sir my husband 40yrs was accidentaly diagnosed HBV positive (2007) and to our surprise 4amongst hil
s family members were positive for hbsag(childhood acquired). he took lamivudine for 3 months and stopped as suggested by his local phycician, his dna reports was undetectable then. every 6 months he used to check alt levels.
now his alt levels is 48 and dna 983iu/ml
does he recquire therapy?
will his dna level comes down without drugs
at the age of 40 and older it is important to make hbvdna undetactable because there is a higher risk of liver cancer or cirrhosis, so unless all the most advanced tests are available better be on the safe side
fibroscan every 6 months, this is the most important test because the only one that detects and monitor liver damage.by this monitoring it is possible to start therapy before serious liver damage happens
ultrasound every 6 months, this is needed because if a liver cancer develops it gets to incurable and lethal in 6 months.by detecting cancer earlier it is possible to save lives or get it longer
hbsag quantity by abbott architect in iu/ml.this shows immune system response and in case of hbsag equal or lower than 1500iu/ml there are high chances of clearance, at higher levels almost no chances
i suggest to check if there is any relevant liver damage by fibroscan or biopsy, if possible check all the hbv mutants that increase liver cancer development:
polimerase resistance test ( you may have developped lamivudine mutants that increase cancer risk even if hbvdna und), genotyeps B and C, precore and bcp mutants
the only drugs that can be used after lamivudine, even if stopped early, are tenofovir or interferon or combo
check also vitamin d and colesterol:
vitamin d 25oh must be higher than 50ng/ml, the higher the better (max 100ng/ml), there is inverse correlation between level of vitamin d3 and hbvdna.if low like in almost 100% hbv infected take supplements 5000-10000iu daily of vit d3 and monitor
chol tot must be less than 150
ldl less than 80
hdl more than 50, there is inverse correlation with the level of hdl and hbvdna low/und
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