Is a High HBV DNA Level of 15 Million Serious for My Health?

A HBV DNA level of over 15 million copies is considered very high and indicates a significant viral load. This can suggest active hepatitis B infection and may require further evaluation and management by a healthcare professional?

Hello Dr.
Li: I am 47 years old and have been a carrier of hepatitis B for 20 years.
In 2000, I was treated with interferon therapy, and after achieving e-antibody positivity and nearly undetectable HBV DNA, I discontinued the medication after about 4 months.
In October 2007, my hepatitis relapsed, with an ALT level of 193 and HBV DNA over 2 million.
I underwent interferon treatment again, and after 5 months, my HBV DNA dropped below 100, leading to another discontinuation of treatment.
During that time, I experienced many side effects that made me very uncomfortable, and I was unwilling to continue taking the medication.
My ALT was below 40 and HBV DNA was below 100, so I requested my doctor to stop the treatment, even though the doctor recommended continuing for another six months.
In June 2008, I felt unwell, and my tests showed ALT levels of 268, 293, and 304, with HBV DNA at over 15 million.
I have now started taking Baraclude (entecavir) 0.5 mg once daily.

1.
Is my hepatitis condition severe?
2.
What level of HBV DNA is considered severe, and what does it represent?
3.
How long is the correct treatment duration for Baraclude, and is it always out-of-pocket? What are the criteria for discontinuing treatment?

YY, 40~49 year old female. Ask Date: 2008/06/30

Dr. Li Xuanshu reply Gastroenterology and Hepatology

Hello Yy,
1.
In your letter, you mentioned that your HBV DNA is over 15 million (is the unit IU/ml or copies/ml?).
When assessing HBV DNA, it is important to evaluate the unit of measurement.
Regardless of the unit, a level of over 15 million indicates a very high viral load.
Additionally, your GPT values are also more than five times the normal range (with three tests showing GPT levels of 268, 293, and 304), indicating an acute exacerbation of chronic hepatitis, with active viral replication.
In severe cases, this could potentially progress to fulminant hepatic failure.
Since you provided limited information, we are unable to assess the severity of your hepatitis.
We hope you can provide us with more complete data: Do you have a liver biopsy report? What are your bilirubin levels? Albumin levels? Coagulation time? Results from abdominal ultrasound? This information will help us provide you with further clarification.
2.
HBV DNA (Hepatitis B virus deoxyribonucleic acid) refers to the concentration of the Hepatitis B virus.
Research indicates that when HBV DNA is greater than 10^4 copies/ml and GPT is elevated by 2-5 times, treatment should be considered.
We aim to control HBV DNA to an undetectable state.
3.
Generally, the timing for stopping antiviral medication is based on the 2008 Asia-Pacific Consensus on Hepatitis B treatment: (1) For patients who were initially HBeAg positive, if HBeAg has successfully converted to HBeAb positive and HBV DNA is undetectable in two tests at least six months apart, discontinuation of medication may be considered.
(2) For patients who were initially HBeAg negative, the duration of treatment is unclear, but if HBV DNA is undetectable in three tests at least six months apart, it may be considered to stop medication.
Therefore, we need to know whether your current HBeAg is positive or negative, and whether HBeAb has developed.
You can discuss your situation with your physician during treatment.
Currently, in Taiwan, the use of antiviral medication such as Tenofovir is out-of-pocket and not covered by health insurance.
Additionally, I would like to inform you that your previous treatment with Entecavir was too short, making relapse inevitable.
Generally, treatment should last at least one to two years, but the duration should be based on your response to the medication.
This aspect should be discussed with your attending physician, so please make sure to consult your hepatologist about your appropriate treatment timeline.
Thank you for your letter.
If there are any details that are not fully addressed, please feel free to reach out again.
Additionally, the foundation has a liver disease consultation hotline at 0800-000583, where professionals and volunteers provide online consultation services.
We also have free publications on liver health and a small handbook on Hepatitis B treatment available for your reference.
Wishing you good health,
The Foundation for the Prevention of Liver Disease Academic Foundation

Reply Date: 2008/06/30

More Info

When evaluating your health in relation to a high HBV DNA level of 15 million (or 15,000,000 IU/ml), it is essential to understand the implications of this viral load and its potential impact on your liver health.
1. Severity of Your Hepatitis Status: Given your history of chronic hepatitis B and the recent laboratory results showing elevated liver enzymes (GPT levels of 268, 293, and 304), alongside a significantly high HBV DNA level, it indicates that your hepatitis B infection is currently active and replicating. This situation is concerning because elevated liver enzymes suggest inflammation or damage to liver cells, which can lead to more severe liver conditions, including cirrhosis or liver cancer if left untreated. The high HBV DNA level signifies that there is a substantial viral load in your bloodstream, which correlates with increased liver inflammation and a higher risk of liver-related complications.

2. Understanding HBV DNA Levels: Generally, an HBV DNA level greater than 20,000 IU/ml is considered high and indicates active viral replication. In your case, with a level of 15 million IU/ml, this is significantly elevated and suggests that the virus is actively multiplying. This level of viral load is associated with a higher risk of liver damage and complications, including the potential for acute exacerbations of hepatitis, which can lead to severe liver injury. Therefore, it is crucial to monitor your liver function closely and consider antiviral therapy if not already initiated.

3. Treatment with Baraclude (entecavir): You mentioned that you have started taking Baraclude (entecavir) at a dosage of 0.5 mg per day. This medication is an antiviral agent that helps suppress HBV replication. The duration of treatment can vary based on individual response and the presence of liver damage. Typically, treatment is recommended for at least several years, and in some cases, it may be a lifelong commitment, especially in chronic cases like yours. The goal of treatment is to achieve an undetectable HBV DNA level, which can take time and consistent adherence to the medication.

4. Cost and Insurance Considerations: In many healthcare systems, antiviral medications like Baraclude may not be covered by insurance, especially if specific criteria are not met. It is essential to discuss with your healthcare provider about the financial aspects of your treatment and explore options for assistance if needed.

5. Criteria for Stopping Treatment: The decision to stop antiviral therapy is complex and should be made in consultation with your healthcare provider. Generally, treatment may be considered for discontinuation if the following criteria are met:
- Sustained undetectable HBV DNA levels for a specified duration (often at least 12 months).

- Normalization of liver enzymes (GOT/GPT) consistently.

- Absence of significant liver fibrosis or cirrhosis, often assessed through liver biopsy or non-invasive tests.

In summary, your current health status, characterized by a high HBV DNA level and elevated liver enzymes, indicates a serious condition that requires ongoing monitoring and treatment. It is crucial to maintain regular follow-ups with your healthcare provider to assess liver function, monitor viral load, and adjust treatment as necessary. Early intervention and adherence to antiviral therapy can significantly improve your long-term health outcomes and reduce the risk of severe liver complications.

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