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Treat or not treat?
Feb 21, 2005

Dear Dr. McGovern,

My mother is asian and is 69 years old, we don't know when she got infected with HBV but the blood tests are as follow:

HBsAG - positive

HBsAB - Negative

HBeAG - Negative

HBeAB - Postive

HBV DNA = 6034 copies/ML

ALT = 19

AST = 15

AFP = 2.0

Her doctor recommended yearly test since the HBV DNA level is still low. I am confused about the definition of the precore mutant and afraid that she is in that stage and she may have ongoing damages to the liver if not treated. Please give us some advice. Thank you very much

Response from Dr. McGovern

Your mother has chronic hepatitis B although has a virus which is a "precore mutant". This means that the virus does not produce eAg; however, we know the virus is actively replicating since it is present in her blood.

It is true that her viral levels are low. She has a much lower chance of responding to medications since she has a low ALT. Therapy is recommended only for those with persistent or intermittent elevations of ALT and substantial histologic abnormalities.

To be absolutely certain all is well, you may want to consider a liver biopsy, although monitoring with HBV DNA and ALT over time can also be reassuring (although does not absolutely rule out liver damage). If a biopsy is pursued and shows significant liver damage, then adefovir may be a good choice if her kidney function is normal. Dr. McGovern



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