My current Hep B status and related questions

[heal_123]

Feb - 2015
HbsAg : +ve
HBV DNA : Undetected (Method: [HBV DNA - PCR (Quantitative)- Viral Load ] - COBAS TaqMan (Viral Load))
ALT : 72 (Method : UV with P5P, Range : 30-65 U/L)
AST : 36 (Method : UV with P5P, Range : 15-37 U/L)

Also, my cholesterol and lot of other things were out of range as I was little on fatter side

At this time, the doctor who is a gastro+hepatologist told me that I do not need to worry, I may be an inactive carrier and suggested me just to get my ALT/AST checked every 6 months to 1 year.

At that time, I did not realize, this is such a serious issue and continued with same life style with lot of stressful work and generic food (not very bad but not good also) along with drinks 2-3 times a month. However, to control my piles issue, from oct 2015-feb 2015, I avoided any oily, processed food, drinks and took fibre fruits and vegetables

This year when I went for annual check up, my ALT/AST/cholestrol , everything was under control

Date 26 Feb 2016:

ALT : 33  U/L (Method UV Kinetic, IFCC , Range <40 U/L)
AST : 22 U/L (Method UV without P5P, Range : < 40 U/L)
Cholesterol and all under good range

However, I decided to go for a HBV DNA (though not suggested by doctor) and was shocked that it was detected

Date 28 Feb 2016:
HBV DNA - PCR Quantitative Viral Load (COBAS Taqman) : 9,716 IU/mL
Analytical sensitivity - 3.8 IU/mL
1 IU/mL = 6 copies/mL
HBeAg : 0.429 S/CO ( Non-reactive <1.0)
Anti HBeAg Antibody : 0.01 (Positive <0.4)

The doctor suggested me to go for a fibroscan. The readings from 1st center where I did fibroscan was:

Liver Stiffness Value : 7.7 kPa (success rate 100%, IQR 0,3 and IQR/med 4%)
CAP : 267 dB/m
Interpretation : Metavir stage F2 (Significant Fibrosis)

However, doctor suggested that average value is 5.8 +/- 1.5, so I am marginally higher but my ALT/AST is normal , so, he would monitor me every 2 months.

While browsing on net, I came to this forum and thanks from heart to steff, aduski, ram and all to spread the knowledge and guide everyone. Based on forum, I decided to go to ILBS Delhi and get checked with Mr. Sarin. I was written another round of tests including fibroscan. The results for fibroscan are very different

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

HBSaG Quantitative : 13186 IU/ml (method, by chemilumiscience)
HBeAg : 0.31 IU/ml, Nonreactive
AntiHbe : .01 IU/ml , Reactive

Another LFT done on 26th march, 2016 (Did as anothr doctor suggested he wanted to check at monthly level in case there are fluctuations):
ALT (P5P,IFCC) : 49 IU/L [Range : 10-50]
AST (P5P,IFCC) : 24 IU/L [Range :  5-37]


I am yet to get my HBV DNA count and genotype report along with latest LFT report from ILBS

I will be meeting Dr. Sarin next week again but I am confused over so much variation in fibroscan.

1. Do you guys have any thing to suggest over so much difference in Firoscan ? Can not eating for 10 hours before fibroscan lead to such difference?

2. Is HBV DNA from undetected to 9000+ in a year common?

3. People who are getting treated in ILBS, Delhi and not resident of Delhi, How are you managing your regular follow-ups ? Coming to delhi is must or there are alternate options? This becomes more important because if the reports are from same institute , it sounds more authentic as I see lot of difference in Fibroscan report and confused, what to trust


On food, I have developed a basic understanding in terms of what to take and what to avoid but still doubtful about some of the Indian food items (people from India like Ram, Jata can help ):

1. I read that even wholegrain wheat has something called gluten and should be avoided. In India, our basic energy diet is roti/chapati and rice. I am taking wholegrain (ITC Ashirvad flour) Roti and have shifted to brown rice. Is it ok to continue or should I completely switch from roti and brown rice to something else. If so, In Indian food market, what are the alternate options?

2. Is it ok to take sprouted grams (channa) as snacks in evening?

3. Is it ok to take pulses( daal) in lunch along with brown rice?

4. Is one cup a day, soya milk with minimum fat ok as I take this along with wholegrain oats?

5. Is it ok to cook vegetable in virgin olive oil (minimal) with little bit of turmeric, very less salt and cummins seed?

6. Any good suggestion for carbohydrates and cereals from Indian diet context as to reduce my weight and BMI i have lost 6-7 kgs weight and feel little weak in case I am sitting for a long time and then get up

7. In case I have to go on medicines, will it affect my professional life ? I mean, personally, I have decided not to travel on business trips for more than 2-3 days but will the medicine stop me from working 8-9 hours diligently provided I give my body a relaxed 8 our sleep along with healthy diet and healthy life style including exercise?

I know, too many questions but I am sure you guys would help. This forum has not only given me important information but positive energy and strong motivation post few days of depression and I am in debt for the amazing help you guys are providing. Thanks

[StephenCastlecrag]

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.

[heal_123]

Many thanks Stephen for your reply. Was very worried for last 1 month. Medicine has started. I am positing below all the details for everyone's benefit. Thanks again for being kind and sorry for late reply

[heal_123]

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

[Aduiski]

Time to start taking the medicine.

[heal_123]

Thanks Aduiski. Yes, you were right.Medicine has started. As per doctor, this is not a generic scenario. I am providing all the details below for everyone's benefit

[varsa]

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

[heal_123]

Yes you were right. Thanks varsa. Medicine has started. Putting all the details below.

[heal_123]

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

[heal_123]

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

[Aduiski]

Based on your results my assumption is that you won't be YET given medication as your ALT in last two months is approaching normal levels for males which is bellow 30 (pay attention that normal ALT for males is bellow 30).

On your place I would continue with close monitoring of ALT and DNA (every 3 months) and if ALT persists to be higher then 30 and DNA higher then 2000/4000 IU/ml I would then start with the treatment.

Basically, if you are older then 30 and on your next measurement 3 months from now ALT > 35 and DNA > 4000 IU/ml I would not wait further and would start with treatment. (but if you are younger then 30 you might decide to wait little longer to see if results improve again in another 3 months after the next measurement).

[SKGNJ]

@Aduiski: If ALT &gt; 35 and and DNA &lt; 500 IU/ml and Fibroscan &gt; 8.7 then what would you advise ?

[Aduiski]

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.

[Ram1982]

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.

[heal_123]

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 .

[heal_123]

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 .

[Ram1982]

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.

[Ram1982]

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.

[Aduiski]

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.

[heal_123]

Hi Aduiski, thanks . one more thing. As I believe , you are on medicine . Does taking medicine has any impact on day to day office work performance due to side effects, provided I follow all the req. Instructions on food n life style ?