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hepatitis B and Fatty liver
Jul 8, 2008

I'm a 38-year-old man. In 2006, I was diagnosed with Hepabitis B and Fatty liver. My test results were as follows:

01/2006 ------- HBsAg: Positive AST (SGOT): 39 reference [<40 U/L] ALT (SGPT): 68 reference [<60 U/L] AFP: 2.45 reference [<10 ng/mL] HBeAg: Negative HBeAb: Positive Hep B PCR Quant: <60 iu/ml (< 1.8 Log 10) reference: 60 to 38,000 iu/ml (1.8 to 4.6 Log 10)

Ultrasound(impression): Very dense and fatty liver without focal mass. Folded gallbladder versus small gallbladder polyp.

08/2006 ------- AST (SGOT): 19 reference [3-50 U/L] ALT (SGPT): 18 reference [3-60 U/L] AFP: 1.6 reference [<6.0 ng/mL] Hep B Viral DNA QT: <100 iu/ml reference: <100 iu/ml Hep B Viral DNA QT: <160 copies/ml reference: <160 iu/ml

Ultrasound(impression): Fatty liver without focal mass. Right liver lobe calcification. Gallbladder adenomyomatosis.

03/2007 ------- AST (SGOT): 20 reference [10-40 U/L] ALT (SGPT): 17 reference [9-60 U/L] AFP: 1.6 reference [<6.1 ng/mL] Hep B Viral DNA QT: 163 iu/ml reference: <100 iu/ml Hep B Viral DNA QT: 266 copies/ml reference: <160 iu/ml

08/2007 ------- HBeAg: Negative HBeAb: Positive Hep B PCR Quant: 110 iu/ml (2.0 Log 10) reference: 60 to 38,000 iu/ml (1.8 to 4.6 Log 10)

Ultrasound(impression): Diffusely coarse, echogenic, and heterogeneous liver echotexture most compatible with fatty infiltration or other causes of diffuse hepatocellular disease. No focal liver mass is identified. 3 mm gallbladder polyp without gallstones or biliary duct dilation.

05/2008 ------- AST (SGOT): 23 reference [<40 U/L] ALT (SGPT): 20 reference [<60 U/L] AFP: <2 reference [<10 ng/mL] Hep B PCR Quant: 3,400 iu/ml (3.5 Log 10) reference: 60 to 38,000 iu/ml (1.8 to 4.6 Log 10)

Please explain the HBV carrier status and give me advice on what I should do next. My primary doctor says there is no need for treatment yet.

Thank you.

Response from Dr. McGovern

I personally think you should consider a liver biopsy. Hepatitis B is NOT associated with fatty liver although hepatitis C is.

If you have evidence of high triglycerides, mild high blood pressure, high insulin levels or high cholesterol, you have some of the findings associated with metabolic syndrome. This is a collection of findings that is associated with fatty liver - or non-alcoholic steatohepatitis. Liver function tests are usually normal in these patients. A liver biopsy would help sort out if you have significant disease.



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