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Increased HBV DNA and E Antigen -ive
Feb 4, 2006

Dear Dr. McGovern,

I have sent this email before but no reply. I understand that you are very busy and would not want to waste your time. But I would very much appreciate a response as this is bothering me. I have withdrawn from those around me and feel that I am very infectious.

Now my history: 1993 diagnosed with chronic Hep B. Interfron A for 4 months. Then Famciclovir first 250 mg then increased to 500 mg both in 1995-1996.

Test Results 1996:

HB S Antigen +ive HB E Antigen +ive HB E Antibody -ive HBV DNA 25.3 pg/ml AST 32, ALT 42

Had biopsy in 1998, diagnosis: chronic Hep B with minimal interface and lobular activity and had achieved E Antigen seroconversion. Unfortunately I have lost the full results.

Had a full set of blood tests done in Feb 2005. Results:

HBV DNA PCR 596 IU/ML HBV DNA PCR 1070 copies/ml

HBS Antigen +ive HB Core AB +ive HB E Antigen -ive HB E Antibody +ive AST 24, ALT 29

The last blood tests I have had were in Jan 2006 with the following results:

HBV DNA PCR 2950 IU/ml HBV DNA PCR 5960 copies/ml

HBS Antigen +ive HB Core AB +ive HB E Antigen -ive HB E Antibody +ive

Did not perform AST and ALT tests.

Now to the quesions:

1)Why has the DNA count increased over the past year, if I am in the inactive non-replicative stage?

2)Could it be due to the fact that I am from the caspian sea region and my age (31) I have developed the precore mutant strand of the virus and the virus has infact reactivated?

(3) Is it Ok to start treatment with Hepsera?

(4) How infectious am I?

I would very much appreciate your comments on this matter as for the first time in the past 12 years, this disease is weighing heavily on my mind. Thank you so much.

Kindest Regards.

Response from Dr. McGovern

I am sorry if you never got a reply before. I have never seen this question that I can recall.

Yes you are absolutely right. You probably have a pre-core mutant and I would call your infection "Hepatitis B e antigen negative infection".

This type of infection usually requires long term treatment. It may be reasonable to get a liver biopsy first to determine the amount of disease you have before you decide on definitely taking treatment. I would opt to do this first before making any decisions about therapy.

Do I have to worry about monitoring my self for HCC(AFP Ultrasound)?
Only 23 years old!!

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