Chronic Hepatitis B: Key Questions and Concerns - Gastroenterology and Hepatology

Q: Chronic Hepatitis B: Key Questions and Concerns

Hello! 1. <br>To qualify for health insurance coverage, you need to have an e-antigen report. <br>I'm not sure if you have been tested for this, as well as for Hepatitis C and Hepatitis D. <br>Since your GPT level is above 200, if the e-antigen is positive and Hepatitis C and D i

Am I considered a severe carrier of hepatitis B?

Hello Doctor: First, I would like to share my family's medical history: My mother was once your patient and passed away at 55 due to severe jaundice, ascites, and cirrhosis caused by hepatitis B.
My grandmother also died from liver disease.
My uncle passed away at 48 due to fulminant hepatitis, presenting with jaundice.
In two years, three family members have died from liver disease, creating a pervasive atmosphere of concern about liver disease in my family.
I finally mustered the courage to go for a check-up.
I am 31 years old, and my medical history is as follows: At 15, during a school health examination, I was confirmed as a "healthy carrier of hepatitis B." At 23, during military service screening, I was still a carrier.
From ages 23 to 24, I had follow-up checks every six months, with GOT levels between 60-80 and GPT levels between 40-80.
In 2001, at age 25, I underwent testing at Jingmei Hospital for insurance purposes, confirming that I was a carrier of hepatitis B.
In April of last year, I participated in a free liver cancer screening at a hospital and received a "normal" notification.
In October of last year, I went to a private health check-up center, and the results were as follows: GOT: 250, GPT: 230, AFP: 30, with mild fatty liver observed.
An ultrasound indicated a small bubble in the liver, with no signs of jaundice and a slightly low white blood cell count.
This March, I went to a major hospital for testing (after fasting for eight hours): Glucose (AC): 80 mg/dl, GOT: 649 U/L, GPT: 1154 U/L, HBsAg: positive, HBsAg ratio: 4021, Anti-HBs: <2 IU/L.
This week, I had a recheck (without fasting for eight hours): Glucose (AC): report not available, GOT: 573 U/L, GPT: 1202 U/L, Bilirubin T: 0.9 mg/dl.
An ultrasound showed splenomegaly, but no abnormalities in the liver.

My questions are as follows: The doctor suggested taking Entecavir for 21 days and then checking liver enzyme levels for changes.
If the levels decrease, it indicates the presence of the virus.
A liver biopsy is not recommended at this time due to lack of insurance coverage.
The current criteria for insurance coverage of Entecavir require that ALT levels be more than five times the normal value and that the e-antigen be positive, to prevent misuse of the medication and the development of drug-resistant viruses.

Question 1: Do I meet the criteria for insurance coverage of Entecavir? The doctor mentioned that abnormal liver function is not necessarily caused by the hepatitis B virus; sometimes, fatty liver or autoimmune liver diseases can also lead to elevated liver function tests, and patients with these conditions may not benefit from hepatitis B treatment with Entecavir, which could instead lead to side effects.

Question 2: If my abnormal levels are indeed due to fatty liver, then I should not take Entecavir.
Why did the doctor recommend it?
Question 3: How should I actively treat my liver in the future?
Question 4: I just got married and plan to have children.
Will taking Entecavir affect the health of my future children?
Question 5: I have a month’s supply of expired Entecavir at home.
If it has not been exposed to moisture, will taking it affect my health?
Question 6: I know I shouldn't take medications indiscriminately, but there are popular health supplements like vitamin B complex and spirulina for liver disease.
Will these affect my health?
I sincerely appreciate your assistance with these questions!

