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Treat or dont treat yet
Nov 11, 2007

My age is 47 and I am male. I am not physically ill or experiencing any symptoms(I think). I was diagnosed with acute hepb about 2 years ago in december. The following 12/2006 I went for a physical and my primary doctor said my ALT was still elevated(about 45). He referred me to a gastroenterologist.I was sent thru another round of diagnostics the quant test showed 57000 IU/mL and 132,000 copies IU/mL; the AST,ALT and ALP were normal. He scheduled to retest in 3 months. 3/2007 the DNA Quant showed 4,070000 copies and the ALT was 49, ALP and AST were normal. The Dr. wanted to put me on Hepsera. I was not comfortable with it since I read it is a lifetime treatment and there is a Kidney problem as potential side-effects. I went to another Dr. in the same practice because my primary DR. said his practice only deal with that group. The new guy looked at all the tests in my file and told me we can do Interferon or go with pills - but he want me to decide and come back in 3 months. He said my virus count was low and we have time. In three months he did not ask for my opinion anymore he just told me we are doing Interferon. He want me to go for Biopsy. I read the side effects of inteferon and they are pretty serious including suicidal tendencies. I am the main bread-winner for my family(bring home 80% of our income). In both of these situations I am uncomfortable both by their approach and the potential of I may not be making the best decision. I went to my primary for annual physical last week and AST,ALP are still normal ALT is 47 and the quant shows 274,000 IU/mL. He noticed my Calcium is 11.9(high) and he want to send me to a Dr. for consultation on removing my Thyroid(diagnosis hyperthyroidism). I am so confused that I dont know what to do. Please help!

Response from Dr. McGovern

You have had your hepatitis B for a relatively short time so I would not expect a lot of scarring unless there are other concerns as well including alcohol use. However, I still think it is prudent to get a liver biopsy to determine how much disease there is. The AASLD guidelines usually recommend a biopsy in patients with virus but who have normal liver function tests. This is a grey area so it is helpful to have some hard data.

If you have moderate disease, I would treat you. I can't say with what because I do not know your e antigen status nor do I know your genotype. Patients with genotype A do very well with interferon. I would probably use an oral agent for other genotypes. The latest data from the liver meetings also suggest that tenofovir is an effective agent in addition to all the other medications.



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