When to go into treatment?

[FingHb]

if hbv can fluctuate, levels go up and down, why jump so quickly jump into treatment for the rest of our lives or for years?  if the hbv is detected and is around the treatment guild line levels, why not wait three to six more months before going into treatment?could there be a possibilities of the hbv levels dropping back to under treatment guild line, by itself without treatment.  If people can go all their lives and not know they have chronic hbv and live till their old age, why not just monitor hbv for 3-6 months with its above the treatment guild line levels?  I understand treat if it's in the millions range, but I am talking about a little over or equal to 20k for hbeag +, and >=2k for hbeag-, why get into treatment just because a doctor says do according to the practice?  Not saying the doctor is wrong, but can you just wait to see how high it gets.  People get treatments when their level is the 100k or more, so why not just wait for treatment until you get close to that level, which maybe in how long?  If the hbv is a slow killer, wouldn't it be worth to wait even if the levels are above normal, so your body may possible fluctuate it down again or does having chronic hbv mean once the levels start going up, without medicine it will always continue to go up?

[nicolefor]

I agree with all your comments . But without hepatitis B virus  ''our immune system woun't  make any  damage,'' The problem is the virus .

[stef2011]

paris conference was posted already few weeks ago, all questions/answers on hbv and eradication cure is discussed here:

http://www.aphc.info/videos-2016/

[stef2011]

and you dont have to look at the virus but a combination of tests especially liver damage

until the age of 20-30yo there is no immune response for almost all carriers, virus is highest and liver is as healthy as non infected people.during this age of immune tolerance to hbv patients must not be treated and need not to be treated

after 20-30yo:
most get inactive carriers and this can be all life, some get to active with liver damage and these are treated with antivirals and everything goes back like the inactve carriers

[stef2011]

the point is hbv makes no damage it is our immune system to make the damage, so it is complex and yo dont have to look at the virus by a combination of tests especially liver damage, until there is no liver damage there is really no need of treatment, the majority of hbv infected are not treated because have infections with no damage or even undetectable virus

[nicolefor]

To FingHb : Your question is very good . I appreciate it much .
Many patients  usually  asked  the opposite .
    ''Why should we wait until the virus is on the point to cause  trouble before we are put on treatment .''
   How can you answer this question .
Do you see any danger  waiting for the virus to start damage before starting treatment .?

[twinboys1girl4me]

Your mind is right, do not go on treatment without enough data to know you will benefit.  For you, track labs for a year since you just found out but next you need to get Fibroscan to assess damage.  If you have a high Fibroscan that may be a reason to treat earlier, but if Fibroscan is low then monitor and track for stability or changes over time.  

Antivirals are expensive without good US insurance and come with possible side effects, so only rush if needed.

[Aduiski]

Don't you think that those committees of best Hep B specialists didn't have questions such as your in mind when they were creating guidelines?

They did, and yet they said if two measurements at least 3 months apart show your ALT and DNA are high, they recommended treatment.

It might be that those committees were wrong...but it is much more likely that you or me will be wrong if we don't follow their recommendations.

[FingHb]

I don't think I asked this question before.  I asked how many were on treatment.  I am asking about what are the consequences about delaying treatment when treatment is recommended based on treatment guild line?  I know the guild lines of when treatment is recommended but how about not getting treatment according to the guild line but waiting it out during abnormal levels

[flyinsky]

It Is the situation o liver wich led to a treatment or not.if it get worst even with little numbers of hbvdna or other tests you should get treatment.if liver Is ok i suppose doc Will wait and do monitorings and observe and start treatment in appropriate time..

[Aduiski]

You asked this question already in another forum topic if I remember correctly.

Follow NICE/UK and Canadian guidelines and start the treatment when recommended.

You won't get better answers by asking random people on the forum...

NICE/UK Guidlines:
https://www.nice.org.uk/guidance/CG165/chapter/1-Recommendations

Canadian:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551569/