Big thanks to Stephen, Aduiski, Varsa for helping. Last one month had been very tensed time as all of a sudden ALT had shoot up to 1000. Met my doctor on 7th of Mrach. As per him, he sees 1 in 100 such cases. Finally, he started medicines. I have been asked to take both tenofovir and entacavir. Have been taking medicine from last 1 month and went through all tests last week. Here are results:
March 07,2017
ALT : 1067
AST : 451
HBV DNA : 1.02* 10^7 IU/ML
HBSaG Quant : 7189 IU/ml
Fibroscan : 7.9
Liver Biopsy : HAI-5 , Fibrosis 2-3
Medicine started on 8th Mar 2017 : Tenofovir+Entacavir along with Vitamin D & Calcium sachet+tablets
Also, was asked to get tested for Hep A,D,E and HIV I & II. Everything was tested negative.
March 15, 2017:
ALT : 1352
AST : 449
March 22, 2017:
ALT : 144
AST : 525
March 29, 2017:
ALT : 77
AST : 276
April 5, 2017:
ALT : 54
AST : 179
April 8, 2017:
ALT : 51
AST : 105
Fibroscan : 8.7
HBV DNA : 3*10^3 IU/ML
HBSAG Quant : 5965 IU/ML
Doctor has asked to continue with same medicine. Any comments if anyone has over numbers. Also
1. Why both medicines together? Is it to bring down HBV DNA rapidly?
2. Even though I had flare or reactivation, dont know what to call, HBV DNA has shoot up but HBSAG quantity has kept falling from last 1 year. Why this abnormal behavior?
As per another doctor of mine whom I am referring as local doctor, he said these are unique cases of flare where there are extreme chances of body clearing virus but if ALT keeps going up, could result in liver failure. Initially, he was of the opinion to wait for 2 weeks but after ALT shoot up furher from 400 to 1000, he was also of the opinion to start medicine.
Hope, medicine will keep working going forward. Thanks all once again for helping and supporting
Time to start taking the medicine.
Your history is rather different to the typical ones that we normally see. As I am not a doctor, I can only give you my opinions. It seems you are under the care of very good doctors, so please continue to consult your doctors.
Reading your history, it seems to you became HBeAg negative, with very low(undetectable) hbvdna, but elevated ALT (Feb 2015). With undetectable hbvdna, ALT should be normal, but then it might be high due to fatty. Since then, your hbvdna had been going up, but ALT varied. Your latest results reported very high hbvdna, elevated ALT. Your HBsAg is also high. So I am guessing two possibilities:
1. You have reverted back to HBeAg positive, and is in the Immune clearance phase again. You need to ask your doctor about your HBeAg status. If it is now positive again, you may afford to wait several months to see if hbvdna and ALT come down, and HBeAg becomes negative again.
2. If your HBeAg is still negative, it is likely that you have developed HBeAg negative chronic Hepatitis B due to mutation of the HBV (precore). In this case, you will need to start treatment, as it is unlikely to resolve by itself, your ALT and hbvdna will remain high, and over time, disease(fibrosis) will progress.
Generally, Fibroscan score is increased if your ALT is very high. Anyway your biospy will give you a better picture.
Just my opinions. Keep us informed.
I think you need to start medicine now.wait for liver biopsy and consult dr sarin he is best dr in this India for hbv
Hi All,
I had following tests in last 5 months. Things ve taken a U turn n I am clueless. Will be meeting doctor today.p posting my recent reports below . Please guide if anyone has come across this situation :
Date HBSAG HBVDNA Fibroscan ALT AST
30-03-2016 13,186 IU/ml 102000 IU/ml 4.8 kpa. 49. 24
After this I did monthly ALT and AST and it came in normal range and no medicine was prescribed . Next full cycle of test done in nov 2016
16-11-2016. 10,230 iu/ml. 24000 iu /ml 5.6 kpa 32 20
Till this, it was all ok.However, on 15 Feb 2017,my ALT n AST shoot up to 81 and 41 respectively.Another test done on 26th Feb 2017, ALT and AST done were 860 and 468 respectively.
Seeing such spike, I rushed to ILBS,Delhi.This is current status as on 3rd MArch 2017
HBSAG : 7538 iu/ml
HBVDNA : 1.07×10^7 iu/ml
Fibroscan : 7.9 kpa
ALT : 807
AST : 344
Liver biopsy report is yet to come.
Really worried due to so much spike in ALT,AST,HBV DNA n deterioration in fibriscan report within 3 months. Any idea what does this mean ? Will be meeting doctor in a day.
