Hi guys, Merry Christmas!
Some background: I'm soon 29 years old, chronic hbver with genotype D and negative hbeag. Never been on any treatment.
Since I got diagnosed back in May last last year, these were my measurements:
ALT/AST always normal.
05.04.15 - 1311 ui/ml
08.05.15 - 865 ui/ml
11.05.15 - 1317 ui/ml
02.05.16 - 1316 ui/ml
05.06.16 - 1390 ui/ml
11.12.16 - 2498 ui/ml
10.01.15 - 2217 ui/ml
08.30.16 - 312 ui/ml
12.16.16 - 2453 ui/ml
My liver ultrasound I did couple of times didn't reveal any problem other than mild fatty liver - Since I'm not fat or eating unhealthy foods, and it's not known that hep b causes fatty liver, the doctor ordered hep c and test for wilsons disease that can cause fatty liver - but both came back negative - so in my case for the fatty liver he said it might be genetic and I should just exercise and keep a healthy diet.
06.18.15 - V (m/s) Median 1,13 (IQR 0,05). E (kPa) Median 3,8 (IQR 0,4 IQR/med 11%)
12.24.15 - V (m/s) Median 1,17 (IQR 0,07). E (kPa) Median 4,1 (IQR 0,5 IQR/med 12%)
05.05.16 - CAP (dB/m) Median 189 (IQR 37). E (kPa) Median 3.9 (IQR 0.4 IQR/med 10%)
A side question, looking at these FibroScan results I see that my E (kPa) which is the stiffness is around 4 kPa which I understand is F0-F1 in terms of the fibrosis score. But I couldn't understand what the V value is? I see it got changed in 2016 to CAP, but it's a different measurement unit - Are V and CAP the same? I found online that CAP means it's the fatty liver levels - From what I understand 189 dB/m is considered pretty low in terms of how fat the liver is - but I couldn't find the reference value for it to know what's considered normal and what not, etc. Could you please advise what's the difference between V value and CAP value? And what's the reference range value for each? Also, is there something in the FibroScan test that can ***** the liver inflammation? e.g. A0-A4? I just don't see it on any of the reports, just the values I posted above - is the liver inflammation deducted based on the combination of these other values (V/CAP/E) or is just missing from these Fibroscan tests results?
And now to the the main question - Since there is currently a tendency of the HBV DNA levels to go up, and I'm hbeag-negative - and the levels just break the cutover barrier for treatment in the US for hbe negative which is HBV DNA 2000 ui/ml and mine is about HBV DNA 2498 ui/ml, but the other condition to start treatment is to have elevated ALT/AST levels, which I don't have, so my gi (Gastroenterologist) doctor presented me two options:
1.) Continue monitoring the HBV DNA levels, and see if it keeps going up - or perhaps it's just a fluctuation and it will go under 2000 UI/ML again after some time (that's his personal recommendation).
2.) Get a liver biopsy, if there is inflammation , then start treatment.
Personally, I rather avoid a biopsy if possible and/or delay it as much of possible - but I'm aware of the limitations of the accuracy of the elevated AST/ALT levels - the doctor then told me I can get maybe another Fibroscan to see what's the liver inflammation , but given my side question above about liver inflammation not showing in the Fibroscan result, can the liver inflammation be even assessed by the Fibroscan? Or are there other non-invasive ways to tell the liver inflammation? Perhaps liver MRI or a fibro blood test (that I do recall have the A0-A4 values, and from the past I remember it was A0). Or maybe I should go to get a second opinion with another gi/ Gastroenterologist or even better a Hepatologist? What would you do if you were me?