Hep B results, should I take additional test ?

[Happyd]

Here are my all blood test results since I started investigate my hepatitis B status. I have had hep B since birth, I'm 24 now. Please help me understand my results  and tell me if I need to take some additional tests.
03/30/12 Hbv real-time pcr, quant: 47,430 iu/ml
INR 1.1 (normal range: 0.8-1.2)
Prothrombin time: 11.1 sec (9.1-12)
aPTT: 28 sec (24-33)
Hepatitis D-negative
AFP: 2.8 ng/ml (0.0-8.3)
Actin (smooth muscle) 7 units (0-19)
ANA direct -negative (negative)
Alpha-1-Antitrypsin, serum 129 mg/dl (90-200)
Ferritin, serum 66 ng/ml (13-150)
Hep Be Ag Negative  (Negative) -so this means that my hepatitis is not so active,it's not actively replicating, i'm in immune tolerant phase?
Hep Be Ab Positive (Negative) it means that the body is fighting HBV, which usually means that there are low levels of HBV infecting and damaging liver cells ?
HBV genotype A.



10/15/12: HBV 192,890 iu/ml; Hep Be Ag Negative. Those were ordered by my gastroenterologist.

My primary physician ordered some routine blood tests and they came back almost normal, except vitamin D level.
bilrubin , total 1.3 mg/dl (0.1-1.3)
alkaine phosphatase 52 u/l (30-132)
SGOT 30 u/l (5-35)
SGPT 51 (7-56).

[Happyd]

So I understood that i'm just a carrier: chronic infection but low risk of liver damage — carrier state. Am I wrong? I don't get it why he suggested me taking Viread and at my last consultation I asked him why not Pegasys and he said I can take it if I want...and he also said that he's worried that my HBV increased but as I saw on this forum that's not important in hepatitis B.
I live in US so i cannot take Hbsag quantitative test.

[Rome70]

Sorry, but you do not qualify for the carrier with such DNA level. So your doctor is probably right.
Read this guidelines, it is the latest official algorithm for treatment of CHB.

http://www.easl.eu/_clinical-practice-guideline/issue-8-april-2012-revised-clinical-practice-guidelines-on-the-management-of-chronic-hepatitis-b

[Happyd]

So if I have high HBV DNA, Hep Be Ag negative it means that my virus has mutated, right ?

[Happyd]

I'm one of the ''luckiest'' ones...thanks

[Rome70]

Also ALT and AST are elevated, the refference values they printed in the test are a bit outdated. They recommend now ALT level to be max 30 for males 19 for females.

[Happyd]

That's what the doctor said, I'm female. Which is the best treatment option for me ? nucs or int ?

[Rome70]

But you are right that your DNA level is not too high there is no rush with the treatment, it can return back to normal, you can monitor for a few months and see.
I am not a doctor, so you should decide yourself, also read the link that I posted it gives a lot of useful info. And find an HBV expert, not GP. The virus is too complicated for GP.

[Happyd]

Thank you. That's what i'm going to do, monitor it and see what happens.

[StephenCastlecrag]

Being Genotype A , female, and young, you should definitely consider Interferon as your first choice for treatment because your response rate is much higher.

I am a bit puzzled by your case. You seemed to have seroconverted your e-antigen naturally, yet you  have moderately elevated levels of hbvdna and ALT, and  you are still 24. You seem too young to have developed chronic HBeAg negative hepatitis.

If you live in the US, you can visit the Hepatitis B Foundation website, www.hepb.org, to find a liver specialist in your area.

Just my opinion.

[Happyd]

This means is really bad, right ? Thanks for the reply, I'll make an appointment for a liver specialist.

[StephenCastlecrag]

It is not good or bad. It just means you should perhaps wait and  test again your ALT, hbvdna, and HBeAg, HBeAb in a few months time.

Just my opinion.

[veteranB]

You need this test also http://www.questdiagnostics.com/testcenter/BUOrderInfo.action?tc=18144&labCode=QAW

to see what kind of a mutant infection you have.. precore or core promoter..

Genotype A yes Interferon works best.. I am Geno A also..  so you have to get yourself ready for 24-48 weeks of interferon.

It is our best option.. anyway... only interferon can clear HBV.. at 20-40% rate per year.. Adding antiviral to it like tdf or etv brings it up to 50%...

But you are young and should treat yourself. Your DNA went up.. 200,000 is not good. Your feritin is normal. Which means very little inflammation or significant liver disease.. So I would just find a good hepatologist and plan for interferon.. Genotype A respond well to it..

But don't delay treatment.. this is my advice to you.. Taking NUCS with e-negative hbv is for life or till they make something for us..

[Happyd]

Is it a chance for me to be at the end of my immune clearance phase despite of my increased DNA? Or it is almost sure that I have depeloped some mutants ?

[Happyd]

Please take a look at my results.

[Happyd]

Also had a biopsy and the results were A1, F0.

[stef2011]

start with tdf and then add on intf after 1-3years

[vijayakumar71]

dear happyd,
      
        iam also hepatitis b positive from starting to birth no any testing
please replay my mail id below please.

i live in uae actual my country is india,
                                                                                                    thank you

  my email id:vijay.***@****            
                                                                          your friends
                                                                          vijayakumar

[Happyd]

So I should start with Viread because my DNA is too high to start with Interferon?