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Is treatment an option now?
Mar 30, 2014

Hey, many thanks for your assistance in this matter.

I have had Hep B for at least 10 years. I have no idea how I got it. In the past I was HBsAG+ & HBeAG- (HBeAB+) with HBVDNA undetectable or under 1000 copies m/l. ALT pretty much always on the high side of normal or just a bit over normal.

About 2 years ago my ALT was x2 of a normal value with HBVDNA of around 20,000 copies m/l. I was offered treatment but asked if I could sit this treatment out for 3 months pending subsequent testing. The nurse now thinks this was just a flare which has started early for me. I am 40 now.

Ever since I have had near normal ALT and HBVDNA of 11,000 - 3,000 copies m/l, (tested every 6 months). The HBVDNA has gradually gone down and has been about 3,000 copies m/l for about a year now. I am near borderline for stage 1 fibrosis, but this could be a faulty test because ultrasound shows fatty liver.

My question is should I now consider treatment or not bother? I feel full of energy but wonder if suppression is a better option long term. What say you?

Many thanks

Response from Dr. Taylor

There are several sets of evidence-based guidelines regarding indications for treatment of chronic hepatitis B infection.

I think the European guidelines are important.

Recommendations from the European Association for the Study of the Liver (EASL) from 2012 suggest that people be considered for treatment when they have HBV DNA levels greater than 2000 international units/mL, have serum ALT levels above the upper limit of normal, and evidence of moderate to severe necroinflammation and/or at least moderate fibrosis (scarring). The guidelines specify various patient types and cutoff values for HBV DNA and ALT that need to be considered in making treatment recommendations. The full guideline is available online (http://www.easl.eu/_clinical-practice-guideline).

I suggest discussing these guidelines with your doctor. Also be sure to get tested for HIV, hepatitis C and A, and to refrain from alcohol and tobacco use. All best to you.



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