver friendly food might actually get your viral load down. if you've done this well for 39 years and you were infected at early childhood then might as well continue with your current monitoring. did your doctor say why he thought  treatment is needed now?
dont mind me asking but also what ethnic background do you come from ?

again, and genrally speaking that is  i wouldnt really start treatment now.. we have a friend on here whose v/l is a few 100Ks and will not start treatment even though he is over 40 yrs old now. he is doing it the opld fashion way of herbal treatment and strict diet .. he was able to bring his v/l down .