Hepatitis B - Biopsy

[Neil888]

I am 31 year old Indian born male currently residing in US.
I have been diagnosed with Hepatitis B earlier this year (Feb 2013) by a screening test.
I had taken Hepatitis B vaccine back in 2007 before coming to use (3 shots), hence it looks like i got infected before that.

My results are as follows.
Date : March 4, 2013
HBV DNA - 1130 IU/ml
ALT - 30 ( Lab reference rage - 0 to 60)
AST- 24  ( 0 to 40)
HBeAg -Ve, Anti Hbe Positive
Date : April 8, 2013
AFP - Not detectable
Lever Ultrasound : Liver is unremarkable ( Normal result)

The HBV DNA and ALT, AST repated after 3 months.
Date : 3 June 2013
HBV DNA - 2590 IU
ALT - 41 ( lab Normal range 0 to 65)
AST - 26

I am really freaked out since my DNA is higher and ALT is also higher.

I met the doctor this week since I was concerned about elevated HBVDNA and ALT values. I requested doctor to have a liver biopsy. My doctor told me that he is not too much concerned with increased DNA and ALT values. He thinks to wait for next three months (for next set of HBVDNA and AST/ALT Tests) before biopsy, and told me if it remains persistently elevated, we may do biopsy. We do not have Fibroscan machines.

Can you please advise on waiting for biopsy for three months?

Also, My doctor told me that ALT seems normal, I have doubt on that as well. Any thoughts?

I really appreciate you insight.

Regards
Neil

[Divinehealing83]

From my understanding US laws states that Hepb treatment is based on viral level my question is what if your viral level is low but you are developed tumor, chriosis, or fibrosis of the liver , what happens?

[Divinehealing83]

Thanks for the information folks.Ive learned a lot from reading your questions and answers. Neil it seems like you're e on top of the game please continue to share your information with other.i would like to know if you're having symptoms like pain, itching, brushes fatigue etc and also if you are taking any supplements and if yes how is it working for you? And if no why not?

[Divinehealing83]

Thanks for the information folks.Ive learned a lot from reading your questions and answers. Neil it seems like you're e on top of the game please continue to share your information with other.i would like to know if you're having symptoms like pain, itching, brushes fatigue etc and also if you are taking any supplements and if yes how is it working for you? And if no why not?

[Neil888]

Update:---- Started taking Vit D - 2000 iu, Vit C 1000 iu daily since July 2013

Latest blood Test date : 9/6/2013
HBV DNA : 694 iu/ml
AFP - Non Detectable
ALT - 36 (Range 0 - 65)
Liver function test normal.

Have Doctor's appointment tomorrow

[Soflab]

Try to get in touch with this lab in france lyon my lab in casablanca use this latter for tests not available in morocco and he charged me 350 dirhams so the french lab must be charging cheaper like 25 euros for the Hbs ag quant so i would suggest droping them an email en how to send the blood sample to them and ask them to email you the result.

http://www.biomnis.com/

[Neil888]

I dont have hbsag quant results as they are not available on my country. Also, i dont have grnotype test done. I do have fibroscan results though. Median liver stiffness is 5.5 kPa. My other test results are at in the initial few posts of this thread.

[Soflab]

Neil any result for your genotype, fibroscan, HBSag Quant.

[Soflab]

Stef according to your findings above i need to wait to get the HBSag quant and other tests fibroscan and gynotype in order HBv or HBSag can be classified as active or dormant. As i am a seaman and on board right now i will be able to get those test done by end of august, but as red in one of the post here talks about HBC Test pos= acute and neg = chronic do i have to do this or can i be concidered chronic since i am over 6 months period and HBV didn t clear since 12/12/12therefore i can be concidered chronic carrier.
-Is it correct when we say active = either chronic or acute that it clears itself depends on tests result.
-dormant: means only chronic

[Soflab]

Alya look at your post i am a seaman as well and just compare your readings with mine. I was hired  even with HBV virus.

[Soflab]

May God bless and cure you stef for the effort you put researching all the info.

[alyaspogi]

My hbasg is 410.9
my anti hbe is 700+
i th this is chornic is this posible to be non reactive?im aplying aboard.the doctor unfited me.

[stef2011]

there is a study just posted look for it on the board

hbsag level depends on genotye for genotype D hbsag around 1000iu/ml but genotypes a,b,c require much lower hbsag.

hbvdna less than 2000iu/ml, alt less than 30 men 19 women, fibroscan less than 6kpa

[grmr]

when HBSAG is <1500iu. DNA UND or <200iu ALT/AST normal and no fibrosisis

[Soflab]

Here is a question for you stef when can i or a person should say that i or he is carying a non active or dormant HBV / Chronic HBe negative.

[Soflab]

Understood stef so i should concider both jessner and kanof and Hbv as 2 defferent sickness unrelated one. My question now doing the hbsag quant and fibro and there result will clarify the gynotype or this latter is a third test and if so how is it configured. By having all the three result this help prescribe the right dosage for peginterferon dose and if not shall i just start the peginterferon with no harm or sideeffect  until i will be able to perform the fibroscan and hbsag quant. Also if there is anything else meanwhile that can help clearing hbv until i be able to do these tests.
Thanks

[stef2011]

hbv has no symthoms at all on chronic carriers, just tireness from time to time and little pain around liver area, all this is not relevant, again you just have to check hbsag quantity and fibroscan and according to results go for hbv genotype test and start peginterferon

infection is from borth, it is too rare to get it as adult

[Soflab]

Thanks stef for the prompt reply.

