i am not a dr, therefore unable give you a professional 2nd opinion. from my experience, my dr. waited and then treated me when my hbv dna viral started spike exponentially to millions around age 30. the fact about this pill, it is costly as you described, has known side effect on bone density lost, cause kidney problem on certain individuals, but also, once started, it will be lifelong of taking this pill, there is a 2% chance of hbsag seroconversion/functional cured, stopping the pill required frequent bloodwork monitoring as there is extremely high chance of strong flare when the virus re-bounce.
Hi, I'm not a doctor; just a patient, and here is my observation about your situation. From the info you posted, your liver is doing quite well, except your hbv dna is a little bit high. Since you're mentioning the cost of the tenofovir, I guess you will be paying for the medicine yourself; in that case it is advisable to seek for a second opinion as you said. If I were in your situation, and if I don't have some troubling symptoms that make my daily life difficult, then I think I would wait before starting any treatment, just keep monitoring every 6 months. Who knows, may be soon we may get some cure for this horrible disease. Let's all pray.
Actually, my hbv disease situation is quite similar to yours, though I'm much older, 45 years, but my alt is around 40. Currently I'm suffering from various muscle, and joint and nerve issues, that could be related to my chronic hepB, according to the docs and I'm pressing my doctors to give me the med.
It seems you are in the Immune Control phase (HBeAg negative, viral load low, ALT normal). As commented by Liverpatient, your hbvdna is higher than the usual typical low hbvdna load of 2,000 iu/ml or lower. However, your ALT is normal, being below 30 iu/L. I am bit puzzled by your liver biopsy indicating a grade of inflammation of 2, which seems to be at odds with your normal ALT, but more importantly, what is your Stage (of fibrosis)?
If your fibrosis stage is high (greater than F2), I may consider starting treatment, otherwise I would wait for at least another six months and test again.
Just my opinion, I am also not a doctor.
Thank you so much guys for your help/suggestions. I am thinking to go for second opinion and see what other doc is suggesting. I do not want to take any long term risk too as my family may suffer if in case any big risk comes on my way. VIREAD is bit costly but if other doc also suggest to go for it than i guess would not have any option. my ALT and liver profile was always normal from 2008 hence always wonder why Liver biopsy shows Grade 2 out of 4 and Stage 1 out of 4 . Am i in really bad stage? please suggest. Thanks again for your suggestions and help....
On your place I would not yet start taking medicine, but would test my HBV viral load and ALT/AST every 4 months. Based on the following 4-monthly tests I would make a decision on what to do.
Update: I went for second opinion on starting antiviral treatment, Doctor monitored me for 9 months before deciding on treatment. My ALT, AST and rest of liver enzyme were within normal range except viral load went up. Below are the last 9 months results:
HBV Load: 3530 IU/mL (Nov-2017), 2,580 (Jan-2018), 4,800 (April-2018), 14,500 (June-2018).
ALT (SGPT):29 IU/L (Nov -2017), 35 (Jan-2018), 29 (May-2018), 42 (June-2018) - (Normal Range 0-44).
AST (SGOT) :21 IU/L (Nov-2017), 27 (Jan-2018), 23 (May-2018), 32 (June- 2018)- (Normal Range 0-40).
Looking at the viral load and slight increase in liver enzyme, Dr suggested to start antiviral treatment. I have started taking Enticavir .5 mg daily. Dr is afraid that I will have to live on the treatment for life. Hope medicine would not have any drug resistance. Hoping a brighter future in term of functional cure sad . Will keep tread updated on progress.