Should I Extend My Interferon Treatment for Chronic Hepatitis B?

Please inquire about the interferon treatment regimen for hepatitis B?

Hello, I am a carrier of hepatitis B, with vertical transmission from my mother.
A year ago, my GOT and GPT levels were about twice the normal values, which qualified me for health insurance coverage.
I underwent interferon treatment for a year, and my treatment recently concluded.
However, my E antigen remains positive, and my viral load decreased from over 700 million to just over 30,000 in the last blood test.
My GOT and GPT levels are fluctuating within normal limits, around 100.
I am unsure whether to self-fund an extension of the interferon treatment for a few more months to see if there is a chance to clear the virus, or if the doctor believes that the results after a year of treatment are as good as they will get, suggesting a shift to monitoring treatment instead.
Thank you.

Chen, 30~39 year old female. Ask Date: 2017/05/15

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, sir.
Interferon treatment is typically standardized for one year, and extending the treatment is not recommended.
After discontinuation, there may still be subsequent immune effects, so continued monitoring is necessary.
On the other hand, if there is a severe hepatitis flare-up, oral medications can be used for long-term management.
Changhua Hospital cares about your health.
Chen Shidian.

Reply Date: 2017/05/15

More Info

When considering whether to extend your interferon treatment for chronic hepatitis B, there are several important factors to take into account. Your current situation indicates that you have been undergoing interferon therapy for a year, and while your liver enzymes (GOT and GPT) have returned to normal levels, your E antigen remains positive, and your viral load has decreased significantly from over 700 million to around 30,000 copies/mL.
Interferon therapy is known to have a variable response rate, and while it can be effective in some patients, it does not guarantee complete viral eradication. The fact that your liver function tests have normalized is a positive sign, suggesting that the treatment has been effective in reducing liver inflammation. However, the persistence of the E antigen indicates that the virus is still present and active, albeit at a lower level.

In terms of extending your interferon treatment, it is essential to consider the following:
1. E Antigen Status: The presence of HBeAg (E antigen) suggests that the virus is still replicating, and this can be a marker of ongoing viral activity. In many cases, achieving seroconversion from HBeAg positive to HBeAg negative is a goal of treatment, as it often correlates with a better long-term prognosis.

2. Viral Load: Your significant reduction in viral load is encouraging, but the decision to continue treatment should be based on whether further viral suppression is likely. If your doctor believes that extending treatment could lead to further decreases in viral load and potentially achieve HBeAg seroconversion, it may be worth considering.

3. Side Effects and Tolerance: Interferon can have side effects, and the decision to continue treatment should also take into account how well you have tolerated the therapy thus far. If you have experienced significant side effects, it may be prudent to weigh these against the potential benefits of extending treatment.

4. Consultation with Your Healthcare Provider: Ultimately, the decision should be made in consultation with your healthcare provider, who can assess your individual circumstances, including your response to treatment, side effects, and overall health. They may also consider other treatment options, such as nucleos(t)ide analogs like entecavir or tenofovir, which can be effective in managing chronic hepatitis B and may be more suitable for long-term therapy.

5. Monitoring and Follow-Up: If you decide not to extend interferon treatment, regular monitoring of your liver function, viral load, and HBeAg status is crucial. This will help ensure that any changes in your condition are promptly addressed.

In summary, while extending your interferon treatment may offer a chance for further viral suppression and potential seroconversion, it is essential to have a thorough discussion with your healthcare provider about the risks, benefits, and likelihood of success. They can help you make an informed decision based on your specific situation and the latest clinical guidelines.

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