Please suggest me, I am worried.

[Asianmale26]

I am sorry for my long question. I tried to put as much information as possible before you can suggest me some thing.

I am 26 Male and Active person. I went to doctor for a general checkup on mar 01 2012.(tested out of range for liver enzymes ast-386/alt-197) Normal Biluribin,ALP, Platelet count etc.
He ordered Hep screenings and my report tested positive for Hep B.
Hbsag positive
Hbsab negative
Anti Hbc Negative

Now I have a very slight pain at time and a little discomfort in my upper abdomen.I never felt this earlier.
I used to work out a little of and on last month a simple set of ABS excersice caused weired pain in my upper abdomen for about a week which I ignored. I never felt this kind of pain earlier with ABS excersice.(tough I do it very rarely).

I went to a Gastroendrologist on Mar 16 2012, He ordered liver ultra sound which he said looks fine.

Here are the other blood work reports he ordered.
Immunoglobulin A  231 (Range 81-463)
GGT     13(3-70)
TSH   2.04(0.4-4.5)
T4   5.6(4.5-12.0)
HBV DNA  6826 IU/ML and 39727 Copies/ML
PROTHROMBIN TIME-INR 1.1
PT   11.7  (9.0-11.5 SEC)************
IGG  <3( says <7 is Negative)
IGA  <3( says <7 is Negative)
ANA TITER    1:40**********************
ANA PATTERN     NUCLEOLAR
HBEAG NEGATIVE
ABEAB POSITIVE

He says that everything looks good and asked me take liver biopsy to decide the treatment.
I think he is puzzled by the elevated ast and alt.

Last thing I has a swelling to my hand elbow the week before my first blood test due to my first day on weights at gym.

I am very worried by reading that liver enzymes evelated at 2:1 ratio often suggest cirrhosis.

[Asianmale26]

Hi Everyone

Thanks Stef/ Stephan and others for sharing all this valuable information so far.

Please suggest me on a good vit d dose to start with. My doctor asked me to take 2000iu D3/day.
I doubt this is a good dose for me as my Vit D level is too low at 9 (30-110) range.
I see people with far better level taking 50000iu/week.

Please suggest me.

[Asianmale26]

Forgot to mention.

Given my low level Vitamin D total level 9 (Range 30-100).What is a good dose of Vitamin D3 for me?

Is taking two 2000IU Capsules at same or different time same as taking 4000IU per day?

Vitamin D3 9
Vitamin D2 <4

[Asianmale26]

My recent labs

Viral load- 2014 IU/ml.(not sure)
April viral load- 9000 IU (ast,alt are both below 30)
March viral load- 6000 IU(Ast 387 alt 197)

After my previous lab in April, I saw a Hepatologist. He explained me that I might have sero converted for hbeag very recently and In this phase Viral load might vary opposite of Alt level unlike reactivation where viral load elevates with elevation in Alt called Flares.
I might soon reach immune clearance phase.
Now when I see my viral load 2000 IU . I think what he said is true and I am in inactive carrier phase. Please give me your opinion on this.

All other results are normal ast/alt pending.

Only vitamin d very low 9.
Now my GI doctor who referred me to Hepatologist asked me to take vit d supplement 2500-5000iu. Is this a reasonable good dose for me?

Do I have to take some thing else with vit d?
I am currently taking B complex.

[grmr]

Probably you got hbv at birth,, as it almost the only case of chrocni hbv development...  I'm 26yo as well and hbs+ since birth.. hbeag+ like u

[Asianmale26]

I feel sorry for you.

I recently came to know it.I am not sure when I was infected.
I came here before couple of years.

[cherry06]

I am hepa b reactive since 2007. I undergone treatment until my doctor said that it is inactive. now I am a nurse and is afraid to apply for a job outside the country because I might failed in the medical exam. but I read some comments here that they were able to go to other country despite the disease. I want to ask help on how to undergone this process and what agencies consideres this situation. hope you could help me.

[Asianmale26]

No I only got Ultra sound which is normal.

My doctor asked me to get Biopsy but later said I might be clearing the virus due to my high AST/ALT levels and wanted to retest in July.

But latest result last week AST/ALT and everything else are normal and no occult blood found now just trace of blood in urine and Virus level increased. I am not sure if this is a good sign or bad.

