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Would you treat?
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Would you treat?

A friend is questioning his doc's knowledge. Here's the case:

Asian male. 31.  New diagnosis.

Viral load is 1500 IU/ml ... figure 3000 - 5000 copies.

ALT is mildly elevated at 54...was 36 8 weeks earlier.  Keep in mind that lifestyle adjustments were just being made and the patient works out frequently.

E-antigen negative but e-antibody was also negative but the lab said it was marginal and needed to retest.  I think this could indicate that the patient is in the end phase of e-seroconversion.

The GI did not have answers about e-antigen.  Had to refer to some notes scratched onto a piece of paper and then told the patient that e-antigen negative meant the virus "wasn't replicating".

Then he put the patient on lamivudine.  The patient is scheduled for biopsy but the doc didn't wait to bx before the lam rx.

Any red flags for anyone? Advice?
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Avatar_f_tn
Additionally, only one viral load test has been done.
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181575_tn?1250202386
Based on that one snapshot of a 54 ALT, I would not treat.  I would monitor and collect more info.

It is a fair assumption that this friend (who I will call Sam) is in the immunoclearance phase towards eSeroconversion.  This phase appears to be going well with a low viral count and reaching the silent phase where the eAntigen and EAntibody are both - (or + for that matter).  Slight elevation of ALT is this phase is normal because the immune system is responding.  If normal ALT then Sam would be still the tolerant phase with high DNA.  So if all goes well, Sam (31) will reach the inactive phase of the disease early without doing a thing.

From what I learned, there is no reason to treat, especially with Lamivudine.  I would very much be concern about helping the virus mutate.  Although the chance of developing resistance to Lamivudine is low given Sam's low DNA, I still would not feel comfirtable.

The only scenerio where I would treat is, if the DNA remains very high during the immunoclearance phase with a very high ALT (like in the 2 to 3 hundreds) for 3-4 months.  I may want combo treatment to cut down on replication and give the immune system some help.  I'll be prepare to treat for 2-4 years and hope in that time, my immune system could take over on its own.  In Sam's case, his immune system appears to be doing well on its own now.  

You already know that there is no such thing as the virus not replicating as long as the surface antigen is still there.

If Sam's sono is fine.  I suspect his biopsy result will show minimal damage.  Given Sam's age and suspected phase of the disease, I think most doctors won't even order the biopsy.
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Avatar_m_tn
Guys.

Since it is a new diagnosis,why not wait for 3-4 months to confirm chronic case. Couldn't it be an active infection and surface antigen also clears in due course ?

Victor
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181575_tn?1250202386
That's a good observation.  Usually yes, it would make sense to wait to confirm the type of infection.

But I've communicated with zelly on her friend and her friend likely has a chronic infection.  Some information is not posted on this thread.
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Avatar_f_tn
Yes, I should have mentioned that this was a new diagnosis of known chronic hep B.
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