Hepatitis B Monitoring: Key Questions and Insights - Gastroenterology and Hepatology

Q: Hepatitis B Monitoring: Key Questions and Insights

Hello Mr. <br>Huang： (1) Nodules smaller than 1 cm are often difficult to characterize and are generally referred to as nodules. <br>Regular follow-up is recommended. <br>(2) Alpha-fetoprotein (AFP) levels may fluctuate slightly. <br>If there is a continuous increase, caution is

Hepatitis B testing issues?

Hello Doctor, I am a carrier of Hepatitis B with e-antibody, and my viral load has been measured at a maximum of 300.
I have been undergoing regular follow-up examinations.
Previously, my liver enzyme levels (GPT) fluctuated frequently, reaching a maximum of 75, while my AFP levels remained within the normal range.
I had fatty liver for several years, which has now normalized.
In March 2014, an ultrasound examination revealed a 0.6 cm hyperechoic lesion, but the doctor could not confirm what it was.
A subsequent liver FibroScan showed no fibrosis, and a CT scan revealed no abnormalities.
Over the past year, I have been monitored every three months, with one instance of GPT at 50 (April 2015) and the rest normal.
The ultrasound examinations have shown little change.
In my most recent check-up on August 26, 2015, my GPT was 30, GOT was 22, and AFP was 7.1.
I would like to ask the doctor:
(1) Based on these examination results, can we temporarily rule out the possibility of liver malignancy? If so, what could this hyperechoic lesion be?
(2) In the last two tests, I had GPT at 50, GOT at 35, AFP at 4.6 in April 2015, and GPT at 30, GOT at 22, AFP at 7.1 on August 26, 2015.
My primary physician mentioned that the fluctuations in liver enzyme levels are related to changes in my body condition.
I am particularly concerned about the increase in AFP from 4.6 to 7.1.
Is such a fluctuation common? Does AFP also fluctuate like liver enzyme levels, or is it more of a trend where an increase indicates a persistent rise or stability without a decrease? Could this suggest the possibility of a small tumor developing?
(3) Over the past decade of monitoring, my GPT levels often exceeded the standard range, typically between the 40s and 60s, while GOT levels remained normal.
My primary physician indicated that, given my viral load (which was undetectable a few years ago and was over 300 last year), the elevated GPT levels are likely due to fatty liver.
I previously read a report suggesting that some individuals of Asian descent may have abnormal caffeine metabolism that could lead to elevated liver function tests.
Although I have resolved my fatty liver and have not consumed coffee since, I am uncertain whether my current normal liver enzyme levels are due to abstaining from coffee.
Could the hypothesis that coffee consumption leads to elevated liver enzyme levels in some individuals of Asian descent be credible?

Mr. Huang, 40~49 year old female. Ask Date: 2015/09/04

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello Mr.
Huang: (1) Nodules smaller than 1 cm are often difficult to characterize and are generally referred to as nodules.
Regular follow-up is recommended.
(2) Alpha-fetoprotein (AFP) levels may fluctuate slightly.
If there is a continuous increase, caution is advised.
(3) There is currently no definitive human clinical trial to confirm this.
However, general literature suggests that drinking coffee may be beneficial for liver function, for your reference.
For fatty liver, weight management is the primary focus.
Changhua Hospital cares about your health.
Chen Shidian

Reply Date: 2015/09/04

More Info

When it comes to monitoring Hepatitis B, there are several key factors to consider, especially for individuals who are carriers of the virus. Your situation, as described, involves a history of fluctuating liver enzyme levels (GPT and GOT), normal AFP levels, and a small lesion detected on ultrasound. Let's address your questions systematically.

1. Possibility of Hepatic Malignancy: Based on your recent tests, including the FibroScan that showed no fibrosis and the CT scan that revealed no abnormalities, it is reasonable to conclude that the risk of a malignant liver tumor is low at this time. The small white spot you mentioned could be a benign lesion, such as a hemangioma or a focal nodular hyperplasia, which are common and usually not concerning. However, continued monitoring is essential, especially if there are changes in size or characteristics of the lesion in future imaging studies.

2. AFP Levels and Their Variability: Alpha-fetoprotein (AFP) is a tumor marker often used in the context of liver disease to screen for hepatocellular carcinoma (HCC). Fluctuations in AFP levels can occur due to various factors, including liver inflammation, regeneration, and even benign liver conditions. The increase from 4.6 to 7.1 is not uncommon and does not necessarily indicate the presence of a tumor. AFP levels can vary based on the underlying liver condition and should be interpreted in conjunction with liver function tests and imaging studies. A single increase in AFP does not confirm malignancy; rather, it is the trend over time that is more telling. If AFP continues to rise or if there are other concerning symptoms or findings, further investigation may be warranted.

3. Liver Enzyme Fluctuations and Their Causes: Your history of elevated GPT levels, which have now normalized, suggests that the previous elevations were likely related to your fatty liver condition. It's good to hear that your fatty liver has resolved, which can significantly improve liver function. The relationship between liver enzymes and fatty liver is well-established, as excess fat in the liver can lead to inflammation and elevated enzyme levels. Regarding coffee consumption, some studies suggest that coffee may have a protective effect on the liver and could potentially lower the risk of liver disease. However, the idea that coffee consumption leads to elevated liver enzymes in certain populations is still a topic of research and debate. Individual responses to coffee can vary, and if you have noticed improvements in your liver function after stopping coffee, it may be beneficial for you personally.

In conclusion, while your current test results are reassuring, continuous monitoring is crucial. Regular follow-ups with your healthcare provider, including liver function tests, AFP levels, and imaging studies, will help ensure that any changes in your liver health are detected early. If you have any concerns or notice any new symptoms, do not hesitate to reach out to your healthcare provider for further evaluation. Maintaining a healthy lifestyle, including a balanced diet and regular exercise, can also support liver health.

Similar Q&A

Understanding Hepatitis B Recovery: Why Ongoing Monitoring is Essential

Doctor, I previously had the following test results: HBsAg(-), HBeAg(-), HBcIgG(+). Today, I followed up on my hepatitis B and paid out of pocket for the HBsAb antibody test, which came back positive (399). Other tests for AFP, ALT, and AST were also normal. I initially thought I...

Dr. Lin Minghui reply Gastroenterology and Hepatology
Hello: HBsAg(-) HBsAb(+) HBcIgG(+) indicates a past infection with hepatitis B, and the individual has now cleared the infection and has antibodies to protect against hepatitis B. However, if someone was a long-term hepatitis B carrier, regardless of whether they have achieved fu...

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!

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....

Essential Guidelines for Hepatitis B Carriers: Health Checks and Vaccination Insights

1. I am 39 years old and was diagnosed as a carrier of Hepatitis B during childbirth in 1980. My two children received immunoglobulin within 24 hours of birth. From 1980 to 1995, my health was normal, and in November 1994, my liver function tests were all normal. Q1: I have been ...

Dr. Lin Minghui reply Gastroenterology and Hepatology
Hello: Q1: If immunoglobulin is administered within 24 hours after a child's birth, HBeAg may be positive, and there could be a diminished viral replication capacity. Liver function should be monitored, as it may change. Q2: It is advisable to first test for antigens and ...