Su Xiansheng, 30~39 year old female. Ask Date: 2008/04/08

Dr. Xu Jinchuan reply Gastroenterology and Hepatology

Hello! 1.
To qualify for health insurance coverage, you need to have an e-antigen report.
I'm not sure if you have been tested for this, as well as for Hepatitis C and Hepatitis D.
Since your GPT level is above 200, if the e-antigen is positive and Hepatitis C and D infections have been ruled out, along with factors like drug-induced liver injury or fatty liver, then you may be eligible for health insurance coverage.
2.
Fatty liver typically does not cause liver enzyme levels to rise above 1000, but if it is confirmed to be caused by fatty liver, there is no need to use Interferon, as it would not be effective.
3.
Please closely coordinate with your attending physician.
4.
Is Interferon safe for fertility? Currently, there is not enough research evidence, but it is generally recommended to avoid using the medication during this period.
5.
As long as the medication has not been opened, contaminated, or exposed to moisture, it should be fine.
6.
Vitamin B complex should not pose any issues, but there is currently insufficient data to confirm the benefits of spirulina, and it is unclear whether it may have adverse effects on the body.
Given your current condition, it is best to keep things simple to avoid confusing your medical situation.

Reply Date: 2008/04/08

More Info

Chronic Hepatitis B (CHB) is a significant public health concern, particularly in families with a history of liver disease, as you've described. Your family history of severe liver complications, including cirrhosis and liver cancer, underscores the importance of monitoring and managing your condition effectively. Let's address your questions and concerns regarding your health and treatment options.

Question 1: Eligibility for Treatment with Interferon (干安能)
Based on the information provided, your liver function tests (GOT and GPT) are significantly elevated, which may suggest active liver inflammation. The criteria for receiving interferon treatment under the National Health Insurance (NHI) in Taiwan typically require an ALT level that is five times the normal limit and a positive e-antigen (HBeAg). Given your elevated liver enzymes, you may meet the ALT criteria, but the HBeAg status is crucial. If your HBeAg is negative, this may affect your eligibility for interferon treatment under NHI guidelines. It is essential to discuss this with your healthcare provider, who can assess your specific situation and determine the best course of action.

Question 2: Potential Impact of Fatty Liver on Treatment
You mentioned that your doctor indicated that liver function abnormalities could be due to factors other than the Hepatitis B virus, such as fatty liver disease or autoimmune liver conditions. If fatty liver is indeed contributing to your elevated liver enzymes, then using interferon may not be effective, as it primarily targets viral replication. In such cases, addressing lifestyle factors contributing to fatty liver—such as diet, exercise, and weight management—would be more beneficial. It is crucial to have a comprehensive evaluation to determine the exact cause of your liver enzyme elevation before proceeding with antiviral therapy.

Question 3: Future Management of Your Liver Health
To actively manage your liver health, consider the following steps:
1. Regular Monitoring: Continue regular follow-ups with your healthcare provider to monitor liver function tests and assess any changes in your condition.

2. Lifestyle Modifications: Adopt a healthy lifestyle, including a balanced diet low in saturated fats and sugars, regular physical activity, and maintaining a healthy weight. These changes can significantly impact liver health, especially in cases of fatty liver.

3. Avoid Alcohol: Given your history of Hepatitis B, it is crucial to avoid alcohol, as it can exacerbate liver damage.

4. Vaccination and Screening: Ensure that you and your family members are vaccinated against Hepatitis A and B, and consider regular screenings for liver cancer, especially given your family history.

Question 4: Impact of Interferon on Future Pregnancy
Interferon treatment can have implications for pregnancy. While some studies suggest that interferon may not pose significant risks during pregnancy, it is essential to consult with your healthcare provider regarding the timing of treatment and family planning. They can provide personalized advice based on your health status and treatment plan.

Question 5: Expired Medication
Using expired medications is generally not recommended, as they may not be effective and could potentially pose health risks. If the interferon has been stored properly and is only slightly past its expiration date, it may still be effective, but it is best to consult a pharmacist or healthcare provider for guidance.

Question 6: Supplements and Health Foods
While some health supplements, such as vitamin B complex and spirulina, are popular among individuals with liver conditions, their efficacy and safety can vary. It is essential to consult with your healthcare provider before starting any new supplements, as they may interact with your current medications or affect liver function.

Conclusion
Chronic Hepatitis B requires careful management, especially in the context of a family history of liver disease. Regular monitoring, lifestyle changes, and open communication with your healthcare provider are vital to managing your condition effectively. If you have further questions or concerns, do not hesitate to reach out to your healthcare team for personalized advice and support.

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