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!