Thanks you for your response @ThomasTu
just an update.
This morning I saw my Hepatologist and had an abdominal Ultrasound, my liver is fine.
my doctor thinks that my ALTs have gone up due to a combination of Fluctuation and body being under stress by travel and Jet-lag ( I just traveled from USA to Italy 6 hours difference and haven’t slept well).
I also had my HBVDNA PCR test results.
in October before I started TDF therapy my viral load was 170.000.000
its now December and I have been on TDF for 6 weeks and my viral load is 55.000 (it went down a lot in just 6 weeks) hopefully it will go down even more soon.
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I’m sorry to hear you were not able to get any help or support back when you were first diagnosed, but I hope you have the help and support you need now, not just in this online forum, but in real life too. When I first found out about my status as a teen, I was terrified. I seriously thought my life was over…it was the longest week of my life lol. But fortunately my sister was in medical school at the time and she was able to help calm my nerves and explain my status to me. It was still hard of course, being so young and not understanding anything, especially where I was living at the time wasn’t a developed country.
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Hi Anon2023,
It was tough back in 2014 when I was diagnosed. Hep. B information or support systems were not what it is today. But I am glad things are a bit better today than it was then. So other patients do not have to go through what I and others went through due to lack of information and support. Things are okay, thanks to my involvement in the community and advocacy work. It is terrifying when you get unwanted news you least expected. Your reaction was normal, we all went through that initial shock. I am glad your sister was able to help during those challenging moments. We will keep supporting each other as best as we can. Thanks for your message. Bansah1
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@ThomasTu and @availlant
Hello,
I hope all is well, I’m a little worried because of the following and I hope you can put your thoughts on this:
due to a recent increase of AST and ALT I was a little worried I went to see a different liver specialist.
She wants me to do redo the HDV test because she said that sometimes it takes time to come out.
Is that true? have you come across that possibility? I have had the HDV test twice during my 6/7months I have been infected with HBV (in July 2023 and October 2023 in both I was Negative to HDV)
please advice.
Thanks you
Dear @Gregory ,
The first question is how are you feeling physically?
It is also important to note that long duration flights (i.e. several hours in duration) can cause very mild altitude sickness in most passengers. This is in part because the inside of the cabin in only pressurized to 6000-7000 feet instead of sea level (making the partial pressure of oxygen lower) and the air also very dry. This is known to cause mild to moderate immunosuppression which contributes to the discomfort of jet lag (see here). Immunosuppression may also be caused by the sleep deprivation which occurs on long term flights. Thus, many times people think they got sick on the plane when in fact they boarded the plane with a controlled infection which got worse with the immunosuppression they experienced during air travel.
As Thomas has said, ALT flares can be a sign of liver injury and a sign of immune mediated targeting of HBV infected cells (the second is a good thing). It is possible that your air travel has impacted your immune function with respect to your immunological battle with HBV. ALT is not really a measure of liver function, just of the death of liver cells. True liver function and its ability perform its function in the body is measured with tests for bilirubin, albumin, INR and platelets. You should consult these results to see if they are normal or not.
In going back through this thread is seems like you started TDF in Oct at 170,000,000 IU/mL HBV DNA (this is quite a high titer consistent with acute HBV) and after three months, TDF is doing its job as the HBV titre is largely reduced but not yet eliminated (still 55,000 IU/mL). This is not uncommon and within the next three months you should see your HBV DNA continue to drop significantly.
The rise in ALT could be caused by renewed immunological activity in the liver against HBV as it is occurring while we are seeing a substantial decline in viremuia or from another cause. Given your previous test history for HDV (was this testing for hepatitis delta antigen or HDV RNA?) is seems unlikely that you have HDV but it is good to rule it out again.
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Dear @availlant
Thanks you so much for your swift response I really appreciate it!
Physically I’m feeling good actually ( I feel stronger and energetic day by day since I have started taking the antivirals TDF)
it’s just emotionally and psychologically not knowing this disease well yet that makes me go trough up and downs especially when I see numbers fluctuation I get anxious.
to answer your questions:
the platelets are at 205. 10^3uL
Total Bilirubin is 0.31 ( it has gone down it was 0.64 in September)
I don’t have the albumin from the recent test but back in in September was 3.4
Gamma GT has gone down from 189 in September its now 72
the only numbers that have gone up are AST and ALT ( you can see the numbers in the above window)
as far as HDV tests:
in July the test was HDV RNA (negative)
in October the results are below. (negative)
again thanks you so much for your time.
Gregory
Keep the messages and questions coming.
That’s what we are here for. To help each other
Any way we can. It’s our pleasure and honour.
So don’t feel worried.
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Dear @Gregory ,
Liver function looks good! This means that those ALT and AST flares have the hallmarks of an immune mediated clearance but still another peak at HDV wouldn’t hurt. You should also ask for a quantitative HBsAg test since you are clearly recovering from acute HBV with the help of TDF. This would give a baseline for understanding how well your immunity is working to control the virus. If your HBsAg declines and becomes undetectable, this is a sign immune control of the viurs has become very effective.
Good luck!
