Hepatitis B: Managing Your Health and Concerns - Gastroenterology and Hepatology

What should I do?

Dear Dr.
Hsu,
I have been aware of my hepatitis B carrier status for 17 years.
Throughout this time, my liver function tests (GOT, GPT), alpha-fetoprotein levels, and ultrasound results have all been normal.
However, my e-antigen has consistently tested positive.
The following are some of my test results: on September 30, 1994, GOT was 33 and GPT was 559; on November 5, 1994, GOT was 23 and GPT was 35; on February 11, 1995, GOT was 72 and GPT was 128; on March 4, 1995, GOT was 48 with a normal ultrasound and GPT was 65; on April 24, 1995, GOT was 29 and GPT was 109; on June 21, 1995, GOT was 35; on June 23, 1995, GOT was 45 with e-antigen at 1300 and GPT was 478; and finally, e-antigen was 1749 with alpha-fetoprotein at 15.52 and GPT at 632.
Dr.
Hsu, is this fluctuation in my test results typical for the disease course? I have an appointment at Chang Gung Hospital on June 28.
Will they definitely prescribe antiviral medication for me? Is it mandatory for me to take it? I am very concerned about the potential for drug resistance and feel quite anxious and conflicted.
Why have my levels suddenly increased so significantly? Should I undergo a liver biopsy or liver puncture? Will my health insurance cover the cost of antiviral medication?
Additionally, I have been taking health supplements from the U.S., such as "Mei An," over the past six months.
Could these supplements be affecting my test results? Is it safe for me to continue taking them?
Dr.
Hsu, I am a very pessimistic and anxious patient.
My mood has plummeted, and I feel very bleak, especially since my child is still very young.
I am quite frustrated and sincerely request your help to navigate this dark period in my life.
Does a low mood affect liver health? Would being more optimistic be better for my liver?
I greatly appreciate your time and patience in reading this and answering my questions.
Thank you!

Miss Lu, 30~39 year old female. Ask Date: 2006/06/26

Dr. Xu Jinchuan reply Gastroenterology and Hepatology

Hello, Ms.
Lu!
1.
Your liver enzyme levels were within an acceptable range until April of this year, but starting in June, your GPT levels have been consistently elevated, indicating an acute episode.
Have you undergone detailed examinations to determine the cause of the liver inflammation? It is likely related to the Hepatitis B virus.
I recommend checking your HBV DNA levels.

2.
It may be suggested that you take Tenofovir, but continued observation is also an option, depending on your physician's judgment and assessment.
You are concerned that taking Tenofovir might lead to drug resistance; however, drug resistance typically occurs only with long-term use, not immediately upon starting treatment, so there is no need to worry excessively about this.
3.
If treatment is considered, the cost of medication must be taken into account.
Currently, health insurance provides conditional coverage, but you must have a positive E antigen for more than six months and a GPT level exceeding five times the normal upper limit (generally above 200) to qualify for coverage.
A liver biopsy is not required, but you must first confirm that your hepatitis is caused by the Hepatitis B virus, which means ruling out other potential causes of your hepatitis.
4.
There have been cases where the use of health supplements has led to liver inflammation, but it is currently unclear whether your hepatitis is related to this.
It is advisable to stop using any supplements for now to avoid affecting your physician's assessment.
5.
Based on the information in the letter, your condition is not as severe as you might think, so there is no need for excessive anxiety.
Try to relax, as worrying will not help your situation.
It is important to follow your physician's instructions and have regular follow-ups.

Reply Date: 2006/06/26

More Info

Hepatitis B (HBV) is a significant public health concern worldwide, particularly in regions with high prevalence rates. Understanding HBV from a public health perspective involves examining its transmission, epidemiology, treatment options, and the role of public health interventions.

Transmission and Epidemiology:
Hepatitis B is primarily transmitted through contact with infectious body fluids, such as blood, semen, and vaginal secretions. Common modes of transmission include sharing needles, unprotected sexual contact, and from mother to child during childbirth. The World Health Organization (WHO) estimates that approximately 296 million people were living with chronic HBV infection in 2019, with the highest prevalence in regions like sub-Saharan Africa and East Asia.

In the United States, the prevalence of chronic HBV infection is lower, estimated at about 0.3% of the population. However, certain populations, including immigrants from high-prevalence areas and individuals with a history of injection drug use, are at increased risk. Public health strategies focus on vaccination, screening, and education to reduce transmission rates.

Clinical Implications:
Chronic hepatitis B can lead to serious health complications, including cirrhosis and hepatocellular carcinoma (liver cancer). The risk of developing these complications is significantly higher in individuals with chronic HBV infection, particularly those who are e-antigen positive, indicating high viral replication and increased infectivity.

Treatment and Management:
Currently, there is no cure for chronic hepatitis B, but antiviral medications can effectively manage the infection and reduce the risk of liver damage. The most commonly used antiviral therapies include nucleos(t)ide analogs such as tenofovir and entecavir. These medications can suppress viral replication, improve liver function, and reduce the risk of liver-related complications.

Regular monitoring through blood tests and imaging studies (like ultrasound) is crucial for individuals with chronic HBV. This includes monitoring liver function tests (ALT, AST), HBV DNA levels, and screening for liver cancer, especially in those with risk factors.

Public Health Interventions:
Public health interventions play a critical role in managing hepatitis B. Vaccination is the most effective way to prevent HBV infection. The hepatitis B vaccine is safe and effective, and it is recommended for all infants, unvaccinated children, and high-risk adults. Additionally, public health campaigns aimed at educating the public about transmission risks and the importance of safe practices (like not sharing needles or personal items that may have blood on them) are essential.

Chronic Hepatitis:
Chronic hepatitis refers to the long-term inflammation of the liver, often due to viral infections like HBV or HCV. In chronic hepatitis B, if the immune system fails to clear the virus, it can persist in the liver, leading to ongoing inflammation and potential liver damage over time.

Resources for Further Information:
For those seeking more information on hepatitis B, several resources are available:
1. "Hepatitis B: A Comprehensive Guide for Patients and Families" by Dr. Robert G. Gish.

2. "Hepatitis B: The Facts" by the World Health Organization.

3. The Centers for Disease Control and Prevention (CDC) website offers extensive information on hepatitis B, including prevention, treatment, and statistics.

Addressing Concerns:
Regarding your specific concerns about your health and the management of hepatitis B, it is essential to maintain open communication with your healthcare provider. If you are experiencing significant anxiety about your condition, consider discussing this with your doctor, who may recommend counseling or support groups. Mental health can indeed impact physical health, and managing stress is vital for overall well-being.

In conclusion, while living with chronic hepatitis B can be challenging, effective management strategies and public health interventions can significantly improve health outcomes and quality of life. Regular monitoring and adherence to treatment can help mitigate the risks associated with the virus, allowing individuals to lead healthy lives.

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