Biopsy or not?

[bmotts2]

A Hepatologist has recommended me having a liver biopsy to rule out any Fibrosis. The following info was provided to the doctor and based on this, decided to recommend it. I've been told by others not to have it done since my levels are so low and is it worth the risk of the liver biopsy?:  On 11-17-1990, treated in ER for 1 week productive cough and diagnosed with Bronchitis.  
On 11-28-1990, I was admitted to Outpatient for Hepatitis test: B Surface Antibody (-), B Surface Antigen (+). Core was (-) and so was C. AST (61) High, ALT (67) High. On 12-8-1990, treated in ER for a fever I had for 7 days. On 12-12-1990 I was tested again: B E Antibody(+), B E Antigen(-). 6-2-2005: AST(28), ALT(40). 3-30-2006: AST (28), ALT (64) High. 7-7-2006:  AST (30), ALT (47). 10-2-2006:  AST(31), ALT(44) High. 2-2-2007:  AST(59) High, ALT(108) High, Bilirubin, Direct 0.2 High. Note:  On high doses of, Relefan, Oxycotin, Skelaxon, Niaspam for a neck injury. Stopped meds on 2-12-2007. 4-7-2007: AST(34),ALT(81) High, Ceruloplasmin 18,Hep Be Ag (-),Hep B Core Ab, Igm (-),Hep B Core Ab, Tot (+),Hep Be Ab (+),Hep B Surface Ab <3.0, HBsAg Confirm(+), HCV Ab 0.1. 4-25-2007: HBV Quantisure, Hep B Quantitation (PCR): 400 Copies/ml. June 13, 2007: AST (35),ALT (48), INR  1.1L(Low). Is it also possible that if I was infected with HIV 17 years ago, could I have been asymptomatic all these years?  What other options do I have besides the biopsy?

[Kevin Pho, MD]

I cannot make specific recommendations as to whether you should have the biopsy or not without examining you.  

Imaging the liver should be done to see if there are any characteristics suggestive of fibrosis or cirrhosis.  However, if those studies are inconclusive, the biopsy is the most definitive test for this.  

An HIV test can be done to ensure that this isn't the case.  If you were infected 17 years ago, it would be possible but unlikely you would have been asymptomatic without treatment.  

These questions can be discussed with your hepatologist.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_