question

[noidea123]

I am new to this forum. I am hep b carrier. Seroconversion 14 years ago.  Antibody e postive and antigen e negative. Checked liver function very 6 months since then.  Always normal. This time i decided to check hbv dna. Here was the results today. Alt 6 u/l (6-29 u/l) and ast 14 u/l ( 10-35 u/l) and hbv dna 5500 iu/ml. Throughout my research, i do not believe i need treatment. But they say dna > 2000 iu/ml needs closely monitor, how often? I will talk to my gi doctor soon. Just need some preparation to ask appropriate questions? Any comments will be appreciated. Thanks.

[noidea123]

Thanks for the advice. I did a ultrasound of liver and bile duct around 4 years ago but for different reason and not for hep B. Result is normal. So it is not exactly 14 years without ultrasound :) I did a little bit research on fibroscan which was approved by FDA in 2012. I am glad we have more tool to use nowsday.

[StephenCastlecrag]

I would agree with antistr that a Fibroscan is prudent to have. 14 year is a long time.

[Nasim65]

At the Management of Hepatitis B workshop in 2000, an arbitrary level of 20,000 IU/mL was adopted as the serum HBV DNA cut-off level distinguishing active and inactive chronic hepatitis.3 After it was demonstrated that this cut-off would misclassify 45 and 30% of active CHB based on one or three serial HBV DNA measurements, respectively,4 major guidelines adopted a lower serum HBV DNA cut-off value of 2000 IU/mL.1 and 5 Still, the EASL acknowledges that there can be inactive HBV carriers with DNA levels between 2000 and 20,000 IU/mL.

Debate on the value that best discriminates between active and inactive infection is ongoing. Chen et al. followed 64 inactive carriers who maintained PNALT during a mean follow-up period of 17.6 years and measured HBV DNA levels periodically (minimum of 5 measurements); 68% had at least one HBV DNA level >2000 IU/mL (excluding those obtained during the first year of follow-up).6

Because HBV DNA levels in HBe-negative active hepatitis can fluctuate from undetectable to >2,000,000 IU/mL5 and some inactive carriers occasionally have HBV DNA levels between 2000 and 20,000 IU/mL, a single HBV DNA level between 2000 and 20,000 IU/mL appears to be a “gray area” which can correspond to both active CHB or inactive carriers. It is thus important for the clinician to be aware of the importance of serial HBV DNA measurements and life-long follow-up to confirm that inactive carrier state is maintained.

[Nasim65]

Please dont comment if you have not enough knowledge. You can read this article and know more abaut hbv dna cut of in inactive carriers. And you will know this is no matter!
http://www.sciencedirect.com/science/article/pii/S2341454514001252

[chihep]

You are not seroconverted unless you made anti-HBs. It is better to be tested HBs antigen and anti-HBs.

[antistr]

you can't decide if you are inactive carrier with this data. you need to test hbsag quantitative and fibroscan. even after they are within limits i would not call it as truely inactive with that viral load. monitoring with 3 month intervals would be safest choice.

[Nasim65]

Some inactive carrier have hbv dna between 2000-20000 . You are inactive carrier for 14 years this means is you are confirmed in this stage dont worry since your alt is normal you dont need to treatment and dont worry about your hbv dna because hbv dna in inactive carrier have fluctuate but under 20000 iu/ml

[noidea123]

Thanks a lot for your rely. You are very kind.

[noidea123]

I mean serconversion from antigen e positive to antigen e negative and produce antibody e. I treated with epivir 14 years ago for 1.5 years and my doctor said that once you had anti e antibodies and it was the end point of my treatment. Before treatement 14 years ago, i had high dna count and elevated alt. After the serconversion (antibody e ), my doctor stopped the treatment and my alt is normal. As a matter of fact, it is pretty low in normal range in last 14 years and remains low. 12 years ago, i tested hep dna one time and i remembered the dr told me was low but i cannot remember the number and he told me to check liver function every 6 months. But i decided to check hep dna a couple day ago as the time i need to check alt . I think it is still classified as low but not very low. Thoughout my research, i do not think i need to do anything but continue to monitor for the rest of life :)

[luckyman316]

How are you a Hep B carrier still if you seroconverted 14 years ago?