Dear @Albasil808 @9ext @CNN,
Thank you for raising what I think is a very important question: should I start antiviral earlier than is recommended by current guidelines?
These guidelines are there for a reason and they are backed by clinical trial evidence as well as cost-effectiveness studies. These are generally conservative (only change when there is strong evidence, e.g. randomised control trials with detectable easily measured biomedical benefits). However, there is also recent data showing that things like HBV DNA integration occur very early on, there can be inflammation even with normal ALTs, etc. that suggest earlier treatment may have benefits later on in life. There are also likely some benefits in limiting onward transmission.
The recommendations may not change until there are enough clinical trials to show these benefits (which will likely need to look at many many people and/or take a long time), but many people are suggesting earlier treatment might be better based on the information we know now.
In the meantime while this discussion takes place, you want to make a decision now. It is very difficult for me to tell you specifically what to do because the risks and benefits are different with each person. There are particular issues that are important to keep in mind:
You have to keep taking it. You will need to keep taking the antivirals for what might be many years or decades; it can be very dangerous and even deadly to stop taking it (even if you are feeling good) unless under close monitoring by your doctor. This means you need to make sure you can afford it and it is available where you are. This might get complicated when you move to different countries. If you don’t fall under the current guidelines, the costs may not be covered by insurance or subsidies.
Taking antivirals doesn’t mean stopping your monitoring. It is still very important that you undergo monitoring to see if the antivirals are working, and if there are other causes of liver disease that might be building on top of your hep B. It is also worthwhile checking out your viral markers to see what stage your infection is in.
Side effects. Though these are very safe drugs, you can see from the other threads, some people do experience some side effects. I myself haven’t, but we do hear from people who do.
I also want to rush to say, do not take any of these (or others’) posts here as medical advice. We are simply here to provide information. Any decision should be taken between you and your health professional.
Thomas