[stef2011]

sorry i can re-read all the posts now because it is late at night, if you are not on antivirals hbvdna changes are not so important while ast/alt and monitoring by fibroscan is

if you already know your liver has no damage from a biopsy or fibroscan wait for treatments because combos with gs9620 antivirals or intf-antivirals may be a close hbv cure

[Asianmale26]

Hi Stef,

I have got re-tested.

My ast/alt are 28/28 now.

Viral level increased to 55*** copies.

Please give me your valuable feed back, What do you think of it?

[Asianmale26]

Thanks for all the information Stef.
I will now plan based on the your advice and info provided.

[stef2011]

the problem is US is decades behind and correct monitoring s not possible.hbsag quant not available, mutated forms of hbv and hbv sequence nto available, fibroscan not available.....

maybe they still use obsolete tests and hbcab igg is negative because of that too.look for abbott architect machine for all hbv markers, if you find it repeat all hbv markers on it, then plan for a biopsy if no fibroscan available.this is a good starting point.
gish in california is a very good specialist, other members went to him and he is very very updated and maybe he can run some of these tests too

[Asianmale26]

Stef,

Thanks for your time.
Do you suggest me to First go to a new specialist and get hbsag quant hbg igg and then get liver biopsy or get the biopsy parallely.

[stef2011]

you should check hbcab igg test and name of test used.there are mutated form of hbv with different type of hbcab igg

anyway even if hbcab igg is negative it doesn t change anything, you need to see liver damage by a fibroscan and if not available by biopsy according to the liver damage level you can choose if to start a therapy

we only have cure by sequential treatment of tdf 1-3 years and then pegintf add on another 2 years but if you have no liver damage it is better to wait because hbv cure drugs are close

be caureful with kidneys, there are no tests to see kidneys damage but only tests tht can show when the damage is done by measuring kidneys function.hbv can also make kidneys damage, see a very good urologist

[Asianmale26]

Stef,
Thanks for your response.

I am living in PA, USA. 
Not sure if fibroscan is available here. Could you suggest me good specialist in this place.

I was tested for hbsag,hbsab,anti hbc at my PHP doctor alone.
Which are hbsag(+) ,hbsab(-), anti hbc(-). I remember it is Igm.

Now specialist ordered Iga Igg both are negative. As i indicated earlier post. Do you think it is the same Igg you are talking about.

Stephan, 
Thanks for the info.

I saw a urologist he ordered blood , urine and ct scan abdomen and pelvis and said he doesnt see any thing wrong but somehow occult blood is passed from kidney. Asked me to come back if I see blood in urine.

[StephenCastlecrag]

I am not a doctor.
I think you should ask your doctor about the occult blood in your urine. Blood in the urine may be related to the kidney or urinary tract, which may explain the elevated AST.

You are HbsAg +ve, HbsAb -ve, HbeAg -ve, HbeAb +ve, but your HbcAb is negative, hbvdna is 6826 IU/mL, ALT 197. It is rather unusual that your HbcAb is negative. I guess to confirm acute or chronic, you should test again a few month's time. In the meantime, concentrate on your AST.

[stef2011]

i never checked all posts just checked the tests done, first of all change liver specialist, you dont see hbv status and liver damage by those tests only, the main test of all is missing making all the rest useless without it:

fibroscan, the first thing to know is liver damage, all tests and even visit is useless without a fibroscan to show your liver damage

hbsag quant, how can we define hbv stauts and especially immune balance with host without hbsag quant...

after these two main tests we can have a discussion, please confirm hbcab igm is negative correct?hbcab igg should be positive.

[Asianmale26]

I am feeling better after locating this site which has very knowledgeable people like stef and others advicing us who are lost with this Hbv.

Stef- please suggest me what my. Status of infection is (could it be acute or it is sure chronic, could it be cirrhosis)

In my general test my doctor also found occult blood in my urine 2+. Which after few blood test , urine tests and ct scan. Told me that he did not see anything wrong. Asked me to come back if I see blood in urine. Is it something related to hbv.

I am also worried of my family. Should I inform them of my infection. So that they could check for it. I am living away from them since past 3-4 years met them 2 times in between for a month each time. I don't want to tell my condition unless it is necessary.

Is liver biopsy good advice at this time?

[Asianmale26]

I am feeling better after locating this site which has very knowledgeable people like stef and others advicing us who are lost with this Hbv.

Stef- please suggest me what my. Status of infection is (could it be acute or it is sure chronic, could it be cirrhosis)

In my general test my doctor also found occult blood in my urine 2+. Which after few blood test , urine tests and ct scan. Told me that he did not see anything wrkng