Is treatment necessary

[macrold]

I was diagnosed as hep B carrier in 1988 at the age of 24. I am 47 years old now. In the past 23 years I had regular check up once or twice a year. My liver profile blood works stayed in the normal range. The ALT mostly stayed close to the upper limit. The sonogram tests all ways showed a normal liver structure. My HBV DNA stayed around 300-600 copies/ml. Depending on this test results my doctors dismissed any treatment or further investigation of my liver by any other test unnecessary. Recently, I had a check up in May and the test results HBV DNA was 4,600 copies/ml my AST= 25 IU/L  ALT=50 IU/L. Looking at these results my doctor said it is time to have a liver biopsy and I have it done this week. He also mentioned that I will most probably be on a pill a day treatment for life. Right now I am waiting for my biopsy result and will see him in mid September. I am also Hep B E antigen (-), had HBV genotype A with 2.7 alpha - Feto tumor marker. Please advise on what your opinion of my situation is and what possible treatment if necessary is the best course to convert HBSAG +. I also feel a pain on my right side under the ribs which the doctors completely dismiss as unrelated to my liver and not to worry.

Thanks in advance for your input.

[4est]

"I also feel a pain on my right side under the ribs which the doctors completely dismiss as unrelated to my liver and not to worry. " - I'm in the same situation, I also fell something around the low part of the ribs, but all the doctors say that has nothing to do with the liver and maybe is something mechanic. I do 5 us for this problem on 5 different doctors and no one found any reason for this pain, is a small pain and I feel this pain when I sit-down for a wile and if I move after it start the pain it go way, so also my feeling ios that this is a mechanical one and no relation with liver.

Also my condition is similar to you, except the age, I'm 32 year old and low viral load (300 copies/ml), HBeAg negative, normal ALT / AST (22/18), 5.2 KPa on fibroscan ... , no medication;

Below you have my monitoring program (maybe you can discus it with your doctor):

every 3 mouth:
- test ALT and AST (at least)
- HBsAg (screening)

every 6 mounth:
- test HBV DNA
- test HBeAg, HBeAb, HBsAg, HbsAb
- test AgHBs quantitative
- test other liver related parameters (SPEP , GGT, ALKP , TBIL .... )
- US (ultrasound ecography)
- (Vitamin D) - this was added by my
- (Cholesterol / HDL / LDL / VHDL) - this was added by me also

every 12 mouth:
- test fibroscan
- test a normal scan blood (CBC, Serum Glucose, serum Urea, Serum iron, TAG, VSH ...)
- test fibromax (this was added by me)

This are the base test that I done, any one of this can be change in case that one is out of parameters . (also in case that you are under treatment this monitoring program have to be changed )

@stef2011 - do I miss something form the monitoring point of view ?

[4est]

I forgot about yopur question regarding physical symptoms - as @stef2011 mentioned I don't think that any physical symptoms can be related to infection (this can appear in case of interferon treatment but are do to interferon and not do to infection )
On the other hand, the news that you have a disease (do not meter what kind of disease) is not a easy one and somehow stay in your mind and you try to correlate everything with this disease and this can be sometime dangerous because you can ignore some other signs. Is better to know exactly what can you correlate with the disease and to pay attention to any other sign and to report all the signs to your doctor / doctors. - easy to say hard to do :)

[stef2011]

sorry i can t check all tests now, about to go to sleep but as regards the pain in the lower part of the liver that is due to inflammation.me and my sister have noticed:

taking antioxidants like heptech or liposomal glutathione and making vitmin d level optimum range 60-70ng/ml this pain goes away so i think we can suggest the following:

lowering oxidative stress by antioxidants, possibly heptech will solve this.this pain is present also with normal fibroscan like 4-6kpa so i guess it is due to worsening of inflammation and not only by total inflammation

very low hbvdna and normal alt can make this pain go away too, but i notice that untreated on heptech can solve this despite hbvdna detactable and abnormal alt

[stef2011]

untreated on heptech....

sorry too tired now...,  i mean untreated for hbv but on heptech antioxidant/antifibrotic therapy

[4est]

" ... pain in the lower part of the liver that is due to inflammation" - how can we test this inflammation (blood test or fibromax or ....)?

I will made my vit D check in end of November and together with the other test (6 month tests) and this will be a base line for me and we cad discuss after that.

[stef2011]

how can we test this inflammation

the best way is biopsy because you can measure it separately but this is not very important to measure, the only thing with very strong influence on liver function is severe fibrosis, i d just check with fibroscan to stay lower than 7kpa at worst