Help me understand my HBV status

[Babar_Ahmad]

Hi every one in this forum all of you doing a great job to spread awareness
specially  stef2011 and StephenCastlecrag your posts are really helpful

I was diagnosed back in 2004 for HBsAG positive, my health was very down and the symptoms were extreme tiredness and not feeling hungry.
I got a treatment from a Hepatologist for 6 months off course i did all my other tests LFT's, PCR for HBV DNA. i could not remember the exact tablet name
that he gave me but i guess it was Zephix or Interferon one tablet on daily basis.

After treatment my HBV DNA viral load was undetectable and in 2005 i was feeling all fine.

After that i did not do any tests regularly or any care just LFTs from time to time and they were always normal.



January - 2014 Test Results
===================================

HBsAg Quantitative - 304.26 IU/ml
HBeAg   -   Negative [CUTOFF VALUE : 1 , My Value : 0.34]

ANTI HBs  - Non-Immune [CUTOFF VALUE: 10 , MY Value: 9.37]
ANTI HBc - Positive [CUTOFF VALUE: 1 , my value: 11.30]
ANTI HBc IgM - Non Reactive [CUTOFF VALUE: 1 , my value: 0.04]

Liver Function tests :
----------------------------------
S.Bilirubin    0.7    [Normal Value: 0.1 - 1.2 mg/dl]
ALT     24    [Normal Value:  < 35 U/L]
AST    19       [Normal Value:  < 35 U/L]  
Alk Phosphatase   262  [Adults < 258 U/L , Children < 725 U/L]
S. Albumin     4.5    [3.5 - 5.2  g/dl]
Total Protein   7.2   [6.6 - 8.8 g/dl]



August - 2015 Test Results
====================================
HBsAg Quantitative = 2531.07 IU/ml
HBeAg   =   Negative [CUTOFF VALUE : 1 , My Value : 0.4]
25-Hydroxy Vit-D3 = 17.4 [ <20 Deficiency, 21-30 Insufficiency]  


Liver Function tests :
----------------------------------
S.Bilirubin    0.6    [Normal Value: 0.1 - 1.2 mg/dl]
ALT    39    [Normal Value:  < 35 U/L]
AST    65       [Normal Value:  < 35 U/L]  
Alk Phosphatase   212  [Adults < 258 U/L , Children < 725 U/L]
S. Albumin     4.5    [3.5 - 5.2  g/dl]
Total Protein   8.3   [6.6 - 8.8 g/dl]



All these 10 to 11 years from 2005 uptil now my LFTs have been normal but in current test my ALT AST are high
Also HBsAg Quantitative is higher than previous


Please suggest what i need to do further any medicine ... precautions what i need.



Thanks a lot

[Babar_Ahmad]

Thanks Stephen appreciate your advice!

Thanks a bundle :)

[StephenCastlecrag]

Yes, with strenuous exercise, comes muscle injuries, muscle cells die, releaseing AST and also to a lesser extend, ALT. So next time before your test, abstain from strenuous exercises.

At the moment, no treatment is recommended for people with hbvdna less than 2,000 iu/ml and ALT normal.

If your HBsAg is less than 1,000 iu/ml, you may like to try Interferon, there is no guarantee that it will cure 100%. There is no evidence to suggest taking antiviral to reduce hbvdna level to undectable, thereby achieving a cure. If your HbsAg is less than 200 iu/ml, there is a good chance you may s-seroconvert naturally within the next few years.

Hope I got it right.

[StephenCastlecrag]

Yes, with strenuous exercise, comes muscle injuries, muscle cells die, releaseing AST and also to a lesser extend, ALT. So next time before your test, abstain from strenuous exercises.

At the moment, no treatment is recommended for people with hbvdna less than 2,000 iu/ml and ALT normal.

If your HBsAg is less than 1,000 iu/ml, you may like to try Interferon, there is no guarantee that it will cure 100%. There is no evidence to suggest taking antiviral to reduce hbvdna level to undectable, thereby achieving a cure. If your HbsAg is less than 200 iu/ml, there is a good chance you may s-seroconvert naturally within the next few years.

Hope I got it right.

[Babar_Ahmad]

Thanks Stephen,

I don't drink or smoke, I joined Gym 4 weeks back and was going to Gym regularly which includes some strenuous exercises, ohh so you mean strenuous exercise can cause AST elevation.

Any chances of seroconversion with some medication?
What's your recommendation.

Thanks

[StephenCastlecrag]

Your viral load is good, it is under 2,000 iu/ml.

As for your elevated AST, do you drink or smoke? Do you have any muscle injuries or strenuous exercise before your blood test?

Keep monitoring your ALT every six months and hbvdna at least once every year.

Just my opinion.

[asifkhaskheli]

check it https://www.google.com.pk/search?q=hepatitis+b+natural+history&es_sm=93&biw=1511&bih=692&source=lnms&tbm=isch&sa=X&ved=0CAYQ_AUoAWoVChMIzeH5w_nFxwIVSKyACh1mMAKI&dpr=0.9#imgrc=_KHlRfai6GEGJM%3A

[asifkhaskheli]

Yes Aaga Khan Hospital Karachi.

[Babar_Ahmad]

I belong from Lahore, this Agha khan fibroscan facility is in Karachi right?

[Babar_Ahmad]

Hi Stephen,

Here is my HBV DNA PCR Result

HBV BY PCR [Quantitative] : 151   IU/ml

[asifkhaskheli]

Babar Fibroscan is available Aaga khan Hospital you Need Biopsy and Pcr.

[Babar_Ahmad]

Thanks for a quicker response

No i just took medicine back in 2005 for 6 months only no medicine after that

Fibroscan is not available in Pakistan but i will do the HBV DNA Quantitative right?

What should i do to increase my Vit-D3, i saw it the first time and i got deficiency of this.

Thanks

[StephenCastlecrag]

Are you still on medication?

We will need to know your hbvdna (viral load) to give you comments. It may also be helpful if you can do a Fibroscan.