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Went to two hepatoligists, one says to start to treatment, the other to monitor?

Hi guys,

Need your help please to make a decision about if I should start treatment or not.

Some background: I'm soon 29 years old, chronic hbver with genotype D with triple mutations:
BCP Mutation: A1762A/T,G1764A
Precore: C1858T
and negative hbeag. Never been on any treatment.

Since I got diagnosed back in May 2015 year, these were my measurements:

ALT/AST always normal.

HBV DNA:
05.04.15 - 1311 ui/ml
08.05.15 - 865 ui/ml
11.05.15 - 1317 ui/ml
02.05.16 - 1316 ui/ml
05.06.16 - 1390 ui/ml
11.12.16 - 2498 ui/ml
03.21.17 - 2242 ui/ml

HBSAG quant
10.01.15 - 2217 ui/ml
08.30.16 - 312 ui/ml
12.16.16 - 2453 ui/ml
03.22.17 - 2233 ui/ml

Fibroscan:
06.18.15 - V (m/s) Median 1,13 (IQR 0,05). E (kPa) Median 3,8 (IQR 0,4 IQR/med 11%)
12.24.15 - V (m/s) Median 1,17 (IQR 0,07). E (kPa) Median 4,1 (IQR 0,5 IQR/med 12%)
05.05.16 - CAP (dB/m) Median 189 (IQR 37). E (kPa) Median 3.9 (IQR 0.4 IQR/med 10%)
01.06.17 - CAP (dB/m) Median 148 (IQR 33). E (kPa) Median 4.8 (IQR 0.9 IQR/med 19%)

My liver ultrasound I did few times in different locations didn't reveal any problem other than mild fatty liver only at one ultrasound location.

I've been seen in the past by 2 gastrologists and 1 hepatologists who said that I should just keep monitoring and no treatment is needed.
I've been seen by two hepatoligists last week, one is a famous hepatologist in the HBV community who surprisingly said I should start treatment because:

-I have this for almost 30 years (probably since childhood)
-I have 3 triple mutation it's very unlikely that I will seroconvert spontaneously
-one of the ultrasound locations noticed that I might have a mild fatty liver or something about the liver texture is off that might indicate that I'm F1 in fibrosis score
-my liver cancer risk is 10-20% (He also ordered some additional cancer bio markers blood work he wants to see (hcc panel) in addition to AFP which is in normal range).
-hbv treatment drugs are not toxic and can't harm (is that right?)
-it wouldn't be a life long treatment because a functional cure drug might be 5 years away, and we will be changing to different drugs through out the treatment phase and he will eventually make me lose surface antigen

I went for a second opinion to another hepatoligist the next day, and he basically said that what the first  hepatoligist is "********" and there is no point for me to start treatment because seroconversion rate is only 1-2% and that my test results don't really require treatment other than keep monitoring every 6 months, etc.

What do you think guys, which of the hepatoligists seem to be right given my test results? Where do I fall in the USA/European treatment guidelines? Could it be true that given I have a triple mutation the virus might give more "less radical test results", which makes it harder to know when to decide starting treatment?

Thanks!
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Avatar universal
the second hepatologist is right, you may use the new type of tenofovir, less toxic to kidneys and bones but this is unlikly to clear hbsag in less than a decade on it

anyway i d monitor right now and wait for replicor's drug to be available, your tests are good
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Thanks Stef. If I choose not to start treatment, but just to monitor, do you think there is a higher cancer risk for me given it's a triple mutation and that a mild fatty liver/F1 fibrosis have been "observed" (in just one ultrasound location, the others were fine)? The hepatologist that said to start treatment also said he's skeptikal that replicor is a serious drug candidate lol... I'm starting to think he has some relation to the drug companies as to why he wants me to start treatment, he's also linked with quest diagnostics and was a consultant for Arrowhead which turned out to be a failed drug. I made a long way to see him, kinda disappointing to think he might be $$$ driven and not give actual rational advise on why to start treatment.
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