Deciding Whether to Resume Medication After Stopping: A Liver Health Dilemma

What should I do if my condition relapsed after stopping Danazol after a year and a half of use?

Hello doctor...
I previously had an index over 300 and took antiviral medication for more than a year, during which my e-antigen turned negative.
After taking the medication for another six months, I stopped.
Three months after stopping, my e-antigen was still negative with an index around 80.
However, three months later, my index skyrocketed to GPT 720, and GOT 250, while the e-antigen remained negative.
I asked my doctor if I should take medication again, but he said he didn't know.
He mentioned that my negative e-antigen with such a high index might indicate a viral mutation.
Previously, I was paying out of pocket for the medication.
He said there is a 30% chance my levels will rise again and a 70% chance they will decrease.
I'm really confused about whether I should take medication again or just wait and see.
The doctor said I could take medication or not, but if I start, I would need to take it for several years, which would be very expensive since I would have to switch from one medication to another if the first one becomes ineffective.
Not taking it might lead to a decrease in my levels.
I asked for his advice on whether I should take the medication, but he said he didn't know either.
I’m really worried about what to do, especially since I have four children and I'm afraid of what might happen to them if something happens to me.
Could you please advise me on whether I should take the medication or not?

A-Hua, 20~29 year old female. Ask Date: 2007/03/15

Dr. Xu Jinchuan reply Gastroenterology and Hepatology

Hello! Indeed, this situation can be quite distressing.
Your physician's perspective is not incorrect; while inflammation may decrease, the current assessment suggests a higher likelihood of ongoing inflammation.
Additionally, although your E antigen is negative, your GPT levels remain elevated, which may indicate that the virus has mutated.
It would be best to check your HBV DNA levels; have you had this test done? If it is confirmed that your HBV DNA viral load is high, medication treatment will be necessary.
However, the duration of treatment is currently not well-defined.
Of course, if the HBV DNA viral load is high and GPT levels have not returned to normal, and if economic considerations are not an issue, it is advisable to pursue medication.
Long-term antiviral therapy is necessary for chronic hepatitis B patients who are E antigen negative.
It is also important to note that there is still a risk of viral mutation.
If there are no financial constraints, Tenofovir or Entecavir could be considered, as both are more effective than Adefovir.

Reply Date: 2007/03/15

More Info

Deciding whether to resume medication after stopping, especially in the context of liver health, is a complex issue that requires careful consideration of various factors, including your current health status, the potential risks of resuming or discontinuing treatment, and the implications for your long-term health.

From your description, it appears that you have been on antiviral medication (干安能) for over a year, and after stopping for six months, your liver enzyme levels (GPT) have significantly increased, indicating a potential flare-up of your hepatitis B infection. The fact that your e-antigen remains negative is a positive sign, as it suggests that the virus may be less active, but the elevated GPT levels indicate that there is still some level of liver inflammation or damage occurring.

Your doctor’s uncertainty about whether to resume medication is not uncommon in the management of chronic hepatitis B. The decision to restart antiviral therapy typically depends on several factors, including:
1. Liver Enzyme Levels: Elevated liver enzymes (like GPT) can indicate active liver inflammation. A significant increase, such as the jump to 720, suggests that your liver is under stress, and this may warrant a reassessment of your treatment plan.

2. Viral Load: If you have access to HBV DNA testing, knowing the viral load can help determine the level of viral activity. If the virus is replicating at a high level, resuming antiviral therapy may be necessary to prevent further liver damage.

3. Clinical Symptoms: Any symptoms you may be experiencing, such as fatigue, jaundice, or abdominal pain, should also be taken into account. If you are feeling unwell, this could indicate that your liver is struggling.

4. Risk of Progression: The risk of liver disease progression is a critical factor. If your doctor estimates that there is a 30% chance of your liver enzymes continuing to rise, this is a significant risk that should not be taken lightly, especially considering your family responsibilities.

5. Long-term Management: Chronic hepatitis B often requires long-term management. If your doctor suggests that resuming medication could mean years of treatment, it is essential to weigh the benefits of controlling the virus against the financial and emotional costs of long-term therapy.

Given your situation, here are some recommendations:
- Seek a Second Opinion: If you feel uncertain about your current doctor’s advice, consider consulting another hepatologist or a specialist in infectious diseases. They may provide additional insights or alternative treatment options.

- Regular Monitoring: Regardless of whether you decide to resume medication, regular monitoring of your liver function tests and viral load is crucial. This will help you and your healthcare team make informed decisions about your treatment.

- Consider Financial Aspects: If the cost of medication is a significant concern, discuss this openly with your healthcare provider. They may be able to suggest financial assistance programs or alternative medications that are more affordable.

- Lifestyle Modifications: In addition to medication, adopting a liver-friendly lifestyle can help support your liver health. This includes maintaining a balanced diet, avoiding alcohol, managing stress, and ensuring regular exercise.

- Family Considerations: Given your concern for your children, it’s understandable that you want to ensure your health is stable. Engaging in a proactive approach to your health, including regular check-ups and following medical advice, can help mitigate risks.

In conclusion, the decision to resume medication should be made collaboratively with your healthcare provider, taking into account your specific health status, the risks involved, and your personal circumstances. It’s essential to prioritize your health while also considering the implications for your family.

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