Deciding on treatment and liver biopsy

Thank you very much Prof Dr Pietro Lampertico for your feedback.I really appreciate your advise.I will do blood test for HBsAg and HBeAg .Will ask the Doctors here in Turkey about Hepatitis B genotype how and where i can do the test.Will discuss about biopsy again…maybe in Turkey biopsy is requested for treatment plan.( i did search myself about Fibroscan in Turkey its about 8 pcs for whole country. Around my area is non …most in Istanbul)
Regards Askul

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Hi all,

I am new to this community.

I was born with hep B. I did a HBV DNA test two years ago, my viral load was slightly above 1k IU/mL, but my viral load had elevated to 5.7k IU/mL. My ALT value shows as 29 U/L in my liver function tests.

I am worry about my situation. Kindly advise which stage of CHB I am currently in now, and do i need to initiate an antiviral treatment?

John

Hi Askul

Your condition is same as I’m trying to get useful information before starting treatment my DNA load is high and little bit fluctuations in LFT, fibro scan is normal ultrasound is normal but undigested food particles in stool regular loosing weight current weight 52 kg height 172 cm

Dr. Suggested liver biopsy before starting treatment.

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Is there any chances that the HBV DNA viral load can be reduced, without the help from anitviral drugs?

Yes off course but with ancient Indian Ayurvedic medicine here in our country a female has experienced now she has zero hbv DNA I’m also thinking to go through with the help of Ayurvedic.

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Dear @John, welcome to the community and thanks for your question. You will require more lab tests to really find out what phase of chronic HBV you are in at the moment. I would recommend talking to a liver specialist about this.

Regarding lowering your HBV DNA load, there are no proven other ways to lower your HBV load. However, there are many ways to make your Hep B worse with poor health in other respects (low exercise, eating poorly, stress, etc.).

In any case, the HBV load is not necessarily what you need to worry about: people can have very high levels of virus but have very little damage to their liver. It is a complicated issue, one which I attempt to explain here: EXPLAINER: How Hep B infects the liver (English and Mandarin).

Hope this helps!

Thomas

Dear @nisarr,

Please do not promote Ayurvedic treatment here.

Firstly, there is no scientific evidence that this sort of treatment works.

More importantly, Ayurvedic treatment has been linked to liver toxicity and damage, with some people dying from it:

From the last paper, many patients that had liver failure from these complementary and alternative medicines (most commonly Ayurveda herbal medicines) died: “Overall, 53% of patients died (median survival 194 days).”

These can be very dangerous substances because they are not regulated (so anything could be in them). Please take care and do not encourage anyone (particularly with Hep B) to take these.

Thomas

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Dear Thomas

What about bone density if you are going through with entacavir or tenofovir that is why I’m asking to you after my biopsy Dr will start treatment currently viral load 54000 IU/mL detected.

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Hi @Nisarr, thanks for raising your concerns which many people share with you about the long-term use of antivirals. These issues have been talked about by the Hep B Foundation here: Taking Antivirals Long-Term for Hepatitis B? Should You Worry About Bone Loss? - Hepatitis B Foundation.

In short, bone loss is not associated with Entecavir at all.

With Tenofovir there is a very low risk of bone loss, mostly in people already at risk of lower bone density (female, being older, smoking, and lower body mass or low levels of vitamin D.). Your doctor should be monitoring your bone, vitamin D, and blood calcium levels if there is a risk of bone loss. This also generally occurs fairly slowly, so you have time to act before it is a big problem if you are being monitored. You can also do things to prevent this if you are at risk (e.g. vitamin D and/or calcium tablets).

@Joan_Block has some experience in this and maybe she can share her insights.

Cheers,
Thomas

Dear @ThomasTu, thank you for all the information that you have shared. It’s help.

And thanks for setting up this forum and community. At least I won’t feel that I am the only person who need to go through this alone, and I find support from this community.

I felt blessed to be part of this community. Thanks again for the invaluable feedback and information.

Regards,
John

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Hi Nisarr, I agree entirely with Thomas about the difference between entecavir and tenofovir. Entecavir is not known to cause bone loss. Tenofovir is know to cause bone loss, but again as Thomas pointed out already, there are specific risk factors. Not sure what you’re gender is, but men generally have heavier bones than women so aren’t at great risk. As a petite, 62 year old Asian woman, I had to switch from tenofovir to TAF since I was losing too much bone density. Since switching to TAF, my bone loss has actually reversed so I’m pretty happy. But as Thomas already explained, entecavir is not known to affect bone mineral density. Hope this helps. Always, Joan

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Dear Thomas
I have had done extra test 2 days ago
HbsAg 7596.0 positive (26.04.21)
HbsAg 4005.86 pozitive ( 16.04.2018) very close in 2019 as well.
HbsAg 5044 pozitive ( 19.12.2013)
HBeAg negative (27.04.21)all other years.
HBV DNA (PCR)Quantitative 5.698IU/ ml( 15.02.2021)
ALT (SGPT) 14 U/L
Kreatinin 0.74 mg/dL
GGT 8 U/L
ULTRASOUND liver size normal…
In two weeks time will go Fibroscan examination.
If Fibroscan will show normal…should I still do licer biopsy ? I am good candidate to start antiviral treatment?
Genotype test is not available here in Turkey…should be send to overseas .Is genotype test is important in my case?
I dont want to miss my treatment now …suffer later cirrhosis or liver cancer .
I have no problem with food digestive and general health issues.
Thank you very much .
Regards Askul

Dear Askul,

Thanks for following up. I assume that the HBV DNA levels are log values. Your ALTs are in a normal range so no active liver damage now, but you don’t know about the past liver damage until the fibroscan.

