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Hepatitis B high ALKP
Mar 31, 2003

Thank you for the great job you are doing Doctor. I was diagnosed with Hepatitis B on December 30 2003 Lab Resulsts as follows: HBSAG Positive (428) ABSAB Negative HBEAG Negative HBEAB Posiive HBCAB Total Positive IGM HBCAB Negative HCB AB Negaive HIV 1/2 Negative LFT's all Normal AFP 1.28 Normal Abdominal Ultra Sound all normal no inflamation or legions

Tests done February 15ht 2003 HBSAG Positive (528) lft normal Alt slightly raised at 41

March 28th LFT Results All normal execpt AFT raised at 52 And ALKP Raised close to 2.5 times at 273

What does the increasing HBSAG titre increase from 428 to 528 with slow increase on Alt from initial of 37 to 41 to 52 and sudden jump over 40 days of ALKP from 78 to 273 imply. I was under the impression that my original panel indicated tha I am a low infective carrier (healthy carrier) and the virus is not acive does the increase in hbsag titre with the increases in alt and alkp indicate that this is an active virus and I am going through a flare or maybe a mutant. Should i be worried about Cirrhosis and HCC even though the abdominal Ultra Sound is normal and AFP is very low my AST and bilrubin direct and indirect have been consistently low. My doctor is recommending that I wait another 3 months and run the tests again, and maybe do a biopsy at the time to see if the core of the virus is active in the liver. Since I am working over seas I don't trust them to do a biopsy here, would an hbv dna by pcr do instead of a biopsy to see if the virus is active (I know it can't give me the staus of my liver like a biopsy can). Your advice in this matter is greatly appreciated.

Response from Dr. Dieterich

The most important test to do is HBVDNA to see if you have any circulating virus. If you do, then you need a liver biopsy! Most people who have had HBV will have your numbers, but with the e Ab if you have HBVDNA then you would be a precore mutant. Good luck! It sounds like your doctor knows what he/she is doing! DTD



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