Managing Chronic Hepatitis B: When to Start Treatment and Testing

Q: Managing Chronic Hepatitis B: When to Start Treatment and Testing

Hello, sir： The e antigen and viral load can represent the "virulence" of the virus, which may increase the chances of future outbreaks or long-term complications such as liver cirrhosis or liver cancer. <br>However, despite advancements in medical technology, there is still no m

Could you please specify your question regarding hepatitis B?

I am a carrier of hepatitis B, which was detected during a blood test when I was 18 years old in high school.
Now I am 27.
There have been a few instances where my liver enzymes spiked to 4 to 5 times the normal level, but that was during periods of sleep deprivation.
Since then, I have normalized my lifestyle, and my liver enzymes and follow-up ultrasounds are all normal.
Therefore, I have not yet developed the disease.
Some information suggests that using antiviral medications or interferon may potentially lead to the hepatitis B surface antigen turning from positive to negative.

1.
I would like to ask the doctor if I should start taking these medications now, even though I have not developed the disease yet.

2.
Additionally, should I undergo further testing related to hepatitis B, such as viral load, e-antigen, and antibody levels? Do these have any specific significance? I am getting married this year or next, and the issue of hepatitis B is really concerning for me.
However, I firmly believe that prevention is better than treatment, so I am being very cautious.

A-Qiang, 20~29 year old female. Ask Date: 2010/06/09

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, sir: The e antigen and viral load can represent the "virulence" of the virus, which may increase the chances of future outbreaks or long-term complications such as liver cirrhosis or liver cancer.
However, despite advancements in medical technology, there is still no medication available that can long-term clear the virus while liver function remains normal (where immunity is relatively low - coexisting peacefully with the virus) in order to produce antibodies.
Therefore, it is recommended to closely monitor your condition.
Changhua Hospital cares about your health.
Chen Shidian.

Reply Date: 2010/06/09

More Info

Managing chronic Hepatitis B can be a complex process, especially for individuals who have been diagnosed as carriers for many years. In your case, having been diagnosed with Hepatitis B at 18 and now being 27, it’s understandable that you have concerns about your health and the implications of your condition, especially as you prepare for marriage.

1. When to Start Treatment: The decision to initiate antiviral therapy for chronic Hepatitis B is typically based on several factors, including liver function tests (LFTs), the presence of liver inflammation, and the level of viral replication. According to current guidelines, treatment is generally recommended if:
- Alanine aminotransferase (ALT) levels are persistently elevated (usually more than twice the upper limit of normal).

- There is evidence of significant liver inflammation or fibrosis (often assessed through liver biopsy or non-invasive methods like FibroScan).

- The Hepatitis B virus (HBV) DNA levels are high (usually above 20,000 IU/mL for HBeAg-positive individuals or above 2,000 IU/mL for HBeAg-negative individuals).

Since you mentioned that your liver function tests have been normal and you have not experienced significant liver inflammation, it may not be necessary to start antiviral therapy at this time. However, regular monitoring is essential to ensure that your liver remains healthy and that there are no changes in your condition.

2. Further Testing: It is advisable to continue regular monitoring of your liver health. Key tests to consider include:
- HBV DNA Quantification: This test measures the amount of virus in your blood and helps assess the level of viral replication.

- HBeAg and Anti-HBe Testing: These tests help determine the phase of your Hepatitis B infection. HBeAg positivity indicates active viral replication, while the presence of Anti-HBe suggests that the virus is less active.

- Liver Function Tests (LFTs): Regular monitoring of ALT and AST levels can help detect any liver inflammation.

- Liver Imaging: Periodic ultrasounds or FibroScan can help assess liver structure and fibrosis.

These tests provide valuable information about the activity of the virus and the state of your liver, guiding decisions about treatment and management.

3. Concerns About Treatment: You mentioned the possibility of antiviral medications or interferon leading to a seroconversion (the HBsAg turning negative). While this is a goal of treatment, it is important to note that not all patients achieve this outcome. Antiviral medications, such as tenofovir or entecavir, are effective at suppressing the virus but do not eliminate it. Interferon can lead to a functional cure in some patients, but it has a lower success rate and can have significant side effects.

4. Lifestyle Considerations: Maintaining a healthy lifestyle is crucial in managing Hepatitis B. This includes avoiding alcohol, maintaining a balanced diet, managing stress, and ensuring regular follow-ups with your healthcare provider.

5. Future Considerations: As you prepare for marriage, it’s important to discuss your Hepatitis B status with your partner. They may want to consider vaccination against Hepatitis B if they are not already immune. Open communication about your health can help alleviate concerns and ensure both partners are informed.

In summary, while you are currently stable, regular monitoring and testing are essential to manage your chronic Hepatitis B effectively. If your liver function tests remain normal and there are no signs of significant liver disease, immediate treatment may not be necessary. However, staying vigilant and proactive about your health is key, especially as you plan for the future. Always consult with your healthcare provider to tailor a management plan that suits your specific situation.

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