Is there any relation between Jesner &Kanof and Hbv infection bearing in mind that i never accepted to take medicine in 2008 for jessner and kanoff after my research that there is no direct medicine for this latter and doctors are prescribing Plaquenil and this latter impare vission and not a direct medicine to this sikness. 2008&2009 had skin erruption normaly around May and they clear after 3 months. But after taking some herbs  only for 1 week my body skin was clear of erruption and they stopped appearing in 2010/2011/2012. However, after 12/12/12 was shoked and stress again and all over then the jessner and kanof skin erruption showed up on June 2013.

[Soflab]

To add to the above realy don t know if i had it from the dentist or way before coz just remember tha in 2008 i had skin issue and my dermato prescribed skin otopsy results were Jessner and Kanof . Would any body know if these two Hepatitis B & Jessner and Kanof are related if the case i might be carrying HBV since 2008 and just knew about it in 2012.

[stef2011]

all the tests you did are almost useless without hbsag quantity in iu/ml and fibroscan, especially hbvdna is useless off therapy, it can go from und to billions without real meaning without hbsag quant and fibroscan

have hbsag quant checked so you will know if you can clear hbsag by peginterferon

[Soflab]

12/12/12 was tested
HBV positive
HBe neg / anti HBe pos
ALT/AST Normal range
HBV DNA 150 ul/ml
Fresh vegy including: black radish/no red meat/ just chicken breast/ no shell fish fried food/ just barbequed or steamed food.

2 months lated :
HBV DNA 29 ul/ml

Took it easy and tried some of the forbiden staff mentioned above
2 months later:
HBV DNA 95ul/ml

Still took it easy and kept on taking some of forbiden staff

2 month later:
150 ul/ ml.   879 copies/ ml
2 months later  27th June 2013
200 ul/ml.    1170 copies/ ml

So as you can see Neil we are on the same boat
Now i am trying a restricted diet as in no fried nor red meat no shell food instead bio food and grilled chicken breast or white fish. Black radish / milk thistle supplement my next test is on the 30 august and i will keep you posted on the result.
I agree with your doctor and stef after my deep research on the net we are in a very early stage for any medicine intake or biopsy . We are called
Chronic Hbv since we passed six months and virus still present but it deosn t mean we can not fall in category of being Acute HBV and virus clear and if the case we will be HBV negative in my case HBC positive since never had vaccination and with god' will if you clear the virus you will be HBV and HBC negative. Also we are called e-antigen negative and this is a good sign when to concider medicine treatment in our case DNA more than 10000 ul/ml
Or ALT 150
I read we can do Alpha - fetoprotein test not clear to me what is it i need to get feedback from my docter probably to see if our liver is devoloping cirrhosis dont know what is the difference to fibrocis need to do research or ask doctor or stef.

Hope this ease your pain. Also i suspect that i got the virus from dentist on march 2012 when i had thoot filling and resulted in an infection.
I am 40 years old by the way.

[Soflab]

12/12/12 was tested
HBV positive
HBe neg / anti HBe pos
ALT/AST Normal range
HBV DNA 150 ul/ml
Fresh vegy including: black radish/no red meat/ just chicken breast/ no shell fish fried food/ just barbequed or steamed food.

2 months lated :
HBV DNA 29 ul/ml

Took it easy and tried some of the forbiden staff mentioned above
2 months later:
HBV DNA 95ul/ml

Still took it easy and kept on taking some of forbiden staff

2 month later:
150 ul/ ml.   879 copies/ ml
2 months later  27th June 2013
200 ul/ml.    1170 copies/ ml

So as you can see Neil we are on the same boat
Now i am trying a restricted diet as in no fried nor red meat no shell food instead bio food and grilled chicken breast or white fish. Black radish / milk thistle supplement my next test is on the 30 august and i will keep you posted on the result.
I agree with your doctor and stef after my deep research on the net we are in a very early stage for any medicine intake or biopsy . We are called
Chronic Hbv since we passed six months and virus still present but it deosn t mean we can not fall in category of being Acute HBV and virus clear and if the case we will be HBV negative in my case HBC positive since never had vaccination and with god' will if you clear the virus you will be HBV and HBC negative. Also we are called e-antigen negative and this is a good sign when to concider medicine treatment in our case DNA more than 10000 ul/ml
Or ALT 150
I read we can do Alpha - fetoprotein test not clear to me what is it i need to get feedback from my docter probably to see if our liver is devoloping cirrhosis dont know what is the difference to fibrocis need to do research or ask doctor or stef.

Hope this ease your pain. Also i suspect that i got the virus from dentist on march 2012 when i had thoot filling and resulted in an infection.
I am 40 years old by the way.

[calebz]

wow and I was thinking our public care is crap.
you need hbsag quant to have a full picture and then make a decision.
contact a faculty that does clinical trials and they will hook you up for that test and maybe some trial where you get IFN for free (like i did).

heres a link to my trial with locations:
clinicaltrials.gov/ct2/show/study/NCT01277601?term=GS-US-174-0149&rank=1&show_locs=Y#locn

if hbsag is low + your other results it might be worth a try IFN to full cure despite statistical odds regarding response.

[Neil888]

The problem is, hbsag quant lab test is not available in US. My doctor thinks that i am not a good candidate for either antiviral or peg treatment as my hbvdna is not superhigh, alt is in normal range and liver stiffness is in normal range( see above posts) Doctor is following AASLD guideline for hepb. He will keep testing me for   every 3 months for first year and if everything is normal he will designate me as inactive career. I consulted another doctor and he is also saying prettymuch the same thing. Peg cost $25000+ here and insurance wont pay in full evenif doc is prescribing it. in my case doc is not considering me for peg.

[calebz]

Neil, stef can sometimes be a bit confusing with his lapidary replies but hes telling you the right things. I suggest you read a few threads here and you will have a good picture on why is HBsAg so important in regards to treatment strategy.

PS. Why is interferon not refunded for you in US ?