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When to start medicine treatment for hep b?
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When to start medicine treatment for hep b?

My doctor recommends me to start medicine treatment for my hep b.

I feel normal, no pain and nothing special.  I don't have liver issue so far. What is the threshold (factors or criteria....) that it is recommended to start a treatment?

My another concern is once I start treatment, how long will it be? when can I stop the treatment?

Thank you
12 Comments Post a Comment
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Avatar_m_tn
Chronic Hepatitis usually does not have any symptoms until the liver disease is advanced, that is severe fibrosis/cirrhosis of the liver. Hepatitis B can be controlled and managed, but it is important not to wait until symptoms appear, such as jaundice, ascites, bleeding from esophageal varices etc.

Decision to treat or not, is usually based on persistent levels of ALT and hbvdna, HBeAg status, age, family history of HCC, and also the current state of your liver (fibroscan or biopsy).

Interferon treatment is usually 48 weeks, but success rate is low. Treatments with oral antivirals are usually long term. There are stopping rules, but the relapse rate is high. The rules are being refined with qHBsAg as an additional factor.

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Avatar_m_tn
Hi Steven,

I noticed you are based in Australia. Do you know any place where I can measure HBsAG? I am from Perth.
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Avatar_m_tn
I don't think qHbsAg is a standard assay that is available to the general public. I have noticed Australian researchers do publish papers that include measure of qHBsAg, so it must be available.

It is also my understanding that the assay for qHBsAg is cheaper than the assay for hbvdna, so cost is definitely not a factor in limiting its use.
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Avatar_m_tn
The threshold is hbvdna >2000 iu/ml

You can read full criteria here

http://www.easl.eu/assets/application/files/ef520780b91cf4f_file.pdf

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Avatar_m_tn
But you also better to know your hbsag quantity in iu/ml. If it is <1000 you can try to clear the virus with interferon treatment.
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Avatar_m_tn
if you have chronic hbv, treatment can be the rest of your life.  or maybe a few years if you are lucky to clear it.  very small percentage chance for that.

you need your hbsag quantity, and your vitamin d level in ng/ml.  

if your vitamin d level is low, i'd start by just taking vitamin d first, until it's at 80-100 ng/ml.  see how your other numbers change.

that's the first step i would take before getting on medicine for life.

you should also have your other numbers, hbvdna, hbeag, liver enzymes, so you can track all progress.
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Avatar_m_tn
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Avatar_f_tn
Below is my blood test result. Do I need to start to take medicine treatment? I have no symptoms and no pain.


Component Results
Component Standard Range Your Value
Total Protein 6.0 - 8.0 g/dL                   7.4
Albumin 3.4 - 4.8 g/dL                           4.7
AST (SGOT) 5 - 33 U/L                    29
ALT (SGPT) 6 - 44 U/L                    33
Alkaline Phosphatase 30 - 120 U/L    76
Bilirubin Total 0.2 - 1.3 mg/dL            0.9
Bilirubin Direct 0.0 - 0.4 mg/dL    0.2

Component Results
Component Standard Range                        Your Value
Hepatitis B Viral DNA < 20 IU/mL                    28395
Hepatitis B Viral DNA < 116 copies/mL           165259
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Avatar_m_tn
have no symptoms and no pain.

no one of us have, even me when i had advanced cirrhosis and even blood tests can be normal in advanced cirrhosis...only fibroscan can tell you how bad you are and if cose to death because you can even dye with few/no symtoms (symptoms) in the days just before death

all you  posted is useless to say if you are ok or close to death, have a fibroscan
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Avatar_m_tn
also have hbsag quantitative to know if you can clear hbv by peginterferon
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Avatar_m_tn
Thank you Stephen. I will leave it up to my hospital. They said it's not important and they are the expert. Thanks again.
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Avatar_f_tn
can I ask doctor to do a fibroscan test?  
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