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Is it foolish to hold out on treatment?
Jan 27, 2013

Asian male 33 infected most likely at birth, adopted so no family history available.

May 2011: BEAG Reactive (currently reactive, no change and also is evidence of pre core mutations) April 2011: HBVDNA 640100000 copies/mL 110000000IU/mL Oct 2011: AST 82 ALT 243 Oct 2011 HBVDNA 640200000 copies 1100000000 IU Nov 2012: HBVDNA 6520000 copies 1120000 IU (so roughly 100 times less than 1 year prior) Nov 2012: AST 28 ALT 80

Biopsies Jan 2011: Knodell 1, Ishak 2 Dec 2011: Knodell1, Ishak 1 Dec 2012: Ishak 2

I am for several reasons very scared to start antiviral medicationsa sthe whole "dependant for life" issue really bothers me. Largely I feel I am young to start what is ultimately likely a lifelong treatment and also I have fears about future availabiity for whatever reasons leaving me with a blooming virus.

I have had very high viral load and ALT for many years and only recently did it drop (sorry no back labs available to post) and it happened right at the same time I lost a lot of weight (240lbs -180lbs in 2012) to fight high blood pressure. It makes me wonder if some of my ALT was due to fatty liver disease and the viral load was high also as a correlation?

I am getting told it's time to treat but I really want to hold off on starting treatment as long as possible. I have hopes that I have years or decades of stage 2 fibrosis left in me untreated. I know there are low to no resistances reported for tenofovir but I hope to live another 50 years and in that time it's very possible a resisitance develops so it seems to me the best method is to wait until you HAVE to treat and fibrosis 1/2 seems like it's not that bad...

So is it foolish to just monitor and wait for stage 3 or 4 before starting treatment?

It's my understanding liver cancer usually comes after stage 4 -6 fibrosis so it seems I should have quite a few more years before it gets bad...

Or is that a bad idea nad liver cancer is so unpredictable and bad that treatment should start now?

I understand the chances of seroconversion are low (espe for Asians with high viral load) and as I see that as the only treatment endpoint I feel if I start medication I am on for life.

BTW If I start I will probably go on a clinical trial of Tenofovir and PEG for 6 months followed by Tenofovir until the doctor sees fit to take me off.

Response from Dr. Taylor

I would consider starting hepatitis B treatment.

AND regarding liver cancer for peeople with chronic hepatitis B, it may occur at any stage of fibrosis, not just at more advanced stages of fibrosis.

Consider getting an HIV test if you have not had one recently. If it is positive, you should be treated for both virues. If the result is negative, talk with your doctor about how not to become infected.



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