Please i need some suggestion

[chrisabdur]

This is my Brothers HBV REPORTS
HBV DNA QUANTITATIVE IS 85700 iu/ml
HBE AG NEGATIVE
ANTI HBE AG POSITIVE
IgM ANTI HBC REACTIVE(>3)
ALT/AST 33/19
US ABD NORMAL
MY GASTROENTEROLOGIST PRESCRIBED BARACLUDE 0.5mg.
What do you think people? Does it really works on viral load despite of Hbe ag negative? Need your suggestions? Espevially STEFF. Really appreciated.

[jrai2014]

I think we are missing the most important test HBsAG in QUANTITATIVE.

[chrisabdur]

No i didnt do the test again . This is the latest what we have now. So u recon me that to wait for one more month than i go for hbv dna test again?

[luckyman316]

Has your brother's viral load increased between tests? If so, then the infection has more than likely become active and this would be the reason for treatment. When mine first went active, my GI doctor wanted to wait. My low viral loads started to increase drastically into the millions. If it's inactive, then treatment with Baraclude is really not necessary. However, as suggested, interferon could potentially clear up the inactive case --- be warned, interferon does not always work. Certain Genotypes do not react well to it and do not clear it up. Plus, the side affects are horrible.

[chrisabdur]

It was tested just one week back  before that we never know that we had this disease. Ok we will go for second opinion.

[Aduiski]

Was your brother measuring HBV DNA and ALT previously as well. And if yes how long ago was that.

Let him take his medical papers to at least one more liver specialist for consultation about the possibility and choice of treatment

[chrisabdur]

Thanks u Andrey19 & Aduiski for your prompt and valuable response. He is 26 years old, always fit and healthy. Mine too a chronic inactive carrier came to know recently. I assuume that he was infected through me. But i dont understand how it was spread. Moreover i am a medical stuudent, so i might have  some exposure during my internship. But i never has any signs and symptoms of this disease. Ofcourse i know that it is a silent infection. I screened all my family members immediately as soon as i knew that i am infected, fortunately everybody tested negative except my brother. I gave the first dose of vaccine to everyone. Regarding Pegasys it will come in to our budget as u know it way too much cost in India. So i cant understand this treatment why he prescribed Entacavir? I am really worrying about this. So is it better to moniter for another 3 months without theraphy despite of high HBV DNA LEVELS? Does Entecavir really need to take  life long? I am really worrying about my bro. Whats the next best approach here? Wait or go for Rx?

[andrey19]

You can also try interferon instead of NUCs and try to get your hep b under permanent immune control. Interferon works even on high  qhbsag solely depending on your immune response, you never know unless you try!

See this http://www.aphc.info/pdf/2014/Luncheons_13012014/S-251/Jorg_PETERSEN.pdf

from 7th Paris Hepatitis Conference / Interferon or Analogues? There is good sample of qHbsag kinetics

[Aduiski]

Also, NUC long term possible negative consequences on HEP B are not yet known, as first people have started to take Entecavir for hep B in 2005/06 I think....

[Aduiski]

Please note that Entecavir is a NUC, so there will be a likely a life-time commitment of regular taking the pills, as opposed to interferon which is frequently preferred for the younger patients without more significant liver desease.
Breaking taking NUC has consequences of possible virus mutations...

My understanding of some of the guidelines is that your bro might not even need a therapy at this point...but would rather had to be monotired closely for ALT values and viral load (every 3 months).

However, this is just my small contribution...on your place I would double check with another liver specialist and get his opinion as well before committing to the choice of the therapy ...just to be sure he is taking the right life-important decision....

Do you have results of his prevoius tests....?
I would recommend he does Fibroscan if he didn't do it....

[Aduiski]

Baraclude = Entecavir

Yes it works on HBEAG -, with following stats:

After 1 year of Entecavir: 88–90% of people will have undetectable viral load
After 2 year of Entecavir: 95% of people will have undetectable viral load
After 3 years this percentace increases to 96-98%.

So your bro shall be just fine in the next couple of years especially as he has relatively good ALT and his US is good.

How old is he, and did he do Fibroscan?

Do you know why did the doc decide to do Entecavir and not Interferon?

Don't spend much time on reading posts here. Instead I recommend you read official guidelines according to which specialist doctors make their decisions. The most recognized recent ones are:

1. http://www.easl.eu/_clinical-practice-guideline
On this link you will find guidelines for both Hep B and Hep C

2. Asian-Pacific consensus statement on the management of chronic
hepatitis B: a 2012 update