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Please Help: Cirrhosis and Hep B
Nov 22, 2004

Hi Dr.Dieterich,

I have a few questions regarding my diagnosis for Cirrhosis. When I first found out I have cirrhosis in July of this year we thought it was from Hep B but later a couple of doctors said they thought it was NASH. Well my doctor just told me last week he doesnt think it is NASH because of the damage done to my liver and how young I am (33 yrs old) also one of my Hep B tests always comes out a bit strange even though my HBV DNA Quant by PCR comes out undectatable. Let me give you my Hep B tests results and can you please let me know what you think. Hep B surface AG-Negative Hep B surface AB-Neg <1 Hep B core AB total-Positive Hep B core AB IGM-Positive Hep Be AG-Negative Hep BE AB-positive

My doctor said it looks like acute Hep B but is perplexed because the HBV DNA by PCR comes out undectatable (both times I had it done came out undectatable) I just had my LFTs done and all my liver functions are still normal...the only test that came out high was my AST 51. My ALT went back to normal and I know that can be either good news or bad. Good news if some of the imflammation is going down or it can mean (I have read) that my liver is so damaged already. My doctor said my looking at my biopsy report my liver looks in bad shape but I still feel good and have no symptoms as of yet (exept feeling run down sometimes). My ultrasound shows fatty liver, enlarged, with boderline splenomegaly. It also said that my liver looked smooth which is funny considering its full of bumps and scarring. I had an endoscopy done and thank God have no varcies. I feel very lost sometimes. I wish I knew what was really going on and why I have this. I know if its Hep I can take meds to help. If NASH all I can do is lose weight(i have lost about 30 pounds). So if there is any info. you can give me it would help me so much. I am scared because I am a single mom with 2 daughters (15 and 4) and hope to be around for many more years to come but also I know how devastating this disease is. Trying to keep a positive attitude. Thanks for your time.

Sincerely, MG

Response from Dr. Dieterich

This is a tough one. It sounds like you did have a biopsy. You can ask your MD to have the biopsy stained for HBV DNA. If it is positive, then there is your answer. Now the NASH issue is much more common and serious than most people think. Losing weight is a great thing. Keep going there. You need to have someone monitor your fasting insulin level and if high, then you need to take some medication that will lower it. (There are three). You also need to be on a low carb diet to help lower the insulin. Why not treat both diseases? Keep up the good work! Stable and improving cirrhosis should be OK if you are staying on top of it. DTD

Effectiveness of Antivirals in immuno-tolerant phase of chronic hepatitis B
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