Is It the Right Time to Start Taking Liver Medications?

There are concerns about taking Liver An?

Hello: I am a carrier of hepatitis B and have been undergoing regular follow-up examinations every six months for the past eight years.
Over these eight years, my GOT and GPT levels have fluctuated.
For the past three years, ultrasound examinations have consistently shown moderate fatty liver.
However, in the last six months, several health check-ups have indicated a significant increase in liver inflammation, which has not been observed in previous regular check-ups.
I do not feel any discomfort, but my doctor has prescribed Hepa-Merz (L-ornithine L-aspartate) and advised me to start taking it.
I began taking Hepa-Merz, Lipitor, and liver protection supplements on June 14.
From my understanding, Hepa-Merz has a risk of drug resistance and requires long-term use, with a possibility of relapse after discontinuation.
I would like to know if it is appropriate to start using Hepa-Merz at this time (ALT levels below 200, HBeAg(+) 1560.544).
I have heard from some hospitals that it is more suitable to use it when GPT is above 200.
Can I take liver protection supplements to help lower GOT and GPT levels? Currently, I am paying out of pocket for these expensive medications.
Is it possible to seek treatment at certified hospitals like National Taiwan University Hospital that are recognized by the Department of Health for liver disease, and obtain medications under the National Health Insurance with the necessary treatment qualifications? My recent four health check-up reports are as follows: 2005/12/10 - GOT 41, GPT 96, AFP 2.8, Cholesterol 255; 2006/4/1 - GPT 104, Cholesterol 254; 2006/5/2 - GPT 156, Cholesterol 245; 2006/6/10 - GOT 62, GPT 157, HBeAg(+) 1560.544, AFP 3.3, Cholesterol 235.
Thank you for your guidance.

ESir, 30~39 year old female. Ask Date: 2006/06/20

Dr. Xu Jinchuan reply Gastroenterology and Hepatology

Hello! 1.
According to the letter, you have moderate fatty liver, which could also be a potential cause of your hepatitis.
2.
Additionally, your GPT levels have consistently been elevated, and since your E antigen is positive, the use of Tenofovir could be considered.
However, you are concerned about the possibility of developing drug resistance.
Currently, it is unpredictable, but the likelihood of developing resistance during the initial phase of treatment is very low.
This medication is covered by health insurance, but since the severity of your hepatitis does not meet the insurance coverage criteria, you will need to pay out of pocket.
For chronic hepatitis B patients who are E antigen positive, if your ALT levels have been elevated more than five times above the normal upper limit (at National Taiwan University Hospital, this is considered above 200 for insurance coverage), you would need to have a liver biopsy report.
Additionally, have you undergone an HBV DNA test? 3.
Liver protection supplements are merely nutritional aids for liver cells and do not have therapeutic effects on hepatitis B.

Reply Date: 2006/06/20

More Info

Determining the appropriate time to start taking liver medications, particularly for a chronic hepatitis B patient like yourself, involves a careful assessment of your liver function, viral load, and overall health status. Based on the information you've provided, including your fluctuating GOT and GPT levels, the presence of moderate fatty liver, and recent increases in liver inflammation markers, it is understandable to have concerns about the timing and necessity of starting medications such as Hepatitis B antiviral treatments.

Understanding Your Current Situation
1. Liver Function Tests: Your ALT (GPT) levels, which are currently below 200, indicate that while there is some liver inflammation, it may not yet warrant immediate antiviral treatment according to some clinical guidelines. Generally, antiviral therapy is recommended when ALT levels are significantly elevated (often above 200) or when there is evidence of significant liver damage or fibrosis.

2. Viral Load: Your HBeAg positivity and the viral load of 1560.544 suggest active viral replication. This is a critical factor in deciding whether to initiate treatment. In many cases, treatment is considered when there is a combination of high viral load and elevated liver enzymes.

3. Fatty Liver Disease: The presence of moderate fatty liver can complicate your liver health. Fatty liver disease can lead to further liver inflammation and damage, which may necessitate closer monitoring and potentially earlier intervention.

Timing of Medication
Starting treatment with Hepatitis B antiviral medications like Hepatitis B immunoglobulin (HBIG) or nucleos(t)ide analogs (like Tenofovir or Entecavir) should ideally be based on a comprehensive evaluation by a hepatologist. While some practitioners may suggest waiting until ALT levels exceed 200, others may advocate for earlier intervention, especially given your rising liver inflammation markers.

Concerns About Resistance and Long-term Use
You mentioned concerns about the potential for drug resistance with long-term use of antiviral medications. It is true that some antiviral therapies can lead to resistance if not managed properly. However, modern antiviral medications have a high barrier to resistance, and regular monitoring can help mitigate this risk. The benefits of controlling viral replication and preventing liver damage often outweigh the risks associated with long-term therapy.

Alternative Supportive Treatments
Regarding the use of liver support supplements, such as milk thistle or other hepatoprotective agents, while they may provide some benefits in terms of overall liver health, they should not replace conventional antiviral therapy if indicated. These supplements can sometimes help improve liver function tests, but they are not a substitute for antiviral medications in the context of chronic hepatitis B.

Seeking Care at Specialized Centers
As for your question about seeking treatment at a certified liver disease center, it is advisable to consult with a hepatologist at a facility recognized by health authorities. These centers often have access to the latest treatment protocols and can provide comprehensive care tailored to your specific needs. If you qualify for treatment under national health insurance, this can significantly reduce your out-of-pocket expenses.

Conclusion
In summary, while your current ALT levels may not meet the threshold for immediate antiviral treatment according to some guidelines, the combination of your liver inflammation, viral load, and fatty liver disease suggests that close monitoring and possibly earlier intervention may be warranted. Consulting with a hepatologist will provide you with a clearer understanding of your treatment options and the best course of action for your health. Regular follow-ups and liver function tests will be essential in managing your condition effectively.

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