Active Hepatitis B: Treatment Options and Next Steps

Hepatitis B carriers are actively infected with the virus?

A 31-year-old male, originally a carrier of hepatitis B, discovered during a health check that his liver enzymes were excessively high, ranging from 400 to nearly 500.
Further testing at a larger hospital revealed a very active viral infection, with the doctor stating a viral load of 640 million.
Although he doesn't fully understand the implications, the doctor has recommended a liver biopsy in three months, followed by treatment.
Initially, he didn't perceive the severity of his condition, but after reviewing a booklet provided by the doctor, he realized that his illness is quite serious.
The treatment is out-of-pocket, and he found online that it could cost around 200,000 NTD for six months.
However, he also discovered that some hospitals might offer coverage under the national health insurance.
He is unsure if this information is accurate.
Now, he feels lost about what to do next.
His family suggests switching hospitals and not delaying further.
Is it really necessary to change hospitals? Are there any reputable medical institutions specializing in the treatment of viral infections? He is in urgent need of guidance.
Thank you very much! Jenny

Jenny, 30~39 year old female. Ask Date: 2007/11/21

Dr. Xu Jinchuan reply Gastroenterology and Hepatology

Hello Jenny!
1.
According to the doctor, 640 million → there was no unit provided for the test result.
If the unit is copies/mL, then the viral load is very high.

2.
A biopsy is recommended before treatment → Is interferon therapy suggested? If so, your physician may want to apply for insurance coverage, as this is a requirement from the National Health Insurance Administration.
A liver biopsy is necessary for insurance reimbursement.
If you do not wish to undergo a liver biopsy, the cost would be approximately 200,000 TWD.
However, the information in the letter is quite vague.
Could you please clarify whether your e-antigen is negative or positive?
3.
You will need to wait another three months, as at least six months of data is required (according to insurance regulations).
Additionally, this will allow for observation of subsequent developments.

4.
Are there any well-known medical institutions related to the treatment of viral infections? → No, the hepatobiliary department of a hospital will suffice.

5.
The information you provided is insufficient; if possible, please provide more details.

6.
How long has your family member been a carrier? Is their e-antigen negative or positive? Do they have e-antibodies? What are their liver enzyme levels (ALT)? What were the previous levels? Is there an ultrasound report available? What are the bilirubin levels, albumin levels, and coagulation time test results? Is there a co-infection with hepatitis C? How old are they?

Reply Date: 2007/11/21

More Info

Dear Jenny,
Thank you for reaching out with your concerns regarding your recent diagnosis of active Hepatitis B. It’s understandable to feel overwhelmed, especially when faced with high liver enzyme levels and a significant viral load. Let’s break down your situation and discuss the treatment options and next steps.

Understanding Your Condition
Hepatitis B is a viral infection that affects the liver and can lead to serious complications, including liver cirrhosis and liver cancer. The fact that your liver enzymes (AST and ALT) are elevated indicates that there is active inflammation in your liver. The viral load of 640 million copies/mL suggests that the virus is highly active, which can lead to further liver damage if not addressed.

Treatment Options
1. Antiviral Medications: The primary treatment for active Hepatitis B involves antiviral medications. The most commonly prescribed antiviral drugs include Entecavir and Tenofovir. These medications work by suppressing the virus, reducing liver inflammation, and preventing further liver damage. It’s crucial to start treatment as soon as possible, especially given your high viral load.

2. Monitoring and Follow-Up: Your doctor has suggested a liver biopsy in three months. This is a standard procedure to assess the extent of liver damage (fibrosis or cirrhosis). It’s important to follow through with this recommendation, as it will help guide your treatment plan.

3. Regular Check-Ups: Regular follow-ups with your healthcare provider are essential. This includes monitoring liver function tests, viral load, and any potential side effects from medications.

Financial Considerations
You mentioned concerns about the cost of treatment. In many countries, including the U.S., there are options for financial assistance or insurance coverage for Hepatitis B treatment. It’s worth discussing with your healthcare provider or a financial counselor at the hospital to explore your options. Some hospitals may have programs that offer treatment at reduced costs or through insurance coverage, especially if you meet certain criteria.

Seeking a Second Opinion
If you feel uncertain about your current treatment plan or the severity of your condition, seeking a second opinion can be beneficial. It’s important to feel confident in your healthcare team and treatment approach. Look for specialists in Hepatology or Infectious Diseases who have experience managing Hepatitis B. You can ask for referrals from your primary care physician or search for reputable medical centers known for their liver disease programs.

Lifestyle Modifications
In addition to medical treatment, certain lifestyle changes can support liver health:
- Avoid Alcohol: Alcohol can exacerbate liver damage, so it’s best to avoid it entirely.

- Healthy Diet: A balanced diet rich in fruits, vegetables, whole grains, and lean proteins can help support liver function.

- Regular Exercise: Maintaining a healthy weight through regular physical activity can also benefit your liver health.

Conclusion
It’s understandable to feel anxious about your diagnosis and treatment options. However, with the right medical care and lifestyle adjustments, many individuals with Hepatitis B can manage their condition effectively. Make sure to communicate openly with your healthcare provider about your concerns and treatment options. Remember, you are not alone in this journey, and there are resources available to help you navigate your treatment.

If you have any further questions or need assistance finding a specialist, please don’t hesitate to reach out. Your health is the priority, and taking proactive steps now can lead to better outcomes in the future.

Best wishes for your health and recovery.

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