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

[veteranB]

I agree with your doctor.. Viral load of 2,500 copies is low.. HBV tends to run high, like in the billions for some people. But viral loads of 100-200 million copies are not that uncommon. Then it is an emergency.

If you are up for it you can try interferon treatment, for six months. But you want be able to work taking that drug.. but it may help you clear HBV since your immune system is controlling it.

The key here is the immune system..

That is why I say we got it all wrong.. Not hepatologists/gastro guys should be treating us but virologists and molecular biologists. These people really study viruses and know more about them them all the MD's in general.. But then again if the world was perfect then we would have FibroScan here.. and surface antigen quant.

[veteranB]

but in your case I would not worry..  Viral load is of course bad, but it could be worse..

Just keep in mind that for us so far interferon is the best option if you are going to treat it..

[Neil888]

Thanks alot for your detailed response. One thing i would like to point out is, above values (1130 and 2600) shows viral load values in IU/ml and not in copies. Do you still think it is okay to wait for 3 months and see next set of test results before biopsy?

[stef2011]

if you dont test your hbsag quantity in iu/ml all the tests you did are useless.your hbvdna is low but again it is a very little meaning test out of antiviral treatment and without hbsag quant

you better wait for a fibroscan to be available, why damage your liver?

[Neil888]

So, looking at the test profile, do you think it is safe to wait for a while and check next set of results ( due in september 2013) before rushing for biopsy?
I found that fibroscan has been approved by FDA last month but we still dont have it in my region.

[stef2011]

blood tests do not reflect any liver damage,

it is impossible to know how the liver is from any blood test, but when you get to very advanced cirrhosis it becomes visible by the nodules on ultrasound and decompensation by out of range blood tests...so you are not at this point

i d check when fibroscan will be available or take a flight to canada/mexico to have it checked

[Ashi2010]

Is doctor has prescribe any drug to you as HBVDNA is >2000.

[Neil888]

Stef2011
If fibroscan may become available by the end of the year, should i wait till than ( while keep monitering HBVDNA and blood enzymes every 3 months)  or i am wasting my time by not having fibroscan/biopsy done right away?
Ashi2010,/ Stef2011
My doctor thinks hbv dna is not elevated enough to rush for treatment. he wants to wait for next set of bloodwork(sep 2013) to see if it is just a radom fluctuation or a pattern. If DNA stays elevated, he said he will order a biopsy in september.
He doesnt think there is much risk of waiting for 3 months based on my DNA levels.
Any comments on his opinion Stef?

[stef2011]

nor dna or alt have any correlation with liver damage, in the meantime you may change your diet and increase fresh vegetables.the liver damage is mainly due to inflammation and oxidative stress from immune response if you act on these parameters you can keep a healthy liver despite an active infection

if you take fibroguard, lipo ghs and lipo vit c you will block any fibrosis development and regress the one present, check that your bmi is less than 25 and doing this way you can wait until a fibroscan is available

you may also test your oxidative stress and vit d and keep d to 80-90ng/ml

[Neil888]

Stef2011
Thanks for your insight. Your comments are really helpful.

I got an appointment of a doctor (hepatologist) who has Fibroscan at his place (A University hospital). I got appointment of middle of July. I will have to convince him to order a Fibroscan in the first appointment.

Thanks for doing wonderful job at helping people.
God bless you!

[Neil888]

I had fibroscan done yesterday. I was the second patient to have fibroscan done. median stiffness was 5.5 kpa and my doctor told that it is in normal range. Any comments on results?

[stef2011]

perfect liver

[Neil888]

Had fibroscan yesterday. Got liver stiffness of 5.5
Doc told me it is normal. Any thougts?

[Neil888]

Stef
With normal fibroscan results, my doctors are suggesting that I may be an inactive career and not a candidate for tratment at this point of time. In US we dont have HBSAG quant test available. Based on my test results, and present test limitations, do you agree with their opinion? What should i do at this point of time?
Thanks

[stef2011]

Based on my test results, and present test limitations, do you agree with their opinion? What should i do at this point of time?

no without hbsag quantity we dont know if you are inactive, we dont know cccdna quantity and number of infected cells in the liver, we also dont know if pegintf can clear your hbv and if you have active immune response.since this test is the most important, which is logic even for the most stupids...the goal is hbsag negative...., you better send your samples to india or europe to check hbsag

[Neil888]

Doctors are telling me that they will observe by doing LFT & Hbvdna every six months and fibroscan every year.

[Neil888]

And again AFP and US every 6 months

[stef2011]

yes that means you wont be cured for hbv

[Neil888]

I know that I wont be cured. But, based on the test data, do you think it will be a correct approach for me now? Should I seek treatment from other country or can I wait for few years by just observing HB?  It is really frustrating to be in US since there is little i can do towards getting rid of my hbv. They dont even have hbsag quant test inUS.
Any suggestions?

[Neil888]

I started taking 2000 iu/ day of D3 and 1000 iu/ day of vitamin c.
I dont have my vitamin D level checked but am planning to have it checked next month at my next appoinment.

[Neil888]

Stef
Hypothetically, Suppose i somehow get hbsag quant test done and it comes back with higher value suggesting that i am an active career with dormant HBV( low dna, normal alt and normal liver stiffness), what would be my treatment options?
Will it stil be peg or will i need to be on antiviral?

[stef2011]

antiviral is useless as long as hbvdna is very low, alt normal and liver with no damage

pegintf is useless on hbeag neg if hbsag is very high like more tna 10.000iu/ml.....

so we do need hbsag quant and genotype to know if you have high chances to respond to pegintf, anyway inactive carriers with hbvdna und and normal alt showed about 30% hbsag clearance so you have a good starting poitn anyway but without hbsag quan *** makes non sense to go for pegintf in such a bad position as yours, i mean you ll have to pay pegintf yourself and only india/vietnam have very low prices

[Neil888]

I will try to see if i can get hbsag quant test done somewhere. But based on your response it looks like I might have limited options since i am hbeag-ve with low but detectable hbv dna and normal alt with low liver stiffness.  
Another question: what suppliments do you recommend to make sure that the HB is in check considering my position? I have reduced 11 lbs since i was diagnosed in feb 13. BmI of 23 now. eating lots of fruits and veggies and taking vit c and D as explained above.

[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 ?