I would wait until your fibroscan results before making a decision. I don’t know if a core biopsy is really necessary, but will tell you for sure if there is small amounts of liver damage. The current guidelines suggest only if there is liver damage should you start treatment.

The most common choice is to get blood tests every 6 months to monitor your ALT levels (a marker for liver damage). If they go up then you should consider treatment.

I hope this gives you more information about your choices.

Thomas

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Hi everyone

Good evening, my name is nancy and I’m from Nigeria
I’ have been having burning sensation on the right side of my abdomen. I Have done my LFt and ultra sound and my liver seems to be ok

I was told it ulcer that causing the pain so I have been taking ulcer drugs but this pain and itching won’t go away

I’m scared
I have been hearing about itching liver
Does anyone thing that’s what happening to me
How can I tell if I have a itching liver

Dear @Oluchi, thanks for sharing your experience. I think it is difficult to know what else may be going on because there can be so many causes of itching and pain. I think you’ve done the right thing with ruling out many liver-based possibilities with the LFTs and ultrasound.

I would return to your doctor to say that the ulcer medication is not working and there should be more investigation into other possible causes.

Thomas

Hi Oluchi, I agree with Thomas that it would be good to return to your doctor to let him or her know that the ulcer medication is not working. In regards to what you’re referring to as an “itchy liver,” I assume you mean that your body feels itchy, that you’re scratching parts of your body. Folks like us living with hep b can sometimes feel more itchy than others. The question is how itchy? And when does your itchiness require medical intervention?

The medical term for itchy skin is “pruritis” and one theory is that those living with a chronic liver disease such as hep b can have increased levels of bile salts, which collect under the skin causing one to feel itchy. [2015 Pubmed article]
Although itchy skin doesn’t necessarily mean you have worsening liver disease, if it’s affecting your quality of life then by all means you should see a healthcare provider who can provide advice (or topical creams) to reduce the sensation of itchiness.

Not sure if this helps, but maybe others have ideas or thoughts to share? Always, Joan

Hi everyone thanks for your all information which you shared here to improve patients life better then better… I’m having problem since March 2021 of very bad smelly farting regular approx 100 times in a day… I don’t know that is reasonable to discuss or not.

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Hi @nisarr, it sounds like you may have a digestive issue because passing gas (or farting) is often due to food getting clogged in your digestive system. This could be due to lack of exercise, not enough water or fluids, not enough fiber (e.g. fruits and vegetables) to help move the digested food through your colon, etc. Have you changed any of your medications or even your diet? It might be useful to speak with your health care provider about possible causes for this problem because something is changing your normal gastrointestinal systems!! Others may have ideas as well. Thanks for sharing. Always, Joan

@Thomus Tu. Thank you very much for the advisory role on Hepatitis B.
I was diagnosed with Hepb in 2013 but could be having from birth.
I am not any medication.
Last result showed;
1- Mild liver fibrosis Metavir 2.
2- Viral Load is 20IU/ML.
3- HBSAG is more than 1000.
4- Hbeag is negative.
5- AFP is 12 and down from 15.

I recently developed
1-pain in the lower side of the right rib cage.
2-Pain on the shoulder blades.
3-Red rashes that comes and goes.
4-Confusion and unstable decisions.
5- Yellow/red urine specially in the morning when I wake up but goes with water drinking.
6- Itching of the body. This is for 6 years.

Doctor decided to treat me and later on changed his mind and said I don’t need treatment now.
My question is
1- What could be the reason of the Doctor deciding to not treat me?
2- If I start treatment, would the CONFUSION go away?. Would the pain under the rib cages go away?
3- which is the best antiviral tablet for new comer in treatment of hbv.
Please your advise of your experience in this ?

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Dear @Wadani1,

Thanks for your questions:

  1. The reason your doctor may not be treating you is that your viral load is very low already. The argument is: the antivirals only work suppressing the virus replication and if the virus is already being suppressed by your body then there is no benefit.
  2. It is impossible to know this because there may be no connection between Hep B and these symptoms at all. We have talked about the pain in the right side in other threads (Upper right quadrant pain; Titling feet and pain on the righ shoulder blade; and Deciding when to start treatment). It is worthwhile to investigate other reasons for why you are feeling these symptoms.
  3. This is really up to your personal health situation and country. Your doctor will be in the best position to tell you this.

Hope this helps,
Thomas

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