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hepatitis chronic carrier
a very close relative has the following reports
03/2010  HBS Antigen>250 iu/ml,Anti HBs- non reactive 0.02 miu/l, HBe Ag- non reactive 0.149, Anti HBe -reactive 0.02,Anti HBc- IgM- nonreactive 0.0 index, AFT- 1.97 ng/l, HBV quantitative- 1800 viral copies/ml plasma
29/2011  HBV quantitative 2500 viral copies/ml plasma, SGOT- 23 units/ltr, SGPT- 24 units/ltr, Bilurubin total- 1 mg/100 l, Alkaline phosphate-58 units/ltr
patient 30 yrs female with no symptoms
Please let me know whether she needs treatment.what should be the protocol in management of this patient.Please help, no good doctor is available locally.
also kindly post a mail to   ***@****  
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03/2010  HBS Antigen>250 iu/m

this is done by architect but the labs tech must made diluition 1:1000 to get exact quantity of hbsag, any hbv carrier has quantities higher than 250iu/ml.....they are usually in the range 1000-50000iu/ml

Anti HBc- IgM- nonreactive 0.0 index
hbv is cronic, s/co quantitative can be usefull, a level of 0.08s/co or lower means inactive replication and no liver damage

treatments depend on liver damage, to know liver damage fibroscan must be done (or biopsy if no fibro machine available)

best treatment scheme is:
alinia 1 pill of 500mg every 5-6hrs with food to a total of 2g daily-monotherapy about 4 weeks.this drug has no sides and is very cheap so it can be useful to try a full year of this and see if hbsag declines

alinia+entecavir or tenofovir 1 year to hbvdna fully und

alinia+entecavir or tenofovir+interferon

another treatment scheme is:
alinia 4 weeks mono as above and then combo of alinia+interferon for at least two years

my suggestion is try alinia first and see if hbsag declines in 6-12months if it does keep using alinia until hbsag negative.never miss pills because hbsag rebounds immediately



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which country are you?a good liver specialist is necessary anyway both for treatment or for monitoring

if there is no liver damage alinia is the most safe because it makes no virus mutations, also interferon is but it is expensive and might have heavy sides

entecavir or tenofovir are ok only to block liver damage in case severe liver dmage is present, they don t have activity to clear hbv
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since AFP, ALT,AST are noral.Viral count low ,can't we wait and watch. Monitor regularly. What is monitoring routine. She is totally asymptoatic.We are in eastern part of India. Facilities are still poorly developed
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