Confused about treatment of HBV with HBeAntigen- and Viral load 285000 and normal ALT

[ZGe]

Im Confused.............

Please tell me if viral load is ~285000 copies/ml
ALT normal
HBeAntigen is negative
HBe antibody is positive

Is any treatment recommended?
someone suggested me enticavir... others are not suggesting treatment right now... im confused

[stef2011]

you are still missing the only important test to see how your liver is: fibroscan or biopsy

if your liver has no damage you have absolutely nothing to worry about, hbvdna is irrelevant especially with your normal alt

liver related research and medication in Pakistan

just keep in mind the following when you see the doctors since only the best researchers are aware of this:

one thing hbvdna is not the virus, the virus is integrated in our dna so hbvdna undetactable has no meaning to clear infection.only hbsag quantity is a measure of infection and clearance, it is even stupid to say that since hbsag negative is cured hbv


antivirals increase infection because  increase hbsag, so they are no use for you unless you have liver damage

interferon is the only drug which might lower or make hbsag negative comboed with antivirals

[ZGe]

Thanks for your reply and time.. I am grateful to you

I have checked the reports and found that i used wrong units for viral load. It is IU/ml and not copies.

1. Viral Load is 284015 IU HBV /ml
    
    Reports says that
    (The kid HBV Real - TM Quant allows to detect HBV DNA in 100% of the tests with sensitivity not less than 250 IU/ml)

2. Hepatitis Be Antigen    :   Negative (Patient S/CO 0.43)

3. HBe antibody :  Positive

4. Liver Function Test:     Total bilirubin    1.0  mg/dL    (0.2-1.1)
                                      AST (SGOT)     27   U/L       (10-40)
                                      ALT (SGPT)      28   U/L       (10-40)
                                      Alkaline Phosphates    175 U/L   (64-306  for adults)

5. Ultrasound Report:    Clear and normal
----------------------------------------------------------

It means viral load is very high as you told that 2000 iu/ml  value can be said low.

I have consulted a well known Gastroenterologist and he has recommended me (inspite of normal LFT and -ve HBeAntigen and normal ultrasound) the Enticavir 0.5 for 3 months and afterward to show him the tests again.

However when i consulted some other doctors they are not agreed to start medication IF LFT is normal.

I am also taking appointment with one doctor who is considered among the most prominant specialists in liver related research and medication in Pakistan. Let see what he suggests.

Thanks once again for your concern...

[stef2011]

if your liver has no damage hbvdna is not very important but you must monitor closely by fibroscan and ultrasound every 6motnhs

copies/ml is a very old assay, check quantity in iu/ml or change lab,  value of 2000iu/ml is conisdered low

in case of therapy a low hbsag at about 1500iu/ml has high chances of hbv eradication with interferon/antivirals combo

[stef2011]

blood test are the less important to determine if to start treatment since all drugs are mainly useless on hbv and can only stop liver damage

so it makes sense to check liver damage and if there is important damage you can start treatment to stope/reverse it

as to infection only interferon antivirals combo for many years have some success while monotherapies are almost useless for this.at this point we know that eradication can reach about 30% at 2 years of antivirals/interferon combo (etv and tnf)

so if yo never checked your liver dmage start with that because all the rest is no use.fibroscan monitoring is better but if not available the old biopsy is required

as to therapies etv is the fastest to reverse severe liver damage/cirrhosis with almost no sides but it has 1.2% resistance, and if lam resistance is present much more (lam resistance is present also naturally)

tenofovir no resistance and more potent than etv