What viral load of HBV requires Baraclude treatment?

Hi everyone.
I'm new to this forum and will appreciate some guidance and info.

i am an asymptomatic hepatitis B carrier for about 10 years.
Viral load went from 50 to ~2k.
Few months ago viral load went up to 40K and last result it is standing on ~1M.
ALT, AST results usually normal. Though, in the test where the viral count was 1M they went to ~250.

I made a fibro-test that did not showed any sign of cirrhosis.
My doctor advised to start taking 0.5mg Baraclude to prevent from the virus going wild. But something is holding me back.


Please advise.!!!

[imran4535]

Tenofovir is a better choice. You might want to combo both Entecavir and Tenofovir until the viral load is undetectable for a few months then go on mono therapy with Tenofovir.

The reason for combo in the beginning is that it would have a powerful effect on bringing down the viral load fast so it cannot mutate. Then once is under control you can go on mono therapy. Some people even say to first go with Interferon then add combo, then mono.

Since there is no cure in the market. Current guideline suggest treatment when viral load is above 2,000 iu/ml and ALT is > 2 ULN

[imran4535]

To get a complete picture you need to routinely get the following tests listed below. It's important for you to bring your viral load down.

Every three months:
1. HBV DNA
2. ALT
3. Surface antigen quantity

Every 6 months:
1. Liver ultrasound
2. AFP
3. E antigen status (if its positive)
4. Fibroscan

Once every few years:
1. Genotype
2. Mutants

[makorepo]

hi,
thank you for your feedback.
those are my last blood test results:
do you think Baraclude is neccecery?


HBV DNA Quant. 951993  IU/mL
FibroTest score 0.17 F0
ActiTest score 0.27 A0-A1
Hemolysis Index NORMAL
ALT(GPT) 43 U/L
Bilirubin, Total 0.74 mg/dL
GGT 43.0 U/L
Apolipoprotein A-I 1.28 g/L
Alpha2-Macroglobulin 1.66 g/L
Haptoglobin 145 mg/dL

[makorepo]

can anyone help me to interperate blood test results?

[makorepo]

those are my last blood test results:
do you think Baraclude is neccecery?


HBV DNA Quant. 951993  IU/mL
FibroTest score 0.17 F0
ActiTest score 0.27 A0-A1
Hemolysis Index NORMAL
ALT(GPT) 43 U/L
Bilirubin, Total 0.74 mg/dL
GGT 43.0 U/L
Apolipoprotein A-I 1.28 g/L
Alpha2-Macroglobulin 1.66 g/L
Haptoglobin 145 mg/dL

[imran4535]

Your viral load is high, your ALT is slightly elevated. Looks like you had immune control over the virus and now it has escaped. The tests I asked you for would have really helped give a good picture, especially if you had a history of results to compare.

According to the EASL and AASLD you are definitely a candiate for treatment. But there are a lot of factors to consider when going on treatment.

Can you please test for as many things as I posted above. You only provided 2 out of the 9 things. Your e-antigen status is important also.

How old are you by the way?

[makorepo]

i'm 30 years old.
this is more or less the tests I've done over the years.
i have scheduled ultrasound and fibroscan for the beginning of march.

iv'e seen 2 Gastro Professors and a doctor specializing in liver diseases, this in addition to my regular physician.
all four of them recommended to start baraclude 0.5mg treatment.
but i'm wondering - if this is the same status for the past 10 years, why shouldn't i keep monitoring the virus, and in case it is out of control then i will start treatment... on the other hand - it might be too late, and the chances to gain control over it will be much lower.

i'm in a big dilemma....

any advise will help... : /

[imran4535]

How is this the same status for the past 10 years, you stated that your viral load went from 50 to the 1 million range. Your ALT in your first post is elevated.

Before you start any treatment you should get a Genotype and Mutants test done. If you do start treatment make sure you combo with TDF and ETV at first. When the viral load is undetectable for 6 months you can ease off and go to a single drug.

[imdrew]

Baraclude is more expensive and has around 1% resistance. Tenofovir is cheaper and has no resistance so far. So Tenofovir is the better choice for first line medication.

Becareful with ETV+TDF combo, if the virus resists, then you only have second and third line drugs which aren't strong. ETV and TDF are the strongest so far.