Managing Chronic Hepatitis B: Treatment Options and Family Planning

Follow-up treatment directions for hepatitis B?

Hello, doctor.
I have been a carrier since childhood.
When I was 20 years old, my liver enzymes spiked to 1400, but after treatment, they returned to normal levels.
However, at 27, my enzyme levels rose again to over 600, so I started taking Baraclude (entecavir), 0.5 mg daily.
Since it was covered by insurance, I continued for three years, and my viral load became undetectable.
My test results showed positive for hepatitis B surface antigen, negative for surface antibody, positive for core antibody, negative for e antigen, and positive for e antibody, with AST and ALT levels within the normal range.
By the time I was 32, my viral load increased to 238.
Due to concerns from my girlfriend's family about this disease, I began paying out of pocket for Baraclude, and I am still taking it because my attending physician believes that continuing the medication can reduce my risk of developing liver cancer in the future.

Additionally, in 2015, I had a quantitative surface antigen test that showed a value of over 700, and in 2016, it dropped to 490.
My doctor advised me to continue the medication to see if it could decrease to below 100, at which point I could stop taking it.
At the end of last year, I underwent a pre-S gene test, and my doctor indicated that having this gene significantly increases the risk of developing liver cancer.
I tested negative for this gene across all seven samples.

Now, I have the following questions and hope you can provide some advice:
1.
Given my current condition, should I continue taking Baraclude?
2.
I plan to have children in the next couple of years, but I am currently on medication.
Should I stop the medication or switch to another one? I have read articles online where some carriers on medication have healthy children.

3.
What is the likelihood of achieving a negative surface antigen result while continuing the medication?
Thank you, doctor, for taking the time to read this lengthy message.

sonic, 30~39 year old female. Ask Date: 2017/02/04

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, sir.

1.
The viral load is only over 200, and medically, long-term medication is not recommended.
However, personal considerations may allow for self-funded long-term medication.
If you decide to stop the medication, it is essential to ensure proper follow-up.

2.
There are no safety reports for the use of Beclomethasone in pregnant patients; it may be advisable to consider using Peginterferon.
However, there are cases where individuals have taken Beclomethasone during pregnancy without issues.

3.
The likelihood of medication leading to a negative surface antigen result is probably low.
You might consider adding interferon treatment for 6 to 12 months, as there are reports suggesting it can increase the chances of surface antigen disappearance.

Changhua Hospital cares about your health.

Chen Shih-Tien

Reply Date: 2017/02/04

More Info

Managing chronic Hepatitis B can be a complex process, especially when considering treatment options and family planning. Based on your history and current situation, it is crucial to approach this matter with careful consideration and regular medical supervision.

1. Continuing Treatment with Baraclude (entecavir): Given your history of fluctuating liver enzyme levels and the fact that you have achieved an undetectable viral load, it is generally advisable to continue your antiviral therapy. The primary goal of treatment for chronic Hepatitis B is to suppress the virus to prevent liver damage and reduce the risk of complications such as cirrhosis and hepatocellular carcinoma (liver cancer). Your doctor’s recommendation to continue treatment to lower the risk of liver cancer is well-founded, especially considering your previous elevated liver enzyme levels.
2. Family Planning While on Medication: When it comes to family planning, it is essential to discuss this with your healthcare provider. Many studies have shown that individuals with chronic Hepatitis B who are on antiviral therapy can have healthy pregnancies and healthy children. The risk of transmission of the virus to the child can be significantly reduced with appropriate medical management. It is crucial to have a thorough discussion with your doctor about the timing of any potential changes to your medication regimen. Some doctors may recommend switching to a different antiviral that is considered safer during pregnancy, while others may suggest continuing your current treatment, depending on your specific circumstances.
3. Chances of Surface Antigen Seroconversion: The likelihood of achieving seroconversion (the disappearance of Hepatitis B surface antigen and the appearance of surface antibodies) while on antiviral therapy varies among individuals. Factors influencing this include the duration of treatment, the specific antiviral used, and individual patient factors such as age and immune response. While some patients do achieve seroconversion, it is not guaranteed, and your healthcare provider can give you a more personalized assessment based on your treatment history and current health status.

4. Monitoring and Follow-Up: Regular monitoring of your liver function tests, viral load, and Hepatitis B serology is essential. This will help your healthcare provider assess the effectiveness of your treatment and make any necessary adjustments. It is also important to keep an eye on any potential side effects of the medication you are taking.

5. Lifestyle and Health Maintenance: In addition to medication, maintaining a healthy lifestyle is crucial. This includes a balanced diet, regular exercise, avoiding alcohol, and managing stress. These factors can contribute to overall liver health and help mitigate the risks associated with chronic Hepatitis B.

6. Emotional and Psychological Support: Living with a chronic condition can be stressful, and it is important to seek support from healthcare professionals, family, and friends. Counseling or support groups can be beneficial for managing the emotional aspects of living with Hepatitis B.

In summary, it is essential to continue your antiviral therapy under the guidance of your healthcare provider, especially considering your history and the potential risks associated with Hepatitis B. Discussing your family planning goals with your doctor will help you make informed decisions about your treatment and ensure the health of both you and your future children. Regular monitoring and a healthy lifestyle will further support your liver health and overall well-being.

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