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To treat or not to treat
Nov 30, 2012

Dear Dr Taylor

Thank you for taking your time to support this valuable website, your help is greatly appreciated.

I am in the UK and apparently it has decided that treatment for Hep B should be more readily encouraged. Before it had a wait and see approach. My gastroenterologist is rather vague about this change in policy, there are few hepatologists here. Can you shed any light on this? (The reality is the advice from doctors in this area is rather inconsistent in London anyway).

Also I am 39 and have had low levels of HBVDNA (less than 1000 copies/ml) since 30 (when I got tested) and recently it has increased to 1 million copies and then dropped spontaneous to less than 3000 copies (it dropped after a period of about 2 months). I had fatigue when it spiked, but now feel fine, in fact better than I have for a long time. Can you explain why the HBVDNA has spiked and then spontaneously declined?

During the spike my ALT doubled to twice 'normal', but typically is within the normal range previously and the last time I checked it was very unremarkable. My serology has always been HBSAG+, HBSAB-, HBeAg- & HBeAB+. If there is no liver damage and my HBVDNA drops to below 1000 copies m/l, is it worth treating and what with? I really want to avoid a lifetime of unnecessary treatment but will follow an experts advice religiously if required.

Thanks

Response from Dr. Taylor

I understand your concern. Treatment for hepatitis B infection is not that straightforward or simple, and there are many factors to consider. These include whether a person also is infected with HIV, how much scarring there is in the liver, whether the eAg is positive or negative, the level of ALT, and the level of hepatitis B DNA (amount of hepatitis B virus in the blood). Hepatitis B blood tests can change over time which is why ongoing care is important.

I suggest discussing with your doctor where you fit in with the hepatitis B recommendations from the European Association for the Study of the Liver (EASL) that were updated in 2012. http://www.easl.eu/_clinical-practice-guideline.

In addition if you have not had an HIV test recently, I suggest considering getting a test. If you are living with HIV, then treatment for both infections important.

In addition, not using alcohol and tobacco decrease the chance of developing serious liver disease and/or liver cancer.

If you do need hepatitis B treatment, the pills are among the safest and best tolerated of ALL medications, in my view, and there are a number of good options.



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