Treatment decision dilemma

[Triestina]

Hello. I've been following this forum for almost 1 yr. I am amazed & so grateful for members of this community, and the wealth of knowledge, personal experiences, opinions, and helpful suggestions members have shared and posted. This is my first post to the forum, and I ask and would welcome your thoughts and suggestions pls about my treatment decision dilemma. Thank you.    

ABOUT ME:
-- Female, 60 YO
-- At 50 (in 2007), I learned I have Hep B, and that I acquired at birth. (Siblings' virus has naturally cleared/gone dormant.)  
-- Alcohol: rarely taken. Approx. 1 -2 glasses of wine every 4 yrs.
-- I am very overweight. I have been at same wt for several yrs (yes, I try to lose -- I lose some, gain some back, etc. -- and always end up at roughly same frustrating number on scale)
-- Having read that it may help liver/HepB situation, I have been taking supplements: Milk Thistle w/ artichoke & dandelion; Alpha Lipoic Acid w/ Acetyly L-Carnitine HCL; Turmeric Extract; Selenium; Vit D3; Vit E; Vit C; multi-vitamin.
-- Other than the above supplements, I am not on any prescription or other medications.
-- Fortunately, to date I've experienced no symptoms (no pain, no jaundice, etc.). (I believe in power prayer.)

TEST RESULTS:
-- Cholesterol usually 2x Upper Level of Normal (ULN) *and* HBV DNA Viral load > 20,000. (My dr. has said ALT criteria of > 2xULN is too high.)
I know that by not starting treatment, my liver may (or perhaps may not) be "rusting" even though it is not apparent -- but I keep hoping that, having lived w/ this for 60 yrs, maybe it's safe to wait few more yrs until drug that cures HepB (like Harvoni/Slovadi for HepC) is finally available.

MY QUESTIONS:
As HBV has been chronic since birth, and given my ALT/AST and HBV DNA numbers, am I foolish to continue to avoid starting treatment? Are my concerns unwarranted? Considering  above info (including concerns), if it were you or your sister or mother, would you recommend starting TAF/Vemlidy treatment?

I appreciate your thoughts & welcome the benefits of your opinions and suggestions. Thank you.  

[cam4930]

I started treatment with test results in normal ranges, because I couldn't take any unnecessary risks. You will never know what will happen.

[Triestina]

TEST RESULTS:
-- Cholesterol usually less than 200, but sometimes above normal (219).
-- Triglycerides: sometimes elevated, but mostly just under 150
-- Vitamin D: Low until 2016 when I started to take Vit D (Thanks to a posting I read by Stef!)
-- Glucose: Normal
-- RDW: Always slightly above normal
-- HBeAb: Positive/Reactive
-- HBsAg: Positive
-- HBeAg: Negative
-- HBV Genotype: A
-- BCP Mutations: G1764A/G
-- MRI Elastrographies: Normal & unremarkable (Dr. says my size prohibits use of Fibroscan, and I do not want liver biopsy)
-- Ultrasounds: Normal & unremarkable
-- AFP: Always within normal range
-- Aside for numbers below, other results normal (e.g., albumin, ALK Phos, Bilirubin, B12 levels)  

                      HBV        
                      DNA       HBV
                      Quant     DNA
Year-MM      (IU/mL)    (log10) AFP  ALT  AST
2007-08     ----------     ------     ----    23   21
2011-07     ----------     ------     ----    20   22
2011-08     ----------     ------     ----    23   24
2011-10     ----------     ------     ----    21   23
2011-11        8,930     3.95     ----    24   25
2012-06      15,000     ------     4.9    26   21
2013-05      32,300     ------     2.3    44   31
2013-12      ---------     ------     ----    29   30
2014-01      84,800     4.93     1.9    40   29
2014-03a      42,276     4.63     2.6    31   27
2014-03b      92,500     ------     3.2    30   24
2014-10        ---------     ------     ----    19   17
2015-07   2,174,976     6.34     ----   211 123
2015-10          3,444     3.54     3.6    19    25
2015-11         ---------    ------     ----     21    21
2016-04         4,030    3.61     3.0    19    20
2016-10         7,929    3.90     2.6    17    18
2017-05       39,718    4.60     3.5    23    24

