Seeking Follow-Up Care for Hepatitis B: Recommendations Needed

Q: Seeking Follow-Up Care for Hepatitis B: Recommendations Needed

Hello： The principles for treating hepatitis B with Gan An are as follows： If the e-antigen is positive, continue treatment until the e-antigen turns negative (confirmed by two consecutive tests), and then continue for an additional three months, but not exceeding one year. <br>I

I need to schedule a follow-up appointment?

Hello, I was hospitalized for ten days at San Chong Hospital last March due to acute hepatitis (at that time, blood tests revealed I had hepatitis B, with liver function indices around 3740, and I exhibited symptoms of jaundice.
I was treated with Hepa-Boost, and by the tenth day, my liver indices had dropped to about 160, allowing me to be discharged).
Since then, I have been undergoing monthly follow-up treatments, and I was on Hepa-Boost until October of last year when I ran out of e-antigen medication (though antibodies were only present once in May and then disappeared).
Until this year, during a blood draw, e-antigen for hepatitis B reappeared, so I have continued taking Hepa-Boost to this day.
Unfortunately, due to the SARS situation, my treatment hospital, San Chong Hospital, has suspended operations (my attending physician is Dr.
Yang Shih-Shan).
Therefore, since April, I have not been able to go for blood tests, but I have been taking Hepa-Boost, so I am unsure of my current recovery status.
Could Dr.
Yang recommend a few suitable hospitals or physicians in the Taipei area where I can go for examinations and continue follow-up treatment? Thank you very much!

Zhang, 20~29 year old female. Ask Date: 2003/06/25

Dr. Yang Peizhen reply Gastroenterology and Hepatology

Hello: The principles for treating hepatitis B with Gan An are as follows: If the e-antigen is positive, continue treatment until the e-antigen turns negative (confirmed by two consecutive tests), and then continue for an additional three months, but not exceeding one year.
If after one year the e-antigen remains positive, consider stopping the medication and monitoring to avoid the emergence of viral mutants.
If the e-antigen is negative but the hepatitis B virus (HBV-DNA) is positive, continue treatment until the HBV-DNA becomes negative (confirmed by two consecutive tests), and then continue for an additional three months.
If the HBV-DNA cannot turn negative, consider continuing the medication.
If liver enzyme levels rise instead of decrease during treatment, it must be considered that the virus may have developed drug resistance, and at this point, the medication should be stopped.
My suggestion is to first monitor GPT and e-antigen levels.
If the e-antigen remains positive, you may consider self-paying for testing for viral mutants (YMDD) and then decide whether to stop the medication.
Several major medical centers in Taipei have considerable experience in hepatobiliary medicine, so you can choose one of them for treatment.
Best wishes for your health.
Sincerely, Dr.
Yang Pei-Zhen, Gastroenterology, Taoyuan Hospital, Department of Health, Executive Yuan.

Reply Date: 2003/06/25

More Info

When managing Hepatitis B, especially after experiencing acute hepatitis, it is crucial to maintain a structured follow-up care plan. Your history indicates that you had a significant episode of acute hepatitis B, with elevated liver function tests and jaundice, which necessitated hospitalization. Following your discharge, you were on antiviral therapy, which is essential for managing the viral load and preventing further liver damage.

Given your situation, here are several recommendations for follow-up care and management of Hepatitis B:
1. Regular Monitoring: It is vital to continue regular monitoring of your liver function tests (LFTs), hepatitis B viral load (HBV DNA), and serological markers (such as HBsAg, HBeAg, and anti-HBe). These tests help assess the activity of the virus and the state of your liver. Since you have experienced fluctuations in your serological markers, close monitoring is particularly important.

2. Consultation with a Hepatologist: Since your primary physician is unavailable, seeking care from a hepatologist or a gastroenterologist specializing in liver diseases is advisable. They can provide a comprehensive evaluation and tailor your treatment plan based on the latest guidelines and your specific condition. In Taipei, several hospitals and clinics specialize in liver diseases, such as National Taiwan University Hospital, Taipei Medical University Hospital, and Chang Gung Memorial Hospital. It would be beneficial to contact these institutions for referrals or appointments.

3. Adherence to Antiviral Therapy: Continue taking your antiviral medication as prescribed. Consistency in medication is crucial for managing Hepatitis B effectively. If you have concerns about your medication or its efficacy, discuss these with your new healthcare provider.

4. Lifestyle Modifications: Implementing lifestyle changes can significantly impact liver health. This includes avoiding alcohol, maintaining a healthy diet rich in fruits, vegetables, and whole grains, and staying hydrated. Regular exercise can also help improve overall health and liver function.

5. Vaccination and Preventive Measures: Ensure that you are up to date with vaccinations for hepatitis A and other preventable diseases. Additionally, practicing safe behaviors to prevent transmission of hepatitis B to others is essential.

6. Education and Support: Educate yourself about Hepatitis B and its management. Support groups can also provide emotional support and practical advice from others who are experiencing similar challenges.

7. Follow-Up Appointments: Schedule regular follow-up appointments with your new healthcare provider to assess your liver health and adjust treatment as necessary. Typically, follow-up visits may be recommended every 3 to 6 months, depending on your condition and treatment response.

In summary, while you have made significant progress since your acute episode, ongoing management of Hepatitis B is essential. Regular monitoring, adherence to antiviral therapy, lifestyle modifications, and consultations with specialists will help ensure the best possible outcomes for your liver health. Don't hesitate to reach out to healthcare providers in your area to establish a new care plan and continue your journey toward recovery.

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