Managing Chronic Hepatitis B: Treatment, Resistance, and Monitoring

Hepatitis B Monitoring and Treatment

Hello Dr.
Lin, I have had HBV for a long time.
Last year at this time, I was in the acute phase.
My liver enzymes reached over 2000, and the viral load was about 4 million.
I received treatment with Baraclude 0.5 mg.
My condition improved significantly, and about two months later, my liver enzymes returned to normal.
An ultrasound examination showed no lesions in the liver.
Currently, my liver enzymes are normal, and a month ago, my DNA viral load was 27 (compared to 4 million a year ago and 4000 six months ago).
I am still taking Baraclude 0.5 mg daily.
My lifestyle is normal, and I do not smoke or drink alcohol.
I would like to ask the doctor: 1) Based on the data, Baraclude may lead to drug resistance after about 8 months.
Should I be concerned about drug resistance? 2) When is the appropriate time to stop the medication? If I stop the medication, is there a chance that my liver enzymes will rise? 3) Three months ago, during an abdominal ultrasound, the doctor mentioned that I have small polyps in my gallbladder.
Today, during the ultrasound, the doctor said that I also have polyps in my liver.
Can polyps cause a burden on the liver? Are there treatment options available? Thank you for your assistance, doctor!

Go Away HBV, 20~29 year old female. Ask Date: 2010/11/06

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello,
1.
The resistance to Beclabuvir is not high; in patients who have not previously taken other oral antiviral medications, the resistance rate is only 1% to 3% over five years.

2.
The timing for discontinuation of the medication should be discussed with your physician.
The goal is to achieve seroconversion of the e-antigen, disappearance of HBV-DNA viral load, or the production of s-antigen.
These medications are intended for long-term use, and currently, the National Health Insurance in Taiwan has extended coverage for up to three years.
They primarily suppress HBV replication, and long-term use can improve liver tissue and liver function.
However, after discontinuation, monitoring is necessary as there is a chance of relapse and viral replication, with indices potentially rising.

3.
I am not very clear about the lesions in your liver, as the term "liver polyp" is rarely used.

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

Reply Date: 2010/11/06

More Info

Managing chronic Hepatitis B (HBV) infection requires a comprehensive approach that includes antiviral treatment, monitoring for resistance, and regular follow-up to assess liver health. Your situation, having transitioned from an acute phase to a more stable chronic phase, is a positive development, but it also necessitates careful management.

1. Concerns About Drug Resistance: You mentioned that you are currently on entecavir (known as 贝勒克 in Chinese), which is a first-line antiviral treatment for chronic HBV. While it is true that some patients may develop resistance to antiviral medications, entecavir has a high barrier to resistance. Studies have shown that the rate of resistance to entecavir is low, particularly in patients who adhere to their treatment regimen. However, it is essential to remain vigilant. Regular monitoring of HBV DNA levels is crucial, as an increase in viral load could indicate the development of resistance. If you notice any significant changes in your liver function tests or if your viral load begins to rise again, it would be prudent to consult your healthcare provider for further evaluation.

2. When to Consider Stopping Treatment: The decision to stop antiviral therapy is complex and should be made in consultation with your healthcare provider. Generally, treatment can be considered for discontinuation if the following criteria are met:
- Sustained suppression of HBV DNA to undetectable levels for a significant period (usually at least 12 months).

- Normalization of liver enzymes (ALT and AST).

- Absence of significant liver fibrosis or cirrhosis.

However, stopping treatment can lead to a rebound in viral replication, which may cause liver inflammation and damage. Therefore, careful monitoring is essential after discontinuation. If you do stop treatment, your healthcare provider will likely recommend regular follow-up to monitor liver function and HBV DNA levels.

3. Liver and Gallbladder Polyps: The presence of polyps in the liver and gallbladder, as noted in your ultrasound, is not uncommon. Most gallbladder polyps are benign and do not typically cause symptoms or require treatment unless they are larger than 1 cm or show signs of growth. Liver polyps, or hepatic adenomas, can also be benign but may require monitoring, especially if they are symptomatic or if there is uncertainty about their nature. While polyps themselves do not directly burden the liver, any underlying liver disease, such as chronic hepatitis B, should be managed effectively to prevent complications. Your healthcare provider may recommend follow-up ultrasounds to monitor the size and characteristics of these polyps.

In summary, managing chronic hepatitis B involves regular monitoring of liver function and viral load, adherence to antiviral therapy, and careful evaluation of any new findings such as polyps. It is crucial to maintain open communication with your healthcare provider to address any concerns and to adjust your treatment plan as necessary. Regular follow-ups and adherence to a healthy lifestyle, including avoiding alcohol and maintaining a balanced diet, will contribute to your overall liver health.

Similar Q&A

Understanding Hepatitis B: Treatment Resistance and Monitoring

Hello Dr. Lin, I am a carrier of Hepatitis B. I have been on treatment with ETV (entecavir) for three years. In December and June of last year, my viral load was undetectable, but this June, the viral load was measured at 28. However, the E antigen, which is currently positive, h...

Dr. Lin Minghui reply Gastroenterology and Hepatology
1) Hepcludex is used for chronic hepatitis B, and the chance of developing drug resistance is very low. 2) GPT: 49 indicates elevated liver enzymes; besides hepatitis B, other possible causes such as medications, infections, or non-compliance with medication should be considered....

Managing Chronic Hepatitis B: To Treat or Not to Treat?

Hello, doctor. Recently, I was monitored for hepatitis B and tested positive for HBsAg, with a value of 3442.72 S/CO; HBV DNA at 29,680,000 IU/mL; and GPT at 48 IU/L. Currently, I do not have any significant discomfort, but I have seen various reports online about relapses and fl...

Dr. Chen Shidian reply Gastroenterology and Hepatology
1. Prioritize treatment. 2. After the treatment course, it is essential to comply with follow-up to check for recurrence; if necessary, timely re-treatment can be administered. 3. Do not oppose lifelong (out-of-pocket) medication for individuals.

Managing Chronic Hepatitis B: Treatment Options and Recommendations

Hello everyone, I have chronic active hepatitis B with a fibrosis scan result of F1. My viral load is only 35,000 copies/ml (7 KIU/ml). I have previously taken urose and silymarin, and my GPT levels have been fluctuating but remain stable. I am HBeAg negative and received a short...

Dr. Chen Shidian reply Gastroenterology and Hepatology
Hello, sir. Please maintain a regular schedule and have regular follow-ups. If your financial situation allows, consider having a FibroScan once a year to determine whether antiviral medication is necessary. Changhua Hospital cares about your health. Sincerely, Chen Shih-Tien.

Managing Chronic Hepatitis B with Abnormal Liver Function: Key Considerations

Hello, doctor. I am a carrier of vertical transmission hepatitis B and have been monitoring my liver function annually since childhood, which has always been normal. This year, on May 20, my AST was 43, ALT was 918, and on May 20, my AST was 97 and ALT was 213. Both HBsAg and HBe...

Dr. Sun Yizhen reply Internal Medicine
Hello, you can visit the Gastroenterology and Hepatology outpatient clinic for an actual assessment by a physician, who will then provide recommendations. Thank you!