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viral load over 100million
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viral load over 100million

With a viral load of 125million is it unusual for a Hep doctor to say that you don't need any treatment yet?  That number seems high.  No liver damage yet.
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Avatar_m_tn
yes you have no immune response so there is no damage to your liver (the damage is made by immune system).so you have nothing to cure and anyway there is no way to lower such high viral load

you are in the immune tollerant phase and don't need anything as long as you stay in this phase
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1191262_tn?1366766621
I was surprised to read that it is the immune system that damages the liver? Can you please explain more Stefano? Thx
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Avatar_m_tn
First I've ever heard that immune system damages the liver. The liver is damaged when the virus takes over the liver cell machinery to replicate itself. When it's done using the cell, it bursts out, rupturing the cell, and causing it's death.

Perhaps the poster was referring to autoimmune hepatitis.
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Avatar_m_tn

search the forum there are links to the explanation of how immune system clears the virus, there is a lot of killing of infected cells on acute hepatitis with alt reaching also 3000-4000, this is the only way to clear the virus on immune system that works

when you are in the immune tollerant phase immune system cannot see infected cells so there is no killing and no damage at all, so in this phase you have extremely high hbvdna and normal alt/ast and no damage to the liver

if you search the forum there are links on studies about immune tollerant phase, then the second phase is immune clearance, in this phase you have alt elevations and liver damage, after immune clearance you can have inactive state with hbvdna und and normal alt or immune escape, usually precore eminus hbv, the virus mutates and you have continuous hbvdna detectable/alt ubnormal, liver damage

during immune clearance it is better to start therapy immediately since you can have more chances to clear the virus before it can mutate or go in to inactive phase, interferon alone or in combo with nucs is the best choice especially if you have low hbsag
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1191262_tn?1366766621
Thanks Stefano! I definitely need to know more about the HBV phases. I believe I am in the immune clearance (low DNA, normal ALT) with little liver damage, or maybe the start of the escape phase. I will this out.
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