2nd opinion

[teababy]

Just back from seeing a new doc and he says that I shouldn't be on medication, my liver function tests are normal and says immune tolerance phase.  He says viral levels this high (110 million) is unlikely to come down. So I've pretty much took a toxic dangerous drug that can kill me on or off of it and I didn't need it. What is your take on this matter?  How can two doctors have two totally diffrnt treatments? My dad died of kidney failure a month after going in for a ttact infection, ordering invasive, painful procedures,on a feeding tube cuz of alzheimers with the same doctor, I wonder.     Thank you

[bram44]

This is a nice compilation :

http://www.hepb.org/pdf/2009_US_Pocket_Guide_Complete_Booklet.pdf

[jhakas]

Hi ,
Thanks for replying.
So what i gather from your answer is this the cycle /

Cycle 1
HBeAG + ve  ----> medicine ---- > hbeag - ve ----> medicine ( life long till hbsag +ve

OR
Cycle 2
Hbeag +ver ---- > naturally ---> Hbeag -ve --- > medicine ( life long till hbsag +ve )

So in a way all goes thru either of this cycle ... and its a good thing to be Hbeag - ve naturally as u did not have to consume lot of chemicals ( read medicine ) to reach a stage which people reach after eating medicine .. right ??

[bram44]

1.  When a person is infected with HBV, HBeAg starts off +ve.  This is needed for HBV to replicate itself.

   Some people convert from +ve to -ve very quicky (seroconversion) naturally. Some require treatment to get there.

   If HBeAg is -ve, it implies HBV is not "active".  Here is an issue - this does not mean HBV is not multiplying. This is where I am confused reading 2 different versions.

  For treat HBeAg +ve has an end-point, where as HBeAg -ve, the end point is losing HBsAg.

  Confused ?  - it is ok I guess :)

2. A very good question. Seniors - please step in.
   If I can guess, HBeAg -ve patients Liver already took a beating and even low level DNA is not good anymore.

3. Acheiving HBeAg -ve quickly will reduce the pounding on liver. Everyone starts of HBeAg +ve.  

[jhakas]

Hi .

1. What is e-Antigen seroconversion ?
2. Why two diff limit for treatment ?? 2000 IU/ML for eag -ve
and 20000 IU/Ml for eag+ve

3. What is good to have Hbeag +ve or Hbeag -ve ?

[zellyf]

What is normal ALT? Its different at each lab. What's the number.

There are more unknowns than knowns in the HBV world and doctors do have opinions on treatment that cover the spectrum from treat everyone with antivirals immediately to eating cockroaches.  You will have to become your own advocate and educate yourself and, to some degree, make your own decisions.  Not ideal but not much about HBV is ideal.

Your doc seems a little confused on the  KNOWNS however.  We KNOW that viral load fluctuates and in fact, children often have viral loads in the billions that eventually come down to undetected after e-antigen seroconversion. Tread cautiously here.

[cajim]

If you are HBeAg(+), then AASLD 2007 recommends treatment when HBV-DNA >20000 IU/ml and ALT >2 ULN; EASL recommends treatment when HBV-DNA >2000 IU/ml and ALT >1 ULN; US Treatment Algorithm 2008 recommends treatment when HBV-DNA >20000 IU/ml and ALT >1 ULN.

If you are HBeAg(-), then AASLD 2007 recommends treatment when HBV-DNA >20000 IU/ml and ALT >1 to 2 ULN; EASL recommends treatment when HBV-DNA >2000 IU/ml and ALT >1 ULN; US Treatment Algorithm 2008 recommends treatment when HBV-DNA >2000 IU/ml and ALT >1 ULN.

[bberry]

liver functions are normal !!

now why does he think 110 mil V/L  wont come down ? i've seen this in the 100's of millions and it came down .

how can two doctors have two totally different opinions? well HBV, with all the advancements of the last 1o years or so , still has more unknowns than knowns.. still confuses the hell out of some doctors..

[cajim]

What are your ALT/AST now?