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Please please reply to my HepB questions
Jun 30, 2011

Hi ,

I am 47 years old with chronic HepB and have been a asking questions here since 2004. I was first diagnosed with chronic HepB in June 2002. I have been updating you periodically with my health status. At that time my ALT was in high 50s and AST was in Low 50s. My viral load was log 8.1 copies/ml with eAntigen = positve and eAntibody = negative. Right after Liver Biopsy in October 2004, I started Adefovir HepB treatment due to Stage 2 Fibrosis and Grade1 Inflammation. Since the Adefovir was not effective for me, I started Entecvir. Entecvir did bring down the viral load but still did not make it undetectable. For that past year and half I have been on Truvada. I seroconverted (eAntigen = negative and eAntobody = positive) in Novmber 2010 with undetecteable viral load. At that time, my doctor asked me to continue with Truvada for another six months to ensure good seroconversion.

As of today, my latest blood work results are as follows:

ALT = 16 ALT = 18 Other Liver function Tests are normal. Hepb eAntigen = Negative Hepb eAntobody = Positive AFP = 3.1 Platalets = 137k CBC = Normal I am able to eat well and do not have vomitting. I do not seem get tired. I do have issues with sleep and getting bad dreams. I am 6 ft 2 inches and weigh 154 pounds. I understand that this weigtht is on low side but this is my normal weight for decades. I have not been taking vitamin supplements but I am taking Milk thistle capsules regularly.

I am happy that I have theoretically sero-converted, but I am bit concerned about my dropping ALT and it is actually two points lower then AST. Six months ago my ALT was 22 and AST was 24. I understand low ALT is good thing, but I also read that too low ALT can be sign of Cirrohsis. Especially if ALT is lower then AST. Long ago back in 2000, when I did not know about my HepB, my ALT was 27. and AST was 24. I am not sure why ALT has gone down so low and why it is lower then AST. Your feedback on this will be great.

The other question is can Truvda cause more injury to Liver?

Based on the blood work is it possible to determine the liver condition? If Liver function test is normal and based on past biopsy can we say that Liver is healthy and it does not have Cirrohsis?

Thanks.

CP

Response from Dr. McGovern

I am very glad to hear that Truvada has led to seroconversion of E antigen positive to E antibody positive. That is great news. Most clinicians treat for 6 to 12 months after seroconversion. After that, you will need to see if the virus returns through careful monitoring. If the virus returns, I would keep you on chronic therapy.

As for the issue of cirrhosis...I would not be concerned about your LFTs. They are simply normal. I cannot say if you have cirrhosis based on this.

Ask your doctor if you have evidence of advanced liver disease on examination or on other laboratories. See if your doctor can order an ultrasound, which may be helpful. A blood test that can be done is something like Fibrotest or Fibrosure, which can often help as well, (although the data on these tests are more extensive with HCV infection). I would not get a liver biopsy now since you are already on treatment.

I would ask your doctor about serial monitoring with ultrasound even though you have attained viral suppression, as part of your routine HBV care. An AFP should be done every six months as well.



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