Worried, pretty high viral load... antiviral treatment?

[cheng302]

Hi guys, just got my viral load results tested last month. They have to send my blood to Toronto, which takes a long time to wait... They didn't test my HBSAG (quantitive). They said they don't care that. Nonetheless, The viral load is pretty high! I am quite worried now. Do I need antiviral treatment right now? Since last October, I began to feel tiredness, especially when I walk upstairs. Also, I lost almost 10 pounds in the last few months. They still want me to see a doctor of internal medicine to make sure these symptoms are not related to other diseases.

2015/01/16
Male, 27
HBV surface Ag:  Reactive
HBV Surface Ab: 0.5 mIU/ml
HBV DNA: 1.1*10^8
ALT U/L [0-54]  197 H
AST U/L [5-45]   94 H
ultrasound: A small amount of free fluid around the liver. The liver parenchyma appears within normal limits otherwise.

I was first diagnosed with hep B in June 2013. The viral load was undetectable that time. HBEAG positive. My parents all have HBV Surface Ab >200 mIU.ml.

[terrywillbeok]

where are u now ? and what kind of medicine have u taking?

[cheng302]

Nova Scotia CA. I haven't taken any medicines so far.

[Tom2013]

You need to consult a good liver specialist immediately.You are having hbeag+,a very high viral load and ast/alt levels well above the normal range therefore don't waste anymore time try to consult a good hepatologist immediately.

[mike9111]

Didyou encounter hbv from ur parents? Or most likely you had it since birth and you just found out in 2013? Hbeag + and high viral load is dangerous especially if you are genotype C (asians in most). You have also high alt and ast. Find good hepatologist and most likely you woyuld need treatment

[pong58]

Immune active phase, need to start antiviral, on my opinion

[flyinsky]

I think You need treatment or checks again after 3monthes to see how your body react
What was your viral load before?also You need fibroscan especially with the appearance of fluid...just my opinion
Just find a good hepato he will do the necessary.

[cheng302]

thanks, I will do it today

[cheng302]

That's also what I want to figure out... I have done many blood tests before 2013, and no one told me that I have hep B. Probably I was not infected at birth, I guess.

[cheng302]

I only tested my viral load three times. Twice in 2013, they are both undetectable (<500). Now it rises to 1.1*10^8... which makes me feel a little bit panic.

[flyinsky]

Mine also is in mlions but my alat is toward 50 70
So I did blood test and I am wating for results of

[StephenCastlecrag]

Normally, if you are HbeAg positive with very high viral load and elevated AL:T, then we will suggest that you are in the immune clearance phase. However, your case is complicated by the facts that you twice tested hbvdna "undetectable", presumably with HBeAg positive. HbeAg positive usually indicates highly replicative state (i.e. high hbvdna) and is not compatible with undetectable hbvdna. So. this is a puzzle to me, anyway.

A prolonged immune clearance phase without hbeAg sero-conversion carries great risk of liver damage and fibrosis. Generally, the advice is to wait and observe for 3 to 6 months to see if you achieve e-seroconversion naturally. However, if your liver functions are highly abnormal(you will need a liver specialist to read your liver function test results), and/or you have several fibrosis already (> F2), then treatment should be started.

So, it is best that you consult a Hepatitis B specialist.

[varsa]

Stephan what is the cause of small ammount of free fluid found in chang abfoman.the same thing is happend in 2012 with me also.please explain

[StephenCastlecrag]

I have no idea. Ascites can be an indicator of serious liver diseases. For Hepatitis B, it generally indicates cirrhosis. I am not a doctor, so I cannot say whether a "small amount of free fluid around the liver" indicates ascites.

[stef2011]

check liver with fibroscan as soon as possible, if fluid is ascites from the liver you may have decompensated cirrhosis which is the most advanced and dangerous for life stage of liver disease

better rule out cirrhosis as soon as possible

[varsa]

Stef how to rule out cirrosis as soon as possible.please clearify.

[melcul]

you never did a fibroscan, or a biopsy ? also, if they didn't search for hbv in particular they couldn't know for sure, because you can have it and have normal blood test ranges . but is weird, when you find out you have a virus like hepatitis, first thing is to check your liver status, and see what damage has it done . what kind of lifestyle do you have, alcohol, smoke, nights out, eating healthy ?

[cheng302]

Never.. I will try to get a fibroscan done asap. I think I have kept a relatively healthy lifestyle for more than one year, no alcohol, no smoke, normal work and rest...

[cheng302]

hi varsa, what happened to u afterwards? Did the free fluid disappear automatically?

[cheng302]

Yeah, I was also confused that time. Without treatment, undetectable hbvdna with HBeAg positive is really rare

[cheng302]

All right, seems like fibroscan is the key. Hope it's not cirrhosis.

[varsa]

I had few ammount of free fluid in my abdomen. It was taken from needle and
Srnd to lab for detecing. But now after 2 and half year gone.my ultrasound normal and hbv dna undetectable and doc put me entehep 0.5 mgdaily.
U meet with good gastro doc as soon as possible. May be doc will start medicine.do fibroscan and post your result. In this forum there r so many
Expert they will guide u.

[cheng302]

Hi stef2011,
I just got a call from my doctor and he told me that my blood test this Monday shows that I don't have any detectable Vitamin D... You have a lot of knowledge regarding Vitamin D. Could this be the reason for my tiredness and high viral load? He suggests me to take 5000 ui a day.

I just began to take Vitamin D 1000 ui three days ago. And I feel a little bit better now. I don't know if this is a placebo effect...

[stef2011]

i think the test is wrong i dont think life is possible on 0ng/ml of vit d....aids patients dies when vit d reaches zero
when taking blood samples they must be covered from light because it reduces vit d in sample.i think they made mistakes

He suggests me to take 5000 ui a day.

totally useless.if vitd25oh is less than 10ng/ml guidelines indicate a dose of 1.000.000iu of vit d3 and then 5000iu as maintenance
if liver is damaged or you are overweight there is no production of vit d in the body and even these doses might not work

i suggest a single dose of 300.000iu and then 10.000iu daily

1000iu is nothing and it will take some days to convert what you take to vitd in the body placebo effect....sun makes 10.000iu of d3 in the skin and you are so low...you need mega doses to correct

[stef2011]

you also need to check your liver damage, if liver is dmaged you may not be able to turn vit d from supplements in vit d in your body, have the fibroscan as soon as possible

retest vit d and retest in 4weeks of supplements like i indicated.take at least 2liters of water daily