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Please Doctor ! I need your opinion..Please
Jun 17, 2007

First I would like to thank you for your great efforts and time for helping us.

I was first diagnosed with Hep B on 1996 ( E AG neg / E AB positive ) with negative DNA and all the other liver related tests were normal . It remained the same till March 2005 , then the DNA count was 50000 c/ml with normal blood tests , anzems and U/S. I used Lamuvidine 100mg tablets one per day then I have been tested after one month and the result was undetectable and still upto date . Please give me your opinion for the followings questions :-

1- How I confirmed that I am precore mutant type with this low count of viruses in the blood and normal LFT and may be I have seroconversioned before I was diagnosed on 1996?? . the reason I am asking is that the doctor is saying that with the precore mutant my treatment period is un noun although my hep b is now un detectable for more than two years.

2- Also I was diagnosed with latent TB and the doctor said that my skin test reading was at low risc ( more than 15mm ) but he is not sure that if I can treat it with HEP B for the reason of the liver although he is sure that my liver is fine . It is latent TB but what about if it is activate one day and I have to use it ??? now my age is 47 and fine liver but what about the future ??? please give me your opinion on this matter too.

3-Finally what is the benefit from using the Lamuvidine when the virus count is undetectable for more than two years?

Thank you so much for for your kindness

Response from Dr. McGovern

1. I agree with your doctor that the period of treatment for HBeAg negative infection is unknown. However, since you suppressed so quickly, which is unusual, I would consider stopping and monitoring quarterly HBV DNA tests. You can restart lamivudine if you need to. This strategy would not lead to resistance since you have had no detectable virus while on treatment.

2. I suspect that TB therapy in you will not be problematic since you probably have mild disease, based on the fact that you were not viremic all your life and have had normal liver function tests. These two facts, do not prove mild disease, but do suggest it.

3. The benefit would be to continue restoring your liver health. However, if your immune system can keep the virus suppressed, there would be no extra benefit to treatment.



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