Should I start medication for HBV with these test results?

[hepbsucks]

I am a chronic carrier of Hep B and 36 of age and male.  I believe my mother told me that I had it at a very young age.  She believe it was transmitted via a needle in the late 80's or 90's in a hospital in China as no one in my immediate family has it.  I never paid it any mind until recently when my doberman died of liver disease.  That really shook me and I was in a state of depression and made me think about my own condition.

I went to a liver specialist and had blood work, fibrosis scan, and abdominal scan done.
Fibrosis - normal no scarring found.
Ultrasound - Liver normal.
Hep BeAg negative
Hep BeAb positive
Viral load 2300 iu/ML

My ALT is slightly elevated at 44
My AST is at 22.

The liver specialist told me that there is no definite need to start on medication and continue to monitor my status every 6 months.  Medication will start if my ALT increased to 70+
Another option is that she could start me on medication if I wish and told me about the side effects and that it could be a lifelong commitment.

I honestly do not know what to do at the moment.  What are your thoughts?

[adhbv]

If possible, you should have hbsag quatitative (in IU/mL) that will tell you weather you are inactive or active hepatitis B.

[hepbsucks]

I don't think they test that in the US.

[living_with_hepb]

We have HBsAG quant available now in US. I got mine tested at Quest Diagnostics. It’s not a test that very useful but monitoring hbsag over time might add some color to your overall hep b activity.

[adhbv]

If your hbsag < 1000IU/mL, it is considered that you are inactive carrier of hbv.

[living_with_hepb]

I would suggest monitor your viral load. With HBV DNA at 2300 IU, you are a "borderline" case between inactive and active hepatitis B especially since your ALT is slightly elevation which could suggest mild hepatitis activity. But then ALT can also rise due to other factors other than hepatitis B. Strenuous exercise, chest workouts and binge alcohol drinking can trigger ALT to go up. If I was you, I would wait another 3-4 months before repeating HBV DNA Viral Load test and ALT. If your viral load is > 2000 IU/L and if ALT is still over 30, I would ask the doctor to start treatment. If your DNA is on the decline naturally and ALT is also close to 30, then you are in true inactive state.

[hepbsucks]

I am on Atrovastatin for high cholesterol for 3 weeks.  I read that statin medications can increase ALT level but I don't know whether it's just a temporary increase or if it will gradually decrease ALT after a while.

[hepbsucks]

Also, I go to the gym and left quite a bit but I've stopped going in sometime around late May due to take care of my sick dog.  The test I took was early July so it's been 2 months between the time I last worked out and the blood test.  That wouldn't impact my result, would it?

[living_with_hepb]

If you didn’t workout in 6-7 days before the blood test, alt increase isn’t because of hepatitis. I once got a reading of 120 IU but I had worked out 2 days before the test. Repeated the test after a week and it was normal.

44 IU isn’t really considered high as such but with hepatitis b present and with DNA > 2000 IU, some doctors may want to repeat the tests in 3-4 months to see your condition. 2300 IU isn’t high enough to start treatment right away. Some people can have DNA in range of < 20,000 IU and still have normal liver function.

Don’t worry about slight elevations. What matters is that fibrosis is abscent, ultrasound is normal so more than likely, you are an inactive carrier. Just repeat tests in few months and hopefully your numbes will be stable. Goodluck!

[living_with_hepb]

Typo above: If you didn’t workout in 6-7 days before the blood test, AlT increase isn’t due to Workout*.

[hepbsucks]

Thanks.  

I've talked with my mom and she voiced her concerns to my aunt who is in China who happens to work in a Chinese hospital.  We got in contact with a doctor who specializes in Chinese traditional medicine and liver disease.  Apparently my condition is extremely common there.  He's going to prescribe me some traditional Chinese medication in pill form to help lower my virus count and ALT level and have them sent to me in the US.  I think I will take that for about 3 months and go get tested again to see where I will be at.  Basically he said my condition is not a huge deal and I have to watch my diet carefully.  Having to take something for life actually scares me.