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Hepatitis and HIV CoinfectionHepatitis and HIV Coinfection
           
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Chronic hep b
Feb 23, 2006

My husband had a transfusion as an infant. he was a "blue baby." His mother always told him he could not donate blood but never explained why. As a young adult he tried to give blood and recieved a letter that he was positive for hepatitis agn. He would not go to the doctor and follow up. He is an Rn and is now 44 years old. Three years ago his liver enzymes became elevated and the hospital required him to follow up. He has been diagnosed with Hepatitis B , chronic,active. He had been on Interfuron which significantly lowered his viral counts which were in the millions. It did not clear his disease. He was then put on Hepsera. His liver values worsened after 18 months on this drug but he did go from Hep Be Ag positive to negative. His Dna Quanttaion went back up to 1,740,000. He is now on Baraclude. He has been taking it for two months. How often should he have liver profiles and viral agn and Dna tests run. He has not had Ab tests run as a liver patient but has always been negative after a vaccination at the hospital for his job. Are we trying to obtain a HBsAg positive but a Hep Be AG negative with a negative DNA quantitaion. What do these tests mean? I know HbsAg refers to a surface agn on the virus? What is the HepBe agn? The Dna is just a quantitaion of the viral load but doesn't always agree with the amount of disease, correct? His albumin is at 2.5 and his total bilirubin is at 2.2. Alt -67 (o-55 normal) AST - 112 (0-40 normal) and his alkphos is 173(normal 25-150). After three years,we don't seem to be making any progress but he is still compensated and feels fine. I know we need to give Barclude time to see if it will work. Is it likely someone who has had the virus for so long will ever clear and if he doesn't what will lie ahead?

Response from Dr. McGovern

Baraclude (entecavir) is the most potent agent available on the market at present for hepatitis B. It lowers the viral load (HBV DNA) levels by about 7 logs after 48 weeks, which is excellent. It leads to E antigen seroconversion in about 20 percent of people after one year and 30 percent after two years.

E antigen seroconversion is an important event in someone with chronic hepatitis B. It signifies that the immune system is now controlling virus since this event is associated with viral load decline.

He may want to have a liver biopsy as well to see how much damage there is. He should also have monitoring of his alfa feto protein level on a regular basis with imaging of his liver.



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