Hep DNA QT level and treatment

[NewHep]

Hi,
I was diagnosed as Hep B carrier 8 years ago.  My initial LFP test is normal, and I do it every one or two years (not strictly twice a year), and I never did any DNA QT test.  Recently I did a Hep DNA QT test and it is 1060 copies/ml which is above normal range (<160 copies/ml).  AFP is 7.9 which is above normal range (<6.1). LFP is normal.  My doc prescribed Hepsera.  Do I need treatment with this DNA level? Is this Hepsera the right drug for my situation? Why not Baraclude (Entevir) or Lamivudine (Epivir)? And also, since I'm breastfeeding a four months old, will the drug have any side effects to the baby? Thanks if anyone can give me a second opinion.

[zellyf]

Glad to hear it!  I hope you continue to visit and even to post and keep us updated.  

[stevenNYer]

Good for you.

I just want to add the comment that the meds don't cause your immune system to stop working.

It's just that the virus works to escape the immune system's control.  The immune system still works, just it came overcome this particular virus and its bags of tricks.

[NewHep]

Finally I met with new doc yesterday.  He is much better than the previous one.  Basically he said the same thing that you guys said here.  He said my immune system is still working now - virus is still in controlled status, with medicine, the number might go down to undetectable, but my body will totally depend on medicine which will make my immune system shut down. Once stop med, virus will come back and my immune system will not function any more.  He said he saw a lot of cases where patients shouldn't be treated at first place, but was treated and later developed resistance to 2 or 3 medicine.  So his ideology is no treatment unless there is really no choice.  For now just monitor to see how it goes.  
Thank you all so much for this forum and good advices that you have given.  Otherwise I would have taken something that I shouldn't. I will surely visit here quite often even though may not posting anything.  I learned a lot at least.  Thanks again...

newhep      

[NewHep]

My pcp referred me another doc. I'll meet him next Monday.  Hopefully he knows more about HepB.  Will let you know what he suggests.  

[zellyf]

Make sure we hear back from you!

[stevenNYer]

" I asked my doc about e-antigen over the phone, he didn't seem to know what my status is."

What???  Time to shop around for a new doctor.  

Don't assume every doctor knows about HepB.  My first PCP gave me a Lamivudine prescription with my 3 million viral load.  IIf I blindly went with that I would have had a 30% chance for pick a Lamivudine resistant mutant strain.  If that happened, I would be depressed now and probably won't be around here posting on this forum.

[zellyf]

Is he a gastroenterologist?

[NewHep]

No, I haven't had chance to ask those questions in last office visit.  I was suspicous while I was picking up my medicine,  so I searched internet and tried to find answers to my questions, then I found this forum, which is very very helpful.  I asked my doc about e-antigen over the phone, he didn't seem to know what my status is.  He scheduled another appointment next week to discuss.  From all your opinion, I doubt that my doc is the rignt person the trust.

[cally44]

Btw, a member on another list said about AFP that when your liver cells regenerate, that is what causes the AFP to go up high...so perhaps this is the case with you not to mention that your just had a baby 4 months ago.  My afp is also around the same as yours.  E antigen like Zelly and Steven said is critical in determining if treatment is needed for you...also your LFT.

Cally

[stevenNYer]

The questions you asked in your opening post, did you ask them to your doctor?  What did your doctor say?

[NewHep]

Thanks a lot.  I will ask my doc about my e-antigen status.  

[zellyf]

You really can't even consider beginning therapy without your e-antigen status.  I would call and see if one has been done and you're missing it.  If your doctor started you on antivirals without knowing your e-antigen status a new doctor would certainly be something to consider.  A second opinion at the very least.

[zellyf]

I've been reading that viral hepatitis can cause elevations in AFP.  Well, that would be us.  The more I read the less 7.9 bothers me at all.

[cally44]

NewHep,

AFP is not incredibly high and I read an article once saying many things can cause it...even after the baby is born..it takes a while for the AFP to go down..i don't know what are the causes but mine was always 6.1 or in the 7 range and pple who have liver cancer their afps are sky rocket high some in the 100's or 1000's.  So i wouldn't be too concerned about this.

You should get your ALT AND AST checked, but i wouldn't undergo any sort of treatment just yet...just wait and monitor since your VL is low...some doctors like to treat at 10,000 or above if you are e antigen negative but your VL is not near that so it is strange your doc wants to treat you.

Enjoy bfeeding your baby for now..and monitor every 2 months or so.

Cally

[NewHep]

Thanks for your response. I'm Asian and 39 years old. I don't know what my e-antigen/e-antibody status is, couldn't find it in lab results.  I did a blood test in Jan and AST is a little out of normal range (don't have it with me now, will post later). So my PCP refer me to a Gastroenterologist, who ordered a Hep function panel test, DNA QT, AFP test and ultrasound. I did them in Feb, this time ALT,AST are all nomal, but DNA QT is high, AFP is high. Ultrasound is normal.  This is the first time I did DNA QT test, so there is no comparision.  And I don't know what is my AFP when I was pregnant. Do you think I should wait and do another test? How soon should I wait? Or should I change a doc?

[jack1642]

1060copies/ml is about 180IU/ml which is very low. A complete blood work (CBC) including ALT, AST, AP test would determin level of liver damage.
Based on these results forum members might be of much help.

[zellyf]

I ask when the AFP was done because pregnant women have high levels of AFP and I'm not sure how long it would take your body to clear it.  The range for a pg woman at 40 weeks is 93 - 320.  

[zellyf]

If you could give a few more details it would help people come up with an answer.  What are your age and ethnicity?  What are your e-antigen/e-antibody status?  Have you had liver imaging done?

1060 copies/ml is not strictly a treatment level of virus...its quite low.  Is this your only DNA test to date? What is your ALT?  Have you done AFP before?

I don't know if I would do treatment at such a low range based on one viral load test.  Usually you want to look at what your DNA is doing over some period of time.  Over the past 9 months mine went from undetected to 940 back down to 140.  Next time it could be up or back down.  The point is that it fluctuates and you can't base any decisions on one single test.

In general you treat e-antigen positive HBV at 100,000 copies/ml and e-antigen negative HBV at 10,000 copies.


Others here have AFP in that range also.  I would consider liver imaging (ultrasound) to rule out any issues but really 7.9 isn't alarming.  Again, you're not looking for one number.  You're looking for a trend.  How recently was that test done?

I strongly urge you to do more research before you begin treatment and get a clear picture from your doctor of his reasons to treat.  Wait for stevenNYer on this forum to give his response as he is much more informed about treatment than me.