Should You Take Tenofovir for HBsAg Positive, e Negative Mutant Hepatitis B? - Gastroenterology and Hepatology

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When considering treatment options for chronic Hepatitis B, particularly in cases where the patient is HBsAg positive and has an e-negative mutant strain, it is essential to evaluate the clinical situation carefully. The recent elevation in liver enzymes (GOT and GPT) indicates that there may be ongoing liver inflammation or damage, which necessitates prompt intervention.

In your case, the recommendation to start antiviral therapy, such as Tenofovir (known as "干安能" in Taiwan), is appropriate given the significant elevation in liver enzymes. Tenofovir is a potent antiviral medication that is effective against Hepatitis B virus (HBV) and is often used as a first-line treatment for chronic Hepatitis B, especially in patients with high viral loads or elevated liver enzymes. The fact that your liver enzymes have spiked to levels of GOT 169 and GPT 306 suggests that your liver is under stress, and antiviral therapy could help mitigate further damage.

The e-negative status indicates that you may have a mutant strain of the virus, which can complicate treatment. In general, e-negative patients can still benefit from antiviral therapy, as the primary goal is to reduce viral replication and improve liver function. While e-antigen positivity is often associated with higher infectivity and viral replication, e-negative patients can still have significant viral loads and liver inflammation. Therefore, the presence of e-negative mutations does not preclude the use of antiviral therapy; rather, it highlights the need for careful monitoring and management.

Regarding the concern about the lack of insurance coverage for Tenofovir, it is essential to discuss this with your healthcare provider. In many healthcare systems, there are specific criteria for antiviral treatment eligibility, and if your liver function tests and viral load meet those criteria, you may be able to appeal for coverage or explore alternative financial assistance programs. It is also worth discussing the possibility of using other antiviral medications that may be covered by insurance, as there are several options available for treating chronic Hepatitis B.

In addition to starting antiviral therapy, it is crucial to continue regular monitoring of your liver function and viral load. This typically involves blood tests every three to six months to assess liver enzymes, HBV DNA levels, and other relevant markers. Regular ultrasound examinations are also important to monitor for any signs of liver damage or complications, such as cirrhosis or hepatocellular carcinoma (liver cancer).

In summary, starting Tenofovir for your HBsAg positive, e-negative mutant Hepatitis B is a reasonable and medically sound decision, especially given the recent elevation in liver enzymes. It is essential to work closely with your healthcare provider to ensure that you receive appropriate treatment and monitoring. If cost is a barrier, explore options for financial assistance or alternative medications that may be covered by your insurance. Your health and well-being should be the top priority, and effective management of your Hepatitis B can significantly improve your liver health and overall quality of life.