Active Hepatitis B Infection: A Guide for Patients - Gastroenterology and Hepatology

The original hepatitis B carrier currently has a very active viral infection?

A 31-year-old male, who is a carrier of hepatitis B, underwent a health check and found that his liver enzymes were elevated, reaching nearly 500.
Further tests at a larger hospital confirmed that he is actively infected with the virus, with a viral load of 640 million.
Although he does not fully understand the implications, the doctor has recommended a liver biopsy in three months for further evaluation and treatment.
Initially, he did not perceive the situation as serious, but after reviewing a booklet provided by the doctor, he realized the severity of his condition.
He discovered that the treatment could cost around 200,000 NTD over six months, and upon researching online, he found that some hospitals might offer coverage under the National Health Insurance.
He is now uncertain about what steps to take next.

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

Dr. Li Xuanshu reply Gastroenterology and Hepatology

Hello Jenny!
1.
According to the doctor, 640 million → without the testing unit attached, if the unit is copies/mL, then the viral load is very high.

2.
A biopsy is needed before treatment → is it recommended to undergo interferon therapy? 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 NTD.
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 renowned 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

Understanding Active Hepatitis B Infection: A Guide for Patients
Active Hepatitis B infection is a significant health concern, particularly for individuals who have been diagnosed as carriers of the virus. In your case, at 31 years old, the discovery of elevated liver enzymes (AST and ALT) and a high viral load (640 million copies/ml) indicates that your Hepatitis B infection is currently active and potentially damaging to your liver. This situation necessitates careful monitoring and management to prevent further complications, including liver cirrhosis or liver cancer.

What is Active Hepatitis B Infection?
Active Hepatitis B infection occurs when the Hepatitis B virus (HBV) is replicating in the liver, leading to inflammation and damage. This is typically indicated by elevated liver enzymes in blood tests, such as AST and ALT. The presence of high viral loads suggests that the virus is actively multiplying, which can lead to more severe liver damage over time.

Importance of Monitoring and Treatment
Your doctor’s recommendation to undergo a liver biopsy in three months is crucial. A liver biopsy helps assess the extent of liver damage or fibrosis, which is essential for determining the appropriate treatment plan. The biopsy results will guide whether antiviral therapy is necessary and which medications may be most effective.

Treatment Options
Antiviral medications, such as Entecavir or Tenofovir, are commonly used to manage active Hepatitis B infections. These medications work by suppressing the virus, reducing liver inflammation, and preventing further liver damage. While some patients may have to pay out-of-pocket for these treatments, many hospitals and clinics offer options that are covered by health insurance, depending on your specific plan and local regulations. It's essential to discuss with your healthcare provider about the costs and potential insurance coverage for your treatment.

Lifestyle Considerations
In addition to medical treatment, lifestyle changes can significantly impact your liver health. Here are some recommendations:
1. Avoid Alcohol: Alcohol can exacerbate liver damage and should be avoided entirely.

2. Healthy Diet: Focus on a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Avoid fatty, fried, and processed foods.

3. Regular Exercise: Engaging in regular physical activity can help maintain a healthy weight and improve overall liver function.

4. Regular Check-ups: Keep up with regular medical appointments and follow your doctor’s advice regarding monitoring your liver health.

Emotional Support and Resources
Receiving a diagnosis of active Hepatitis B can be overwhelming. It’s essential to seek support from healthcare professionals, family, and friends. Additionally, consider connecting with support groups or organizations focused on liver health and Hepatitis B. They can provide valuable resources and emotional support as you navigate your treatment journey.

Conclusion
While the diagnosis of active Hepatitis B infection can be alarming, it is manageable with proper medical care and lifestyle adjustments. Stay informed about your condition, adhere to your treatment plan, and maintain open communication with your healthcare provider. Remember, early intervention and consistent management can lead to better health outcomes and a more positive quality of life. If you have further questions or concerns about your treatment options or the financial aspects of your care, do not hesitate to reach out to your healthcare team for guidance.

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