Do I need Hepatitis B treatment?

[Adi1984]

Hi All,

I am 33 year old male and new to the forum hence will start with Hello!!!!.. I need help/suggestions on the recent visit and discussion I had with my doctor on my test results and treatment he suggested.

I have been diagnosed with hep B in 2008 since then I have been keeping an eye on viral load and ALT.  Below are my recent test results:

1. HBsAg Screen: Positive

2. HBeAG: Negative

3. HBeAB: Positive

4. HBV Load: 3530 IU/mL (Log 3.548)

5. Liver Ultrasound: Normal

6. Liver Biopsy:  Grade 2 out of 4 Stage 1 out of 4

7. ALT (SGPT):  29 IU/L (Normal Range- 0-44)

8. AST (SGOT) : 21 IU/L (Normal Range 0-40)

After looking at the result my doctor is suggesting to start treatment by taking viread (tenofovir tablet 300 mg).

I am little concerned about starting the treatment as it is way costly. I am not sure if treatment is right choice at this moment. Kindly suggest if I shall look for second option before deciding on medication or shall I start the it.

Thanks in advance for all your help..

-Adi

[Liverpatient]

Hi, I'm not a doctor; just a patient, and here is my observation about your situation. From the info you posted, your liver is doing quite well, except your hbv dna is a little bit high. Since you're mentioning the cost of the tenofovir, I guess you will be paying for the medicine yourself; in that case it is advisable to seek for a second opinion as you said. If I were in your situation, and if I don't have some troubling symptoms that make my daily life difficult, then I think I would wait before starting any treatment, just keep monitoring every 6 months. Who knows, may be soon we may get some cure for this horrible disease. Let's all pray.
Actually, my hbv disease situation is quite similar to yours, though I'm much older, 45 years, but my alt is around 40. Currently I'm suffering from various muscle, and joint and nerve issues, that could be related to my chronic hepB, according to the docs and I'm pressing my doctors to give me the med.

[Liverpatient]

Thanks for the tips, I'm certainly going to try this one as well. I will report back if I see marked improvements.
Thanks again

[Adi1984]

Thank you so much guys for the suggestions.....

[Adi1984]

Update: I went for second opinion on starting antiviral treatment, Doctor monitored me for 9 months before deciding on treatment. My ALT, AST and rest of liver enzyme were within normal range except viral load went up. Below are the last 9 months results:

HBV Load: 3530 IU/mL (Nov-2017), 2,580 (Jan-2018), 4,800 (April-2018), 14,500 (June-2018).

ALT (SGPT):29 IU/L (Nov -2017), 35 (Jan-2018), 29 (May-2018), 42 (June-2018) - (Normal Range 0-44).

AST (SGOT) :21 IU/L (Nov-2017), 27 (Jan-2018), 23 (May-2018), 32 (June- 2018)- (Normal Range 0-40).

Looking at the viral load and slight increase in liver enzyme, Dr suggested to start antiviral treatment. I have started taking Enticavir .5 mg daily. Dr is afraid that I will have to live on the treatment for life. Hope medicine would not have any drug resistance. Hoping a brighter future in term of functional cure sad . Will keep tread updated on progress.

[edninojugan]

hi how are you doing with enticivir?

[Adi1984]

Hello All, I took the entecavir.5mg daily for 3 months . Oct 18 doctor checked my viral load. It was undetectable.  Liver enzymes were within range he suggested to continue the medication for now. I am due for another blood work will let you all know if it is still undetectable. Hoping for function cure.

[needadvicewithhep]

VERY RARE for resistance to ETV so don't even entertain that thought.
ALT AST normal range.

Just my opinion i'm not a doctor.  

I used to take NUCS I'm now functionally cured

I posted my experience on here read it  you never know what you might find useful :)

[Aduiski]

On your place I would not yet start taking medicine, but would test my HBV viral load and ALT/AST every 4 months. Based on the following 4-monthly tests I would make a decision on what to do.

[Adi1984]

Thank you so much guys for your help/suggestions. I am thinking to go for second opinion and see what other doc is suggesting. I do not want to take any long term risk too as my family may suffer if in case any big risk comes on my way.  VIREAD is bit costly but if other doc also suggest to go for it than i guess would not have any option.  my ALT and liver profile was always normal from 2008 hence  always wonder why Liver biopsy shows Grade 2 out of 4 and Stage 1 out of 4 . Am i in really bad stage? please suggest. Thanks again for your suggestions and help....

[Adi1984]

Thanks for the suggestion .. I am going to start this and see how it works for me. Thanks again

[StephenCastlecrag]

It seems you are in the Immune Control phase (HBeAg negative, viral load low, ALT normal). As commented by Liverpatient, your hbvdna is higher than the usual typical low hbvdna load of 2,000 iu/ml or lower. However, your ALT is normal, being below 30 iu/L. I am bit puzzled by your liver biopsy indicating a grade of inflammation of 2, which seems to be at odds with your normal ALT,  but more importantly, what is your Stage (of fibrosis)?

If your fibrosis stage is high (greater than F2), I may consider starting treatment, otherwise I would wait for at least another six months and test again.

Just my opinion, I am also not a doctor.

[StephenCastlecrag]

Oh, I just notice you are stage 1. I would wait.

[Bm2016]

i am not a dr, therefore unable give you a professional 2nd opinion. from my experience, my dr. waited and then treated me when my hbv dna viral started spike exponentially to millions around age 30.  the fact about this pill, it is costly as you described, has known side effect on bone density lost, cause kidney problem on certain individuals, but also, once started, it will be lifelong of taking this pill, there is a 2% chance of hbsag seroconversion/functional cured, stopping the pill required frequent bloodwork monitoring as there is extremely high chance of strong flare when the virus re-bounce.

[Adi1984]

Thank you so much for the inputs... appreciate your suggestions....