Hi, I am 36 years old. My LFT levels are normal but HBV DNA Viral Load is 6200 IU/mL. HBe Antigen is negative and HBe antibody is positive. Can you please explain what all these mean and how likely is the sever damage to liver in this state? What do I need to do to reduce or finish the Viral load and how much time is it likely to take?
Thanks
This combination of test results combined with a viral load suggests you have chronic Hepatitis B and need to be on treatment of an antiviral such as Entecavir or Lamivudine to suppress the viral load.
It also suggests you are infectious. I would recommend your close family are vaccinated with the Hepatitis B vaccination and that you are extremely careful with body fluids. Do not share things like your toothbrush or razor, cover cuts, and if you are sexually active use a condom.
This forum has a section within Health Information explaining in detail the Hepatitis B virus, treatment etc. Its worth reading.
Having hepatitis B virues in the body is actually not a big problem as long as it is not causing damage to your liver. Plus, your viral load is not that high anyways.
According to WHO (World Health Organisation), treatment is not needed unless the damage become chronic. menaing that if your ALT level in your LFT is high for more then 3 months, then you would require treatment.
For now, the best thing to do is not to kill the viruses, instead you should work on enhancing your liver function and maintaining a normal ALT level. ALT level can be maintain and protected by a healthy diet, and limiting substances that can harms the liver cells, or you can also look for supplements to help.
Muhammad's viral load is well above the minimum for starting treatment, which used to be 3,000. In fact current practice in the UK is that everyone with chronic HBV should be on treatment. My viral load at its highest was 123 units which, over time, still damaged my liver sufficiently for me to develop cirrhosis and then liver cancer.
HBV is not a virus where it is ok to do nothing, unless as you say Munhammed is still within 6 months of knowing exactly when he was infected and should be tested again to see if the virus has gone.
Thanks for the reply. I have an appointment with Hepatologist this month and will discuss with him about starting medication.
Thanks dear, I appreciate your response. I read that for e antigen negative patients, medication should be started if their viral load is more than 2000 units / mL. What do you think about that? My HBe Antigens are also negative and HBe antibodies are positive.
Treatment varies depending on whether you are in the initial active stage (blood tests and your knowledge of when you were infected) with give that answer. Or in the chronic stage, again blood tests, and knowing if by now it is at least 6 months since infection.
You hepatologist should be able to interpret your blood tests accurately and advise whether you are acute or chronic. If you are chronic, with a viral load of over 6,000 iu/mL then yes you should be on antiviral treatment for life.
What does the UK practice do if a patient has a viral load of way over 3,000 or 6,000, but with a normal ALT and AST levels? Do they still put them on life long medication?
What i found is that different doctors say different things. If your ALT level is within the normal range, meaning that your liver is completely healthy, then why there is the need to take antiviral medication even you have a high viral load?
Your liver is not being attack or injury by the virues, right?
The amount of viruses is not directly related to the extend of liver damage. And many people can have a high viral load, and yet liver health is completely normal, and can aviod taking antiviral treatment for life.
Yes new protocol is that ALL patients with chronic Hep B should be offered treatment, regardless of viral load level.
This is very interesting, is there any references/ links that you can provide for us?
If ALT and AST is normal, even patient has a high viral load, it is not consider as chronic hepatitis Ｂ, and it is just consider as carriers.
Links posted on here have to be moderated. What you could do is look online at the EASL Guidelines for treatment of Hepatitis B. The most recent are 2012 so some protocols have undergone further change. It was my UK hepatologist who told me that treatment is now recommended for everyone diagnosed as chronic. Different recommendations may apply to non UK patients.
Thanks dear. So, what is the advice under my current circumstances? How long will I need to be on medication? What are the common side effects of the medication? And finally what does this medication achieve, I mean is the Virus totally cleared of the body or just the viral load is reduced?
You need to discuss your current circumstances with the hepatologist you said you were seeing this month.
Once you start anti viral medication you stay on it for life.
The medication stops the replication of the virus and reduces the risk of further damage to the liver.
Some anti virals affect calcium levels but this can be addressed with a calcium and vitamin D3 supplement.
I would recommend you to not start any medicaitons if your liver functon is normal. Why on earth should you take meds when you are healthy?
Having viruses in the body is a very common and normal thing as long as it does not attack your organs.
Why starting a long term medicaiton that can not be stop is benifiical to your health? When it does not even clear out the viruses for life.
All you need is to make sure your liver is healthy. (ALT stays normal).
Viurses could causes liver damage, but does not equal to liver damage.
high viral load does not mean serious liver damage,
low viral load does not mean little or no liver damage.
FACT.
Thanks for very valuable suggestions indeed
As someone with chronic Hepatitis B for 30+ years I present the opposite view to Ivan.
I was diagnosed with Hepatitis B in 1976.
My GP said my liver function was fine and the viral load was low.
The highest viral load we measured over the years was 183iu compared to Muhammads 6,000.
I remained untreated.....
....until I was diagnosed with HCC primary liver cancer and subsequently cirrhosis.
Unless you are having your ALT and other liver functions measured every week you will miss brief elevations of the enzymes. Every elevation causes just that little bit more inflammation and damage.
Primary liver cancer has a poor outcome with only a 50% survival rate of 5 years post diagnosis.
You may stay well. You may never develop cancer. But knowing that you have a virus that has a high risk of developing into liver cancer, will you risk it?
Its your choice Muhammad.
You are right. I have the appointment tomorrow and will see if the Hepatologist suggests medication, I will go for it. The only thing which worries me is the Side effects as I heard people saying that it is accompanied by weight loss, hair loss etc etc. And then the other thing that you have to stay on medication all your life. I mean can't we do away with medication once the viral load is reduced to a minimum?
I know, side effect worry everyone. I think you may be confusing anti virals which you will take with chemotherapy which is no longer used as a treatment for viral hepatitis.
I'm on Tenofovir and have no hair loss, no weight loss and take a daily calcium and Vitamin D supplement in case of calcium loss.
List the risks of the side effects against the benefits of no liver damage. Your liver performs around 500 functions for you, you only have one liver, once it's gone it's gone.
List the risks of no treatment (progressive liver damage and ill health) against the benefits of treatment.
If you have a decent and experienced Hepatologist they are in the best position to advise you. We don't know enough about your medical history and we are not doctors.
And yes you do stay on meds for life. If you stop the virus comes back resistant to the antiviral medication.