Should I Treat High Viral Load with Medication Despite Allergies?

Q: Should I Treat High Viral Load with Medication Despite Allergies?

Hello： (1) The e antigen is positive, liver function tests are normal, and the viral load is high. <br>It is recommended to consider the degree of liver fibrosis in the patient and whether there is cirrhosis. <br>Continued monitoring is advised, and understanding the effects of p

Hepatitis B e antigen positive with a viral load of 800 million. GTP and GOT levels are normal. Should treatment be initiated?

I am 40 years old this year and I am positive for hepatitis B e-antigen with a viral load of 800 million.
My serum e-antigen level is 1452, and my GTP (GOT) levels are 18 and 20.
The physician has recommended medication treatment, mentioning that it is a drug that "binds" the virus (without specifying which drug).
The medication is out-of-pocket and needs to be taken for 3-5 years.
The physician stated that the drug has no side effects, but I have a tendency to be allergic and can even have allergic reactions to antihistamines.
Do I really need to take medication to eliminate the virus? Is it true that there are no side effects? Should I take the medication?

Eunice, 40~49 year old female. Ask Date: 2011/04/12

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello: (1) The e antigen is positive, liver function tests are normal, and the viral load is high.
It is recommended to consider the degree of liver fibrosis in the patient and whether there is cirrhosis.
Continued monitoring is advised, and understanding the effects of pharmacological treatment is important.
(2) Antiviral medications are necessary to eliminate and suppress the virus.
Currently, there are five oral antiviral medications and injectable interferon treatments available for hepatitis B.
The oral medications chosen should have low resistance and strong antiviral effects, with fewer side effects compared to interferon.
(3) Based on the current situation, if medication is to be used, the treatment goals should include not only reducing the viral load but also achieving e antigen seroconversion.
The seroconversion rate for oral medications or interferon treatment is approximately 20-30%.
Long-acting interferon treatment lasts for one year, while the duration of oral antiviral medication is variable and may require long-term use.
The benefits of medication include long-term viral control, preventing further liver inflammation and deterioration.
With long-term medication use, if no resistance develops, liver tissue fibrosis may improve.
Wishing you good health, Dr.
Lin Ming-Hui, Taoyuan Hospital, Department of Health.

Reply Date: 2011/04/12

More Info

When considering treatment for a high viral load, particularly in the context of hepatitis B (as suggested by your e-antigen positivity and high viral load), it is essential to weigh the benefits of antiviral therapy against the potential risks, especially given your history of allergies.
Hepatitis B virus (HBV) can lead to serious liver complications, including cirrhosis and hepatocellular carcinoma, particularly when the viral load is significantly high, as in your case (800 million copies). The presence of e-antigen (HBeAg) indicates active viral replication, which is a critical factor in determining the need for treatment.
Antiviral medications, such as tenofovir or entecavir, are commonly used to suppress HBV replication. These medications can significantly reduce the viral load, improve liver function, and decrease the risk of liver-related complications. While the majority of patients tolerate these medications well, side effects can occur, including but not limited to renal impairment, gastrointestinal symptoms, and, in rare cases, hypersensitivity reactions. Given your history of allergies, it is crucial to discuss this with your healthcare provider.
Here are some considerations regarding your situation:
1. Need for Treatment: The decision to initiate antiviral therapy should be based on several factors, including your viral load, liver function tests (such as ALT levels), and the presence of liver inflammation or damage. In your case, with a viral load as high as 800 million, treatment is generally recommended to prevent liver damage.

2. Allergy Concerns: Since you have a history of allergies, it is vital to inform your doctor about your sensitivities. They may consider prescribing a medication that has a lower risk of causing allergic reactions. Additionally, they can monitor you closely for any adverse reactions during the initial phase of treatment.

3. Potential Side Effects: While your doctor mentioned that the medication has no side effects, it is important to understand that all medications can have potential side effects, and individual responses can vary. It is advisable to have a detailed discussion with your healthcare provider about the specific medication they are recommending, including its side effects and how they plan to manage any potential allergic reactions.

4. Alternative Options: If you are highly concerned about taking medication due to your allergies, discuss alternative management strategies with your doctor. In some cases, lifestyle modifications, regular monitoring, and supportive care may be appropriate, but these should be tailored to your specific situation and the severity of your liver disease.

5. Long-term Commitment: Antiviral therapy for hepatitis B is often a long-term commitment, typically lasting several years. It is essential to consider your willingness and ability to adhere to the treatment plan, especially if it involves self-financing.

In conclusion, while antiviral therapy is often necessary for managing high viral loads in hepatitis B, your unique situation regarding allergies requires careful consideration and open communication with your healthcare provider. It is crucial to weigh the risks and benefits of treatment and to explore all available options, including potential alternatives or adjustments to the treatment plan that can accommodate your allergy concerns. Always prioritize a collaborative approach with your healthcare team to ensure the best possible outcome for your health.

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