makes sense.
My doctor handed me about 20 different cases (he got it part of his professional website). I am surprised to see even for people into 50s with higher viral loads, the suggestion was not to treat.
The selection of treatment in them is more based on symptoms/general health of patient, liver fibrosis (either through blood tests or through biopsy), age, viral load.
As you said various parameters are taken into consideration, before placing patient on treatment path. As some of the forum members pointed out in the past - there are many doctors who do not update themselves :)
More often, I read that using ALT as a treatment parameter is not as accurate b/c it doesn't reflect the state of the liver...just cell death at that blood draw. However, consistently low viral load and consistently low ALT the chances of a good outcome are high.
What I have read there are 2 categories of HBeAg -ve patients :
1. Hep B which is not mutated (starts of HBeAg +ve and seo converted)
2. Hep B which is mutated (which does not produce HBeAg)
Second one is more common in Asia.
Treatment path is suggested by doctors based on age, length of infection and viral load.
There are cases where the viral load is high, but doctors suggest not to treat because the age is too low (and liver fibrosis is none).
So in essense viral-load alone should not (and is not) a factor in treatment.
Can you cite some studies?