Stef, aduski, ram , brij please help
Hi ,
Hope you are doing good. I had met Dr. Sarin (best in India as per community). He had asked to keep a close watch on ALT/AST monthly and meet again after 3 months. He said I might need to undergo biopsy.
Here are my numbers for last 3 months:
Jan 2016 :
HBV DNA - PCR Quantitative Viral Load (COBAS Taqman) : 9,716 IU/mL
30 March, 2016 :
Liver Stiffness Value : 4.8 kPa (success rate 100%, IQR 0,5 and IQR/med 10%)
CAP : 228 dB/m , iqr : 27
HBV DNA - PCR Quantitative Viral Load (COBAS Taqman) : 102000 IU/mL
HBSaG Quantitative : 13186 IU/ml (method, by chemilumiscience)
HBeAg : 0.31 IU/ml, Nonreactive
AntiHbe : .01 IU/ml , Reactive
ALT (P5P,IFCC) : 49 IU/L [Range : 10-50]
AST (P5P,IFCC) : 24 IU/L [Range : 5-37]
May 2016:
ALT (P5P,IFCC) : 35 IU/L [Range : 10-50]
AST (P5P,IFCC) : 22 IU/L [Range : 5-37]
June 2016:
ALT (P5P,IFCC) : 32 IU/L [Range : 10-50]
AST (P5P,IFCC) : 25 IU/L [Range : 5-37]
Fibroscan result was ok and ALT AST was marginally high for a month out of last 6 months and then has been within range. Have you seen similar cases where HBV count was high but other things in control? Should I start medicine? My Doctors have kept me on monitoring. Will be meeting Dr. Sarin again this month. Also, does undergoing biopsy helps when Fibroscan is there? In my case two fibroscans have relatively higher difference
Oral medicines, Tenofovir or Entecavir, in most cases don't have any major side effects except for maybe first few weeks. However, Pegasys interferon does have side effects for many of the patients.
You can choose to go for Tenofovir or Entecavir, most doctors recommend them anyways...they shall not have any impact on your work.
I am from Bangalore, currently in US.My height is 5' 6". My weight is 83 KGs. I need to reduce my weight..Trying to reduce it to 75 in next 6 months.
Ram, your profile shows you are from Bangalore .are you from Bangalore or Hyderabad ? I am from Bangalore .was trying to be particular on food as I see many flowing strict food regime here but not able to find matching diet replacements based on Indian diet system . I have excluded drinks, fatty milk products , sugar, processed food and fried food permanently and take lot of fruits n green vegetables now .
Thanks Aduiski, Thanks Ram. My height is 5 feet 7 inch. I used to be 72-73kgs 6 months back but now 65 kgs. Now, my bmi is also good at 23.still, if I go with latest fibroscan , fatty lever measurement is 228. So, I need to manage diet in a better way. I do some exercise everyday (15 min yoga plus either 3 km walk or 15-20 min jog plus basic body exercise without any weight lifting ).further, I don't have any fat on body as such, so, I believe , that can not be reason for fibroscan difference . let's see what doctor says. Thanks a lot for guidance .
I work in software field. I work on an average of 11-12 hours per day. I sleep around 6 hours per day. I do t think this disease stops you from working hard. I am not sure how it will be after u start taking medicines.
Hi,
Instead of worrying all these HBV related parameters, I would suggest you to loose your weight for few KGs so that your BMI tells you that you are not overweight.
I remember one of the famous doctors in Asian institute of Gastro Hyderabad told me that if I am fat, he wouldn't suggest me Fibroscan because the abnormal result in the Fibroscan might be because of Fatty liver. So, until ur weight is normal, I wouldn't worry about Fibroscan reading as it might not reflect liver status because of HBV.
I have some answers for few of your questions.
For lab results and all you can do them in your local city, Hyderabad IIG also has Fibroscan, you can do it from there. If you find any abnormal results then only u can visit famous doctors, otherwise I wouldn't suggest to go for Hyderabad or Delhi for each visit. Any lived specialist can guide you.
Regarding your dieting, as long as you don't drink alcohol and will not eat lot of junk foods you are good. You can check my old post what I am taking every day like Vit D3 supplements, lemon juice, black seed, Brazil nuts...Don't be too much specific about the food you eat. Normal food should be fine.
Variation of ALT and DNA levels such as yours is a frequent thing for Hep B carriers...you should monitor them more often now as at the moment both ALT and DNA are increased (ALT > 30/40 is considered high, DNA > 2000 is considered high)
If your ALT persist > 40 and DNA > few thousands...then you might be advised to start with TDF/ETV.
It doesn't look like you have F2 fibrosis...it is most likely an F0 or F1, with somewhat fatty liver....so very good news there.
You'll need to modify your diet and do regular exercise.