Do I Need Antiviral Treatment for Chronic Hepatitis B? - Gastroenterology and Hepatology

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When it comes to managing chronic Hepatitis B, the decision to initiate antiviral treatment is crucial and often complex. Based on your situation, where you have a history of Hepatitis B infection, recent ultrasound findings of liver roughness, splenomegaly, fatigue, and serological markers indicating negative surface antigen (HBsAg) but positive surface antibody (anti-HBs) and core antibody (anti-HBc), it is essential to evaluate your condition further.

Firstly, the presence of positive anti-HBs suggests that you have either cleared a past infection or have been vaccinated against Hepatitis B. However, the positive anti-HBc indicates a previous infection, and the absence of HBsAg raises the possibility of a resolved infection. Yet, the symptoms you describe, such as fatigue and the ultrasound findings, warrant further investigation.

It is advisable to check for HBV DNA levels to assess whether there is active viral replication, even in the absence of HBsAg. This situation can occur in a small subset of patients known as "occult Hepatitis B infection," where the virus is present but not detectable through standard serological tests. The presence of HBV DNA, despite negative HBsAg, can lead to liver inflammation and damage, which could explain the roughness of your liver observed on ultrasound.

Given that you have signs of liver damage, such as roughness and splenomegaly, it is critical to evaluate the degree of liver fibrosis or cirrhosis. This can be done through non-invasive methods like elastography or a liver biopsy if necessary. If significant fibrosis or cirrhosis is present, antiviral treatment is generally recommended to prevent further liver damage and complications such as liver cancer.

The current guidelines suggest that patients with chronic Hepatitis B and evidence of liver damage, regardless of HBsAg status, should be considered for antiviral therapy. The primary goal of treatment is to suppress viral replication, improve liver function, and reduce the risk of complications.

In terms of treatment options, several antiviral medications are available, including tenofovir and entecavir, which are highly effective and have a low resistance profile. The choice of therapy should be individualized based on your specific circumstances, including the presence of any liver damage, potential drug interactions, and personal preferences.

In conclusion, it is essential to conduct further testing, including HBV DNA quantification, to determine the presence of active infection. If active viral replication is confirmed, and given your symptoms and ultrasound findings, antiviral treatment should be strongly considered to protect your liver health. Regular follow-up with a hepatologist or a specialist in liver diseases is crucial to monitor your condition and adjust treatment as necessary.