Chronic Hepatitis B with Liver disease

[ManishK]

I need your advice to avoid any liver related complications in the future. Kindly suggest me the way to avoid HCC in the future, frequency of MRI/AFP and if any medications required to overcome CHB.

Patient Details
Manish, Male, Age – 33, Currently on Tenofovir 300 mg
HBV DNA -   ,   HbeAg -   , Anti Hbc + , HCV -
Patient Health - Very Normal (Working 8 hours daily)

Patient History
-          CHB (Got to know in 2013), Later Family History of HCC

-          LFT – Normal so far, (Latest: SGOT – 26, SGPT – 27, Alkaline Phos - 103)


-          Weight – 59 Kg, No weight loss

-          HBV DNA Negative till now.

-          AFP – 3.8

-          Fibroscan (10/05/2016) -  LSM – 5.9 +- 1.5upa, Cap – 220 +- 13 d3/m

-          Endoscopy – Normal (30-Jul-2013)

-          Liver Biopsy (14/09/2013) – focal evidence of macrovesicular steatosis, limited to zone 3 (< 10%) with focal spotty necrosis, no significant fibrosis, Grade (HAI) = 2/18, Stage – 0/6, Possibility of NASH Could not be ruled out.

Evion 400, UDA – 300mg, Nusam – 400 mg for 3 months

Peg IFN Alpha 2B + Tenofovir (48 Weeks) – 27/06/2015 to 28/05/2016
-          Peg IFN started as CT (Aug - 2015) Seg 6,8 has small foci lesion seen. HCC Ruled out.

-          Genotype – D

-          HbsAg Quantitative History

27-06-2015 (Before Peg IFN started) – 6537

12- 12-2016 (Within six month of Peg IFN) – 3756

05-10-2016 (After 5 month of Peg IFN completion) - 4258

PEGIHEP – 100 (Zydus Cadilla) – First six months
PEGVIR – 100 (Cipla) – Last six months

Latest MRI Report (27-08-2016)

No HCC
Chronic liver disease with multiple subcentrimetric arterial enhancing lesions in segment VI, VII and VIII, no washout on venous or delayed phase, no diffusion restriction likely dysplastic nodules. Compared to previous scan (before one year), new arterial enhancing lesion in segment VII and VIII.
Segment VI lesion – no interval change

MRI on Report (29-08-2015)

Small arterial enhancing lesion (5 mm in size) in segment VI of liver in the subcapsular region with no evidence of contrast washout in venous and delayed phases.

[StephenCastlecrag]

Many people, including myself, would like to know the answer to your question. I will just outline the major HCC risk factors:
1. Avoid significant/fibrosis at all cost; so treat HBV if hbvdna is > 2,000 iu/ml
2. Avoid becoming diabetic - so regular exercise, healthy diet, minimum sugar, and again treat with Metformin if per-diabeteic
3. Avoid being obese, fatty liver, Nash, metabolic disease, high cholesterol (consider Statins)
4. No smoking, no drinking
5. Regular Ultrasound and AFP every 6 months, investigate with MRI (specifically enhanced for liver) if lesion detected.

And see your doctor regularly.
Just my opinion