HBV with High VL - should I treat?

[Ann8]

Hi Dr, I was dx'ed as Chronic HBV carrier 3 mths back. My DNA VL was 500+ copies/ML with slightly elevated ALT level - last measurement in May '08 was 46 (w/ high limit  scale 36). I'm HbAg-ve & antibody +ve. I had ultrasound done last mth and came back normal w/ slight fatty. Should I treat? What is the best treatment options? My Dr says wait & monitor? He wanted to see ALT at least 2x before considering treatment? Is this the right approach? Thanks in advance

[Douglas Dieterich, MD]

Not sure what you mean by 500+ copies. Does that mean >500 million because that would be high and yes you should be treated. If it is 500 only then maybe not. This is not a simple internet answer. Id depends on how old you are, family history of liver cancer, various mutations in your HBV virus, when you got it etc. All of those are factors in treating HBV except ALT. That is not very helpful at all. So, sorry could not answer the question. HBV is very easy to treat, but very hard to understand. DTD

[Ann8]

Sorry for not giving enough information, my DNA VL was measured to be 86,716 IU/ML which is equivalent to 504,687 copies/ML. I am 42 year old and most probably infected since birth. No family history of liver cancer. Is pre-core mutation one of the factor for treatment? Thanks again....