High Viral Load in Hepatitis B: Should I Start Treatment?

Fetal protein and liver enzymes are normal, but the viral load is very high?

Hello Doctor, I have had hepatitis B since childhood due to vertical transmission from my mother.
I have been undergoing regular check-ups every six months, and my liver enzymes and alpha-fetoprotein levels are all normal, but my viral load is very high at 120 million IU.
My outpatient doctor suggested that I could either self-pay for antiviral medication like Baraclude or, if I have financial constraints, I could continue regular monitoring without medication.
I would like to ask if, without financial pressure, taking the self-paid medication to suppress the viral load would reduce my future risk of developing cirrhosis and liver cancer.
Additionally, due to my work schedule, I have to work shifts and cannot maintain a normal lifestyle, which makes me concerned about the risk of acute hepatitis.
If I start the medication, will the risk of acute hepatitis approach zero?

muggle, 20~29 year old female. Ask Date: 2021/04/01

Dr. Chen Shidian reply Gastroenterology and Hepatology

There is currently no definitive conclusion regarding lifelong prevention.
It is recommended to follow regular monitoring, and if symptoms develop, medication will be covered by health insurance.

Reply Date: 2021/04/01

More Info

When considering the management of high viral load in Hepatitis B, particularly in the context of a patient with a history of vertical transmission, it is crucial to weigh the benefits of antiviral therapy against the risks of potential complications, including liver cirrhosis and hepatocellular carcinoma (HCC). Given your situation, where you have a high viral load of 120 million IU/mL but normal liver function tests and alpha-fetoprotein (AFP) levels, the decision to initiate treatment should be based on several factors.

Firstly, the presence of a high viral load is a significant risk factor for liver disease progression. Chronic Hepatitis B infection can lead to liver inflammation, fibrosis, and ultimately cirrhosis and liver cancer. Studies have shown that antiviral therapy can effectively reduce the viral load, which in turn decreases the risk of liver-related complications. If you can afford the treatment, starting antiviral therapy such as entecavir (Baraclude) or tenofovir (Viread) could be beneficial in reducing your viral load and minimizing the risk of liver damage over time.

The recommendation from your doctor to monitor your condition without immediate treatment is not uncommon, especially if your liver function tests remain normal. However, given your family history of liver cancer, it may be prudent to take a more proactive approach. Regular monitoring is essential, but initiating treatment could provide peace of mind and a safeguard against potential future complications.

Regarding your concern about the risk of acute liver failure or "fulminant hepatitis," it is important to note that while antiviral therapy can help control the virus, it does not completely eliminate the risk of acute exacerbations. However, the likelihood of experiencing severe liver inflammation or acute liver failure is significantly reduced with effective antiviral treatment. The goal of therapy is to achieve viral suppression, which can stabilize liver function and reduce the risk of acute exacerbations.

In terms of lifestyle factors, maintaining a healthy lifestyle is crucial. Since you mentioned having a job that requires shift work, it is essential to manage your overall health through a balanced diet, regular exercise, and avoiding alcohol and hepatotoxic substances. These lifestyle choices can further support liver health and reduce the risk of complications.

In conclusion, if financial constraints are not an issue, starting antiviral therapy would likely be a wise decision to reduce your viral load and mitigate the risk of liver disease progression. Regular follow-ups with your healthcare provider will be essential to monitor your liver function and adjust treatment as necessary. Ultimately, the goal is to achieve a sustained viral response, which can significantly improve your long-term prognosis and quality of life.

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