Why Does Viral Load Increase After Successful Interferon Treatment for Hepatitis B?

Why does the viral load increase significantly after interferon treatment, even after the HBeAg becomes negative?

Dear Dr.
Lin,
I am a carrier of hepatitis B with positive e-antigen (transmitted from my mother).
I discovered in mid-2008 that my liver began to show signs of inflammation (GOT and GPT levels around 700-800).
After receiving treatment at the hospital, I started a six-month course of interferon therapy.
The entire treatment course ended in January 2009, followed by six months of monitoring.
Initially, the results seemed promising (with a decrease in viral DNA levels and normalization of GOT and GPT values), and the e-antigen converted from positive to negative.
However, during my follow-up this month, I found that my liver enzyme levels had risen again (200-300), and the viral DNA count had significantly increased, although the e-antigen remained negative.
I have the following concerns:
1) I clearly transitioned from "e-antigen positive to negative" (which I understood as a decrease in viral replication capacity), yet the viral load has increased significantly after this transition, and my GOT and GPT levels have risen again.
Since the interferon did not show any resistance, why has the virus that I thought was suppressed reactivated? Does this mean the treatment was a failure?
2) Can I undergo interferon treatment again? (I hope to avoid lifelong medication.)
3) Regarding my initial application for health insurance coverage for the interferon treatment, can I apply again? Or is the health insurance coverage limited to only one instance for a lifetime?
Thank you very much for your response amidst your busy schedule.
I greatly appreciate it!
Sincerely,
Ajie

A Jie, 20~29 year old female. Ask Date: 2009/10/22

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello,
1.
In patients with hepatitis B, after six months of interferon treatment, the rate of e-antigen seroconversion is approximately 30%.
The rate of HBV-DNA < 5 x 10^5 copies/ml and normal ALT levels is about 24%.
The benefits of interferon treatment include no development of resistance, a fixed treatment duration, and if effective, the effects are more durable.
There may also be delayed responses, such as a continuous decline in the virus and even seroconversion of HBsAg.
However, there are still some more resilient strains of hepatitis B virus, where the e-antigen may revert to positive or the viral load may continue to rise, thus follow-up is recommended.

2.
According to current health insurance reimbursement regulations, after a one-year observation period of interferon treatment, if a relapse occurs and is assessed to meet the criteria, oral antiviral medications for hepatitis B can also be used.

3.
It is recommended to regularly monitor viral load and liver function, and to initiate appropriate treatment at the right time.

Wishing you health,
Dr.
Lin Ming-Hui, Taoyuan Hospital, Department of Health

Reply Date: 2009/10/22

More Info

Hello 阿杰,
Thank you for reaching out with your concerns regarding your Hepatitis B treatment and the recent changes in your viral load and liver function tests. Your situation is indeed complex, and I will do my best to address your questions based on current medical understanding.

1. Viral Load Increase After Interferon Treatment: It is not uncommon for patients to experience fluctuations in viral load after completing a course of interferon therapy. While interferon can effectively reduce viral replication and lead to seroconversion (like your e-antigen turning negative), it does not guarantee a permanent suppression of the virus. The increase in viral load you are experiencing, despite the e-antigen remaining negative, could be due to several factors. One possibility is the emergence of viral mutations that allow the virus to escape the immune response or antiviral effects. Additionally, the immune system may not have fully cleared the virus, and the initial response to treatment may have been temporary.
2. Is Treatment Considered a Failure?: While it may feel like a setback, it does not necessarily mean that the treatment was a failure. The fact that your e-antigen has turned negative is a positive sign, indicating a change in the virus's activity. However, the increase in viral load suggests that ongoing monitoring and possibly additional treatment may be necessary. It is essential to discuss this with your healthcare provider, who can evaluate your specific situation and determine the best course of action.

3. Re-Treatment with Interferon: You may be eligible for another course of interferon therapy, but this decision should be made in consultation with your hepatologist. They will consider factors such as your overall liver health, previous response to treatment, and any potential side effects. There are also other antiviral medications available that may be more suitable for your situation, such as nucleos(t)ide analogs, which can provide long-term viral suppression without the need for lifelong treatment.

4. Health Insurance Coverage for Interferon: Regarding your question about health insurance coverage for interferon treatment, policies can vary significantly. Generally, many health insurance plans may cover a course of treatment once, but it is essential to check with your specific plan. If you are considering re-treatment, your healthcare provider may need to provide documentation to justify the medical necessity for the insurance company.

In summary, while the increase in your viral load and liver enzymes is concerning, it is crucial to approach this situation with a comprehensive plan. Regular monitoring, open communication with your healthcare team, and possibly exploring alternative treatment options will be vital in managing your Hepatitis B effectively.
Please ensure you have regular follow-ups with your hepatologist, as they will provide the most tailored advice based on your health status. I wish you the best in your treatment journey and hope for a positive outcome.

Take care,
Doctor Q&A Teams

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