Managing High Liver Enzymes in Chronic Hepatitis B Patients: Treatment Options

The disappearance of the E antigen and persistently elevated liver enzymes?

Hello Dr.
Hsu: I am a patient with hepatitis B, without hepatitis C, and I do not drink alcohol.
I have been receiving liver protection medication from the hospital for the past five to six years, but my GPT levels remain around 120, and GOT levels are between 60 and 70, which have not decreased.
Both my ultrasound and alpha-fetoprotein tests are normal, and I only have fatty liver.
My E antigen is negative.
Recently, I was referred to a hepatobiliary and gastroenterology specialist, who suggested that I undergo treatment with long-acting interferon injections, stating that it has better efficacy and could reduce the risk of developing liver cancer in the future.
However, I have heard that the side effects can be significant, and the levels may not necessarily decrease, especially since my E antigen is negative.
How should I assess the duration of treatment? This has been troubling me, and I am uncertain whether to proceed with the treatment or simply focus on weight loss to reduce fatty liver (I am currently 160 cm tall and weigh 70 kg).
I would greatly appreciate your guidance.
Thank you!

Liu, 40~49 year old female. Ask Date: 2005/01/22

Dr. Xu Jinchuan reply Gastroenterology and Hepatology

Hello lbkth888!
1.
Your condition can be considered for treatment with long-acting interferon, which has shown good results.
However, as you mentioned, your e-antigen is negative, indicating that you are a patient with a mutated strain of hepatitis B.
In this situation, the e-antigen is no longer a reference indicator for treatment success; instead, you can consider the HBV DNA test results.
If the HBV DNA is negative after treatment and the ALT (GPT) levels are within the normal range, it indicates that the treatment is effective.
Currently, the treatment duration is primarily six months, but it may be adjusted based on individual circumstances.
However, long-acting interferon treatment is not yet covered by health insurance and will need to be paid out of pocket.
2.
If you have fatty liver, it is certainly possible that the elevated ALT levels are related to the fatty liver.
Regardless, weight loss is necessary; perhaps if you manage to control your weight, the ALT levels will decrease, indicating a connection to fatty liver.
This is something you can currently work on.

Reply Date: 2005/01/22

More Info

Managing high liver enzymes in chronic hepatitis B patients is a complex issue that requires a comprehensive understanding of the disease, treatment options, and patient-specific factors. Chronic hepatitis B (CHB) can lead to liver inflammation, fibrosis, and potentially cirrhosis or liver cancer if not managed appropriately. Elevated liver enzymes, such as GPT (ALT) and GOT (AST), indicate liver inflammation and damage, which can be a result of the hepatitis B virus (HBV) activity.

In your case, with GPT levels around 120 and GOT levels between 60-70, it is essential to evaluate the underlying cause of these elevated enzymes. Since you have been on liver-protective medications for several years without significant improvement, it may be time to consider more aggressive treatment options. The fact that your ultrasound and alpha-fetoprotein (AFP) levels are normal is reassuring, as it suggests that there is currently no significant liver damage or cancer.

The recommendation for long-acting interferon therapy is a valid option, especially considering your HBeAg negative status. Interferon therapy can help reduce viral load and improve liver enzyme levels, but it is not without its side effects, which can include flu-like symptoms, fatigue, and potential impacts on mood. The decision to start interferon therapy should be based on a thorough discussion with your healthcare provider about the potential benefits and risks, as well as your personal health goals.

In terms of treatment duration, interferon therapy typically lasts for about 48 weeks, but this can vary based on individual response and tolerance. Regular monitoring of liver enzymes, HBV DNA levels, and overall liver function is crucial during this period. If you do not respond adequately to interferon, or if the side effects become intolerable, alternative antiviral therapies such as nucleos(t)ide analogs (e.g., tenofovir or entecavir) may be considered. These medications are generally well-tolerated and can effectively suppress HBV replication.

Weight management is also an important aspect of your overall health, especially since you mentioned having fatty liver. Losing weight can help reduce liver fat and improve liver function, which may contribute to lowering your liver enzyme levels. A balanced diet, regular exercise, and lifestyle modifications can be beneficial in managing both fatty liver and chronic hepatitis B.

Ultimately, the decision to initiate treatment should be made collaboratively with your healthcare provider, taking into account your liver enzyme levels, viral load, overall health, and personal preferences. Regular follow-ups and monitoring are essential to assess the effectiveness of any treatment regimen and to make necessary adjustments.

In summary, managing high liver enzymes in chronic hepatitis B patients involves a multifaceted approach that includes evaluating the need for antiviral therapy, considering lifestyle modifications, and closely monitoring liver function. Engaging in an open dialogue with your healthcare provider will help you navigate these decisions and optimize your treatment plan.

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