chronic HBV HbeAg-ve

I am confused Dr. Schiano. I read that for chronic HBV,HbeAg-ve, treatment starts when viral load is over 10,000 and ALT more than 2X Upper limit i.e. 2x19=38. With my viral load of 2.74 x 10 log 4 i.e. 27,400 and Alt of 31, you advised to hold off treatment.

I was diagnosed with chronic HBV, HbeAg-ve in 2001. Needless to say, it devastated me. Since then I started to take milk thistle and lately phospatidyl choline.All those years till April 20, 2010, my viral load had been 1.74 x 10 log 3. April 21, 2010 it was 7.84 x 10 log 3. After 8 months,
Jan 2011, it went up to 2.3 x 10 log 4. After 3 months,
March 29, 2011, it went down to 7.44 x 10 log 3. (1 log down).
July 2011 went up again to 2.74 x 10 log 4.
Regardless of viral load, ALT had always been 31 and below, and AST 34 and below.

Shall I still hold off treatment doctor?
Your insights have been a great help. Appreciate it greatly.

What do you think of the above results doctor?

[Thomas D Schiano, MD]

the genotype would be helpful and if you could get a fibrosure test.  interferon has a lot of potential side effects but almost always it is tolerated adequately so as to complete the treatment course

[Thomas D Schiano, MD]

with normal ALT and a viral load no greater than 27400 i would not start Rx right now.  as long as there is no evidence of advanced hepatic fibrosis and your close personal contacts have protective antibody against HBV you can hold off.  if you were able to check your genotype you would have more evidence to see if interferon treatment down the road would be a potential option as it is a chance for cure while the oral medicines are not.

[Babylove0728]

Thank you doctor.

What kind of test will I do to detect evidence of advanced hepatic fibrosis? Will sonogram show it? My last sonogram of the liver was in Feb 2011, and from the results, according to the doctor, there was no evidence of cirrhosis; but there was fatty liver, compatible to having a chronic HBV.

I am not sure what is my genotype but will try to find out or be tested for it.

Are there any side effects with interferon treatment?

Thanks as usual for your insights doctor.

[Babylove0728]

Hello Doctor Cshiano,

Where can I get a fibroscan test? Does Bellevue Hospital has that machine?

DO I have to wait for evidence of advanced hepatic fibrosis before starting treatment?

Or is it better to start it now to prevent the liver from getting worse, as prevention is always better than cure.

I may have had this HBV for more than over 10 years probably, maybe 18 years, although as mentioned from my blood tests, ALT have been 31 and below and AST have been 34 and below. Also I am HBBeAg-ve. Does that make any difference?

I am very confused and dont know what to do about when to start treatment, because this could be a lifetime of viral treatment.  

Also, when treatment brings you to an undetectable viral load level, infection is still there. In fact I read that with viral treatment, liver cells get to be infected more and more and it spread out to other cells. So somehow contradicting. Seems like viral treatment just lower virus replication, but cccDNA is to be worried about. What is your opinion on this doctor?

[Thomas D Schiano, MD]

even though the virus is still present in the liver, numerous studies show the significant advantage of keeping the viral load (-) in the blood. This is a very low titer of HBV-DNA however.  i do not believe bellevue has the fibroscan but you can get check a fibrosure blood test which is commercially available and is a fairly good assessment for advanced fibrosis. if you have genotype C i would be apt to recommend treatment as it is more associated with the development of liver cancer and cirrhosis.

[Babylove0728]

Where can I have fibroscan rested?

where can I have genotype tested?

Can you please recommend a place. I am at a loss on whether to start treatment or not. But I want to do your advise of getting fibrosure (is it the same as fibroscan) and genotype testing before starting treatment.

Please help me where to get them tested.
Thank you doctor.

[Thomas D Schiano, MD]

fibroscan is a procedure that is not readily available in the US.  fibrosure test and HBV genotype are commerically available lab tests.

[Babylove0728]

Hi Dr Schiano,

I think I should start treatment even without genotype and fibrosure given that I, as chronic HBV HbeAg-ve patient of more than 10 years, maybe nearing 20 years now, of Asian decent and JUly 2011 ALT of 31 and AST of 34 and HBVDNA of 27,400.

My question doctor is if I choose Tenofovir, what is the recommended dosage and for entecavir, what is the recommended dosage?

At the moment, I am leaning towards entecavir given that I have ostepenia. However, I am taking Caltrate along with Vit D3 1000 now. However, form publications, I read that tenofovir has no known resistance issues so far, but can affect bone density and renal functions. DOes entecavir affect renal functions as well?

THank you Dr.

[Thomas D Schiano, MD]

tough question--cannot argue with your resolve to start rx.  entecarvir also has to be dose reducted.  right now i prefer viread 300mg daily because of no known resistance idwentified