Hepatitis B: Key Questions for Patients and Management

Issues related to Hepatitis B?

Hello, Dr.
Hsu: About four years ago, I was diagnosed with hepatitis B, and the doctor told me that I am a healthy carrier, and I only need to return for check-ups every six months.
I would like to ask a few questions:
1.
I only know that my surface antigen is positive and my e antigen is also positive.
Does this mean I am a healthy carrier?
2.
I have been returning for check-ups every six months, and my most recent results from June showed SGOT at 33, SGPT at 53, and AFP at 1.64.
The doctor asked me to return in three months.
Do these results indicate liver inflammation? Do I need to take medication, or should I eat something specific to help lower these levels?
3.
The doctor mentioned that at one point my levels rose to 130, but then six months later they dropped back down to 29.
Is it normal for these levels to fluctuate like this? Could this lead to cirrhosis? I don’t understand why they rise and fall since I haven’t taken any medication (the doctor hasn’t prescribed any) and I don’t drink alcohol.

4.
Is there a regulation that allows for an ultrasound to be done only once a year? (Because at the clinic I go to, the doctor is reluctant to perform it, saying I am too young and don’t need it frequently.)
5.
Is it currently safe for me to become pregnant? Will it affect the fetus? (I might have accidentally become pregnant.)
6.
Once a person has hepatitis B, is there no chance of complete recovery? Does this mean I am on a path toward cirrhosis and liver cancer? I feel like life is dark and hopeless.
Is there no absolute certainty? Are there any treatment or health maintenance options available? (I am feeling quite depressed.)

Huang Tai Tai, 30~39 year old female. Ask Date: 2007/06/17

Dr. Xu Jinchuan reply Gastroenterology and Hepatology

1.
The definition of a healthy carrier is someone who is infected with hepatitis B but has normal liver function tests and ultrasound results.
2.
Your SGPT level is 53, which is slightly elevated, indicating mild inflammation; therefore, close monitoring is necessary, but currently, medication is not required.
3.
If the levels are occasionally elevated but mostly within the normal range, there is no need to be overly concerned.
As long as there is no frequent inflammation, the risk of developing cirrhosis is low.
The fluctuations in liver enzyme levels are primarily due to the hepatitis B virus in your body, and it is unpredictable when it will cause inflammation in your liver.
Typically, this is not directly related to your lifestyle habits.
In other words, even if you maintain a regular lifestyle, the enzyme levels may still be elevated, or if you frequently stay up late, the levels could still be normal.
4.
How often should ultrasounds be performed? It depends on your condition; if it remains stable, once a year is sufficient.
5.
It is possible.
6.
Once you are a carrier, the likelihood of remaining a carrier for life is higher, but it does not necessarily mean you will develop cirrhosis.
As mentioned earlier, as long as there is no inflammation, the risk of cirrhosis or liver cancer is very low.
7.
In fact, there is a significant population of individuals with hepatitis B in Taiwan, but most can coexist peacefully with the virus.
Based on our experience, many people live to be 70 to 80 years old, so do not limit yourself and try not to worry too much.

Reply Date: 2007/06/17

More Info

Hello! Thank you for your questions regarding Hepatitis B. It’s understandable to have concerns about your health, especially when dealing with a chronic condition like Hepatitis B. Let’s address your questions one by one.

1. Understanding Your Status as a Carrier: If your Hepatitis B surface antigen (HBsAg) is positive and your e-antigen (HBeAg) is also positive, it indicates that you are indeed a carrier of the virus. Being a "healthy carrier" means that while the virus is present in your body, it may not be actively damaging your liver at this moment. However, it’s crucial to monitor your liver function regularly, as the situation can change.

2. Interpreting Your Liver Function Tests: Your recent liver enzyme levels (SGOT 33, SGPT 53) are within a range that is generally considered normal, although SGPT is slightly elevated. These levels do not necessarily indicate active liver inflammation, especially if they are not significantly elevated. It’s essential to follow your doctor’s advice regarding follow-up appointments. If your liver enzymes were previously higher (like the 130 you mentioned), fluctuations can occur due to various factors, including infections, stress, or even diet. Maintaining a healthy lifestyle, including a balanced diet and regular exercise, can help support liver health.

3. Fluctuations in Liver Enzyme Levels: It’s not uncommon for liver enzyme levels to fluctuate. These changes can be influenced by many factors, including viral replication, lifestyle, and even laboratory variations. While occasional spikes in liver enzymes can be concerning, consistent monitoring is key. If your enzymes remain elevated over time, further evaluation may be necessary to assess liver health and the potential for fibrosis or cirrhosis.

4. Ultrasound Frequency: Regarding liver ultrasounds, while the standard recommendation is to have one annually, your healthcare provider may suggest more frequent monitoring based on your individual risk factors, family history, and overall health. If you feel that your concerns warrant more frequent imaging, don’t hesitate to discuss this with your doctor.

5. Pregnancy Considerations: If you are considering pregnancy, it’s crucial to consult with your healthcare provider. Hepatitis B can be transmitted from mother to child during childbirth, but with appropriate management, the risk can be minimized. Vaccination for the newborn and antiviral treatment during pregnancy may be recommended based on your viral load and liver function.

6. Chronic Hepatitis B Management: Chronic Hepatitis B is a lifelong condition, but it does not always lead to severe liver disease. Many individuals with Hepatitis B live healthy lives without significant liver damage. Regular monitoring, a healthy lifestyle, and adherence to medical advice are essential. While there is currently no cure for chronic Hepatitis B, antiviral treatments can effectively manage the virus and reduce the risk of liver complications.

In summary, while living with Hepatitis B can be daunting, many patients lead fulfilling lives with proper management. Regular check-ups, a healthy lifestyle, and open communication with your healthcare provider are vital. If you have further concerns or feel overwhelmed, consider seeking support from healthcare professionals or support groups specializing in liver health. Remember, you are not alone in this journey, and there are resources available to help you navigate your health.

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