@availlant
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That’s fantastic @Gregory, that the medication is working. It should continue to go down.
@Caraline @Bansah1 @availlant
Thanks you I really appreciate the support and promptness Happy Holidays to you all!
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That is kind of you, Gregory. Thank you and Happy Holidays to you as well. Best Regards, Bansah1.
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Dear @availlant
I hope you don’t think I’m taking advantage of your kindness, and not overstepping my boundaries, but your answers feel always good and human VS my doctor’s always feel like I’m a number in a statistic.I just wanted to show my latest blood work, I forgot to do a quantitative HBsAg as you suggested I will ask next time in April.
6/29/2023 Diagnosed with Acute HBV with strong symptoms.
started TDF on October 27th 2023 with HBVDNA: 170.000.000
December 10 2023 HBVDNA: 55.000 (AST 110 and ALT 254 )
January 26 2024 HBVDNA : 2.000 (AST 79 and ALT 161 still high but lower than last time)
please see attached
thanks you Gregory @ThomasTu @Caraline @Bansah1
Dear @Gregory ,
Your sentiments are greatly appreciated. However, I am sure I speak for Thomas and my other colleagues here when I reiterate the following to you and all the members of the community out there - we are here for the benefit of patients just like you. No one should ever feel like posting their information is a bother to us. A little care, consideration and advice goes a long way and this is easy for us to give!
So in your case:
- An HBV DNA value of 2074 IU/mL is not high but rather indicates very good suppression of your viral replication given you only started TDF three months ago. At this level of HBV DNA in the absence of therapy, we rarely see liver inflammation or progression of liver disease.
- Of course you will still keep taking your TDF and you should expect to see additional declines in HBV DNA over the next 3-9 months.
- Although your liver enzymes are technically over the upper limit of normal, they are not of concern given your recent acute HBV with only relatively short term exposure to TDF. It is important to note that these lever enzyme results (ALT / AST) can only give us an indirect signal for the elimination of cells in the liver. In the case of chronic HBV infection (not acute HBV infection), these elevated values are typically disconnected from alterations in important liver functions. Direct assessment of these liver functions are provided by other liver tests (bilirubin, albumin, INR and platelets) which in your case are normal.
- HBsAg testing will let you know if you can safely remove TDF therapy. The guideline for this is two consecutive tests indicating HBsAg below the limit of detection over the span of 6 months. This is very rare in patients with chronic HBV but I advise you to follow this with a quantitative HBsAg assay to gauge the change over time in your case. Many acute HBV infections such as yours self resolve so this could be happening (no promises here…) during your TDF therapy.
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Dear @availlant
thanks you and always so generous.
Hi @Gregory,
Your results look good just in 3 months of taking TDF. The viral load has dropped steeply, which is proof of TDF doing its job. I can see the AST and ALT numbers are down too but at a much slower pace. This is good as it shows that TDF is working. These antivirals even though they are not able to cure many patients with chronic infections, it’s always good to see how they change the course of the disease when introduced by lowering viral load and stabilizing AST and ALT numbers thereby protecting ones liver.
Like @availlant suggested, it will be interesting to see what your HBsAg results will be in the next few months to see if you cleared the virus. Let’s hope your results will be even better in 3 more additional months on TDF. But overall, this is good and keep on taking the medicine until your provider tells you otherwise.
Thanks for sharing this with us and I hope this is helpful. Bansah1.
hello and thanks you @Bansah1 @availlant
I don’ t have much experience, I gather from your positive review, I am on good route. (makes me feel a little more relaxed)
Is it a good sign if HBVDNA drops significantly with TDF in my case 3 months?
in general can HBVDNA take long to drop even with antivirals?
thanks you
Gregory
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Yes, from your results we can assume that you are on the right track given where your numbers were previously. Each patient is different and so their outcome will be different. I am now on Vemlidy, but I remember when I was started on entecavir back in 2015, it took me a few months to become undetectable. Some patients might see a quick drop while others it could be a slow drop over a period of time. Results will be different for each person or patient.
I hope this helps, Bansah1.
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Hello dr. @availlant @Bansah1 I hope all is well, it has been three months.
I’ve being going through few very anxious days that you all very well know about it. Blood work etc check up.
Please I hope I don’t take too much of your time… I really appreciate it.
I would like to show where I’am at with my journey with HBV that started 10 months ago.
here are the latest tests
Unfortunately still not seroconversion, and stil HBeab negative.
The AST and ALT although still elevated have gone down to 39 and 70 ( down from 79 and 115 two months ago)
HBVDNA is 30 ( 2000 two months ago)
being on TDF since October 27 2023 .
thanks you
Gregory
Hi @Gregory,
Thanks for reaching it and your anxiety is understandable. I will suggest you don’t put so much stress on yourself and allow your body the time to recover. Your numbers are still going down and usually it will take a few months after the initial 6 months (of exposure) to start testing negative. I am actually happy to see that your numbers keeps going down throughout all the HBV tests performed. Let’s keep our fingers crossed here. Don’t lose hope and give up now, we have come to far for that. Stay positive and remain hopeful. Things might look better at your next test. Hang in there. Bansah1
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