Hep dr. has wanted me to start treatment for 3 yrs and wants me to start on Vemlidy (TAF). I understand the benefits that make TAF preferred over (e.g.) TDF and Entecavir.  
I respect my hep doctor VERY much (though I was surprised when dr. and associate dr. ask me for reason why I take Milk Thistle, Vitamins D & E, Turmeric, Selenium).

MY CONCERNS:
-- Dr. says I would have to take anti-viral drug for life
-- I realize all drugs come w/ warnings & risk of side effects. Primarily for me are the Vemlidy/TAF side effects I've read re: weight gain around waist & back; increased bad cholesterol (up as much as 22%) noted for some; increased triglycerides for some; cough. If I start taking TAF, I don't want to have to start to take other drugs to address raised cholesterol/triglycerides levels, & it's not good for me to gain more weight.
-- I read documentation that states risk of some known TAF side effects are greater for women, and for those that are obese.  
-- Perhaps least concern when one is considering health, but cost in US is $1,200 for 30 tablets. There is no news yet as to when less expensive Vemildy generic will be available.
-- Various available documentation indicates that for HBeAg Negative patients, treatment should be started if ALT>2x Upper Level of Normal (ULN) *and* HBV DNA Viral load > 20,000. (My dr. has said ALT criteria of > 2xULN is too high.)
I know that by not starting treatment, my liver may (or perhaps may not) be "rusting" even though it is not apparent -- but I keep hoping that, having lived w/ this for 60 yrs, maybe it's safe to wait few more yrs until drug that cures HepB (like Harvoni/Slovadi for HepC) is finally available.

[StephenCastlecrag]

Thank you for your interesting data. I am not a doctor. I want to provide some comments.
1. Medhelp software will delete any text in between angled brackets ">", " 2 x ULN is in all the guidelines.
3. If TAF is too expensive, TDF(Viread) or Entecavir are viable alternatives and their side effects are well tolerated.
4. It is not true that you have to take antiviral for life. It is true that you may have to take it for long time, but it is possible to stop for some, and a cure may come along in the future.

At age 60 and with a high viral load (> 2,000 iu/ml), I would generally agree with your doctor to start treatment. However, you have very persistent normal ALT, so I am not sure your liver has been damaged by HBV. In this situation, a Fibroscan is suggested to try to ascertain the state of your liver, but because you are overweight, you must use the XL probe. You may also like to check your APRI, Fib-4, and palelette count to help with the Fibroscan.

But most important of all, you have Genotype A. Patients with this genotype are most likely to be cured by Interferon treatments.

You may like to consult a HBV liver specialist to get a second opinion regarding treatment.

[StephenCastlecrag]

As you can see part of my text was also deleted. Sigh.
"1. Medhelp software will delete any text in between angled brackets ">, "......... 2 x ULN is in all the guidelines. "

1. Medhelp software will delete any text in between angled brackets ">", "the right angled bracket". Medhelp is aware of this problem but never bothered to fix.
2. The ULN of ALT for female is 19. The criterium of > 2 x ULN is in all the guide lines.

[Triestina]

For some reason, portions of Test Results and Concerns sections I pasted in orig above disappeared when I hit SUBMIT. I will try to post again here:

TEST RESULTS:
-- Cholesterol usually 2x Upper Level of Normal (ULN) *and* HBV DNA Viral load > 20,000. (My dr. has said ALT criteria of > 2xULN is too high.)
I know that by not starting treatment, my liver may (or perhaps may not) be "rusting" even though it is not apparent -- but I keep hoping that, having lived w/ this for 60 yrs, maybe it's safe to wait few more yrs until drug that cures HepB (like Harvoni/Slovadi for HepC) is finally available.