Urgent Help Needed: Managing Severe Acute Hepatitis B Symptoms

Acute Hepatitis B Emergency

Hello Dr.
Chen,
I have not been previously diagnosed with hepatitis B or C.
On October 17, I visited a hepatobiliary and gastroenterology clinic due to fatigue and jaundice.
Blood tests showed GOT: 2000, GPT: 4000, T-bil: 10.7, HBsAg: 1801, Anti-HBc IgM: 39.98, Anti-HAV: negative, Anti-HCV: negative, AFP: 2.39.
The doctor prescribed Poulican and Entecavir (Taiwanese manufacturer) and scheduled a follow-up appointment two days later.
On October 19, my blood tests showed GOT: 3000, GPT: 5000, T-bil: 17.5, PT: 17.6s, HBeAg: negative, Anti-HBe: positive.
The level of liver inflammation has worsened, and liver function remains abnormal.
I continued taking Poulican and switched to the original manufacturer's Entecavir under a trial program, with another follow-up appointment scheduled two days later.
On October 21, my blood tests showed GOT: 3800, GPT: 6000, T-bil: 22.0, which has increased again.

I would like to ask if there is a risk of life-threatening complications? Is the negative HBeAg due to a mutation of the e antigen? However, the positive e antibody indicates that the treatment is effective and the viral activity is low.
Yet, it feels like the virus is causing significant damage.
The inflammation and jaundice have not improved after medication.
Could this be due to drug-resistant strains of the virus? How did I acquire HBV? Was it something I had all along without knowing, or was I recently infected through blood or bodily fluids? Given the alarming levels of GPT and T-bil, is there a chance for recovery? Would switching to other medications, such as Tenofovir, help, or is a liver transplantation necessary?
Thank you very much for your assistance, Dr.
Chen!

Mr. Li, 40~49 year old female. Ask Date: 2015/10/21

Dr. Chen Shidian reply Gastroenterology and Hepatology

Dear Mr.
Lee,
1.
When starting the medication, the antiviral effect has not fully suppressed the virus yet, so there may still be a short-term upward trend.
It is advisable to be hospitalized for close observation.
Changing the medication may not have a significant effect, but a short-term combination therapy (out-of-pocket) is possible.
2.
Please do not take traditional Chinese medicine!
3.
An IgM level of 39.9 suggests a "possible" recent infection with hepatitis B, but there are exceptions, which we can discuss later.
The priority is to address the liver failure.
Changhua Hospital cares about your health.
Sincerely,
Chen Shih-Tien

Reply Date: 2015/10/21

More Info

Acute Hepatitis B is a serious condition that can lead to significant liver damage and even life-threatening complications. Based on the laboratory results and symptoms you've provided, it appears that you are experiencing a severe form of acute Hepatitis B infection. Your elevated liver enzymes (GOT and GPT) and bilirubin levels indicate significant liver inflammation and dysfunction.
Firstly, regarding the potential for life-threatening complications, yes, there is a risk of acute liver failure, especially given the rapid increase in your liver enzyme levels and bilirubin. The presence of high levels of HBsAg suggests active viral replication, and the IgM anti-HBc positivity indicates a recent infection. The HBeAg negative status could be due to mutations in the virus, which can sometimes occur, leading to a situation where the virus is still active but not producing the e-antigen. The presence of anti-HBe suggests that your immune system is responding to the infection, but it does not necessarily correlate with a decrease in viral activity or liver inflammation.

The fact that your liver function has not improved despite antiviral treatment with Entecavir and Poulican raises concerns about possible drug resistance or the severity of the viral infection. It is essential to monitor your condition closely, and hospitalization may be necessary for more intensive management, including potential intravenous antiviral therapy and supportive care.

As for the source of your HBV infection, it is possible that you have been a carrier for a long time without knowing it, or you could have been recently infected through exposure to infected blood or bodily fluids. Hepatitis B is primarily transmitted through contact with infectious body fluids, including blood, semen, and vaginal secretions.
In terms of treatment options, if your current antiviral medications are not effective, your healthcare provider may consider switching to another antiviral agent, such as Tenofovir, which has a different mechanism of action and may be effective against resistant strains of the virus. However, this decision should be made by your healthcare provider based on a thorough evaluation of your condition.

Regarding the possibility of liver transplantation, this is typically considered only in cases of acute liver failure where the liver is no longer able to function adequately, and other treatment options have failed. It is a complex decision that involves multiple factors, including your overall health, the severity of liver damage, and the availability of donor organs.

In summary, it is crucial to maintain close communication with your healthcare provider, adhere to prescribed treatments, and seek immediate medical attention if your symptoms worsen or if you experience signs of liver failure, such as confusion, severe jaundice, or bleeding. Regular monitoring of liver function tests and imaging studies will be essential in managing your condition effectively.

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