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Hep B or something else?
Mar 27, 2005

Dear Dr. McGovern, This is my 3rd try. Please do address my question.

My husband has been Hep B carrier for many years - 15/20 yrs. 2 years ago his blood tests were normal except for the positive surface antigen. But this past december the ALT was elevated (61 on a scale of 2-60 u/l) and AST was normal. He went to his PCP who ordered somes tests and referred him to a GI specialist who ordered them again after a month. In both, the ALT was around the same, AST normal, the Hebp core and surface antigen were both positive, ANA screen was positive, Anti-nuclear Ab titer was 1:160 (normal was <1:40), ANA pattern speckled Hep B viral DNA < 100 (normal <100), <160 (normal <160 copies/ml). The AFP was negative/normal. His HAV ab Total and Igm and HCV ab were non-reactive. He is a vegetarian and non-drinker, non-smoker. He has taken painkillers often but not tylenol, mostly advil or motrin. Does not take any other medications / vitamins (except ensure)

What could such results mean? What would the next step be?

Thanks!

Response from Dr. McGovern

1. His hepatitis B profile is consistent with a chronic hepatitis B carrier. However, without a hepatitis B e antigen, E antibody, and HBV DNA viral load, I don't know if he is an inactive or active chronic carrier. 2. His ANA is suggestive also of autoimmune disease. This will need further follow-up by the hepatologist. 3. His liver enzymes are reassuring but will require further monitoring. If they change and become much more elevated, he may need a biopsy. 4. His lack of alcohol intake is a very good thing.

Dr. McGovern



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