Viral Load

Friends,

Please comment on my viral load results.
I was diagnosed with Hep B last year

My results: 4000 copies/ml on april 2008

Latest: 4000 copies/ml on July 2009

so, the viral load has remained the same.....it is neither too low which causes less worries nor it is high enough to start enough.

I am HeAb +ve, HeAg -ve so 10,000 copies/ml is considered threshold for treatment.

How much damage do you think my liver is facing based on this results?

[mady2004]

With 4000 copies/ml (it's a pretty low viral load), I don't think the liver is damaging now.
If you want to see if the liver is currently damaging, test yourself for AST and ALT.
Maybe you have damage from the past, when the virus were active (a lot of copies/ml, HeAg +ve), and the immune system fought against it.
The virus doesn't damage the liver, your immune system is killing the liver cells with the viruses.

[bram44]

As per US treatment guidelines :

Given you are eAg-ve and eAb+ve, the guideline for treatment is >2000 IU/ml with persistent high AST/ALT levels (> 1.5 times).

This means 10000 copies or less as you mentioned.

Since you are not above the threshold, you need get AST/ALT monitored, which my guess are in normal range. BTW - the normal-range listed on test results seems not accurate per some of the guidelines. ALT for men should be below 30 and for women it should be in low 20s.

As per NIH guidelines, the limits are even higher (100000 copies/ml) with persistent elevated AST/ALT levels.

There is room for lot arguments/counter-arguments. But the bottomline, how do you feel and what the liver tests are saying should dictate the treatment course.

As of now you seem to be in inactive-carrier state and enjoy your life - liver friendly.

[concerned811]

mady, bram,

thanks for your comments - my AST was 27 in April 2008 and jumbed to 50 when I got tested in November 2008. I dont have my most recent results yet.

the doc just said that the viral load is stable and same as before so dont need to worry.

what i was worried about was the fact that 4000 copies / ml is not very small, its almost halfway to the recommended load for therapy.

but as you said, I should wait for my AST/ALT results before worrying too much.

[bram44]

Try to have a normal life and just go for 6months or 1 years checkup (like you go to a dentist).

As long as you feel healthy and the AST/ALT/Viral load stay the same, just ignore that you have this in your body :)

[zellyf]

AST or ALT?

ALT is the more important number.  

[concerned811]

ok - so I finally got all my results and hepatic funtion panel results are of concern:

AST / ALT levels:
---------------------------

25 / 39 on 3/13/2008
36 / 59   on 11/15/2008
39 / 62 on   7/25/2009

so - both AST and ALT have been steadily increasing,  which looks to be of some concern to me.

other results:
--------------------
albumin / globulin / blirubin total / alkaline phosphatase

4.6 / 3.0 / 0.6 / 73 on  3/13/2008
4.5 / 3.5 / 0.8 / 90 on 11/15/2008
4.4 / 3.1 / 0.5 / 96 on 7/25/2009

so alkaline phosphatase has been increasing steadily. Is it a good thing or bad thing?

Viral Load
----------------

3700 copies/ml on 4/10/2008
3700 copies/ml on 7/25/2009

same viral load, but AST/ALT steadily increasing. Looks like HbeAg - ve hepatitis does cause slow damage even with such low viral load.

[zellyf]

ALT can't tell you if you are having permanent damage/scarring.  Are you a man or a woman?

[concerned811]

I am a man

[bram44]

Seems you are inactive (non or low replication).

ALT levels usually fluctuate depending on what we eat and drink. Yours are 2 times the lower limit (new recommendations).

If I am in your shoes, I would get untra-sound. I would try non-anti-viral remedies (hoping they work). I would consider treatment only if the viral count is increasing. Ensure everyone in your close circle tested/vaccinated.