Hepatitis B: Key Questions on Viral Load and Treatment Options

Hepatitis B issues

Hello Dr.
Lin: I am a carrier of hepatitis B and have regular check-ups every year.
Earlier this year, I underwent tests, and the results showed that both GOT and GPT levels were normal, AFP was 2.7, e-antigen was negative, e-antibody was positive, and the abdominal ultrasound was normal.
However, the qualitative test for hepatitis B virus was positive (quantitative result was 990 IU/ml or 0.052 pg/ml).
I would like to ask you: 1.
Is it possible for the e-antigen to turn positive again and the e-antibody to turn negative in the future? 2.
Is this level of hepatitis B virus considered high? Is there a need for further treatment? Thank you!

Mr. Li, 30~39 year old female. Ask Date: 2009/04/28

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello,
1.
The e antigen may turn negative again, but the chances are low.
Those who have spontaneously cleared the e antigen are less likely to experience this.
However, individuals who have received antiviral medication may have a chance of turning e antigen negative, although the rate is low.
2.
Currently, your status shows e antigen negative and e antibody positive, with HBV-DNA at 990 IU/ml.
The viral load is not high at this time.
It is recommended to consider treatment only if the viral load exceeds 10,000 IU/ml or if there are abnormal liver function tests.
Currently, no further treatment is necessary; please focus on liver protection and regular follow-up.
Wishing you good health,
Dr.
Lin Ming-Hui, Taoyuan Hospital, Department of Health

Reply Date: 2009/04/28

More Info

Hello! Thank you for your questions regarding Hepatitis B and its treatment options. Understanding the nuances of Hepatitis B is crucial for managing the condition effectively. Let’s address your inquiries step by step.

1. Can HBeAg turn positive again while HBeAb turns negative?
Yes, it is possible for HBeAg to turn positive again after being negative, and for HBeAb to turn negative as well. This phenomenon can occur due to various reasons, including viral mutations or changes in the immune response. In some cases, the virus may undergo mutations that allow it to evade the immune system, leading to a reactivation of the virus. This is particularly relevant in patients who have previously cleared the virus or have achieved seroconversion. Regular monitoring of these markers is essential to detect any changes early.

2. Is a viral load of 990 IU/ml concerning, and is treatment necessary?
A viral load of 990 IU/ml is considered low, especially in the context of Hepatitis B. The decision to initiate treatment is not solely based on viral load; it also depends on liver function tests (like ALT levels), the presence of liver inflammation or fibrosis, and the overall clinical picture. Since your liver function tests (GOT/GPT) are normal and your AFP level is within the normal range, it suggests that there is currently no significant liver damage.
The guidelines generally recommend treatment for patients with chronic Hepatitis B who have elevated ALT levels, significant liver inflammation, or evidence of liver fibrosis. In your case, since your liver function is normal and you are asymptomatic, immediate treatment may not be necessary. However, it is crucial to continue regular monitoring to ensure that the situation does not change.

3. Understanding the importance of monitoring and treatment options:
Regular monitoring is vital for individuals with Hepatitis B. This includes liver function tests, viral load assessments, and imaging studies like ultrasound to evaluate liver health. If there are any significant changes in your liver function tests or if your viral load increases, your healthcare provider may recommend starting antiviral therapy.

Antiviral treatments for Hepatitis B include medications such as tenofovir and entecavir, which are effective in suppressing the virus and reducing liver inflammation. These medications are generally well-tolerated and can significantly lower the risk of liver-related complications, including cirrhosis and liver cancer.

4. Lifestyle considerations:
In addition to medical treatment, lifestyle modifications can play a crucial role in managing Hepatitis B. Maintaining a healthy diet, avoiding alcohol, and managing any other health conditions (such as diabetes or obesity) can help protect your liver. Regular exercise and stress management techniques can also contribute to overall well-being.

5. Conclusion:
In summary, while your current viral load is low and your liver function tests are normal, it is essential to continue regular monitoring and maintain open communication with your healthcare provider. If there are any changes in your condition, such as elevated liver enzymes or increased viral load, treatment options can be discussed at that time. Always consult with your healthcare provider before making any changes to your treatment plan or lifestyle.

Feel free to reach out if you have more questions or need further clarification on any aspect of your health!

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