Your test results indicate that you have chronic HBV infection with evidence of increasing viral replication. Although there is no evidence of fibrosis, some studies have suggested that the progression of HBV infection is faster in individuals with steatosis.
According to some international guidelines, antivirals like tenofovir disoproxil fumarate (TDF) are not indicated until evidence of fibrosis and or abnormal liver function (elevated ALT) is present. On the other hand, your HBV titer is increasing (perhaps as a result of your steatosis).
So I suspect one doctor is following the standard guidelines (request review in 6 months) while the other doctor is looking at your steatosis and increased HBV titers as justification to initiate early TDF therapy as a preventative measure. The difference between these two approached should not raise any concerns on your part but reflect the reality of differing approaches with different doctors.
Its important to note that how to proceed with your own therapy is a decision between you and your doctor in concert. However, it is true that early introduction of TDF has a very high chance to prevent any progression of liver disease from HBV infection.
Hi CNN
I am happy hear from your concerns. I may not answer you directly but probably as a person experiencednin hep b and many doctors in Kenya, I can refer to the best honest gastro if you donāt mind.
Kinoti
At Agha Khan hospital, book Dr M.V Shah(endescopy department)once a week. Consultation fee is ksh4000,but I use my NHIF cover as a civil servant.
M.V.Shah is the senior most gastroenterologist in Kenya with now over 35years experience.
Wish you well.
Kinoti
Hi CNN.
Yes. Dr. Mahesh V. Shah is available one a week.
I have been to KNH doctors plaza, Ruai Family Hospital (Hospital of speciality)MP Shah and the handling has always been divastating.
Kinoti
Hello,
what do you mean by āupcoming cureā?
upcoming cure used in combination with antivirals ā¦
Do you know where I can read more about this upcoming cure?
This is a prediction based on the number of agents that are out there being tested at the moment (https://www.hepb.org/treatment-and-management/drug-watch/). From this, we expect at least one of these or ones still in pre-clinical development to contribute towards a cure in the future.
Most of these have been tested in combination with current antivirals (tenofovir or entecavir).
Ah, I see. I misunderstood your previous post. I thought the āupcoming cureā as in the one that is going to cure HBV completey for current chronic patients. One magic pill. I misunderstood.
I should be hopeful seeing so so many list of companies working on different drugs. But Iām also feeling worried that there are so many working separately on separate paths. Wouldnāt it be more effective if they all work together and share information? Covid vaccine came out pretty quickly because all the countries worked on it together.
My other worry is that HBV is more of disease of outside of USA. I worry that it wonāt get the funding it needs because itās not a priority for America.
Anyway, Iām still grateful that we have many drugs being developed and really hope that we will find a ācureā very soon for hep B just as they did for hep C.
Which antiviral medication are you taking?
You need to share with us other liver function data such as bilirubin, albumin, INR and platelets if you have them.
In the interimā¦
You are experiencing a good antiviral response to therapy (4 log decline in HBV DNA within 3 months). How are you feeling?
You are also experiencing a mild transaminase flare (GPT/ALT is 123). Normally when an ALT flare is occurring in the presence of a good antiviral response, this signals the immune mediated clearing of infected hepatocytes from your liver (which is a good thing).
I did a liver ultrasound 3 months ago, all looks good.
At this point, I am feeling good.
I was a little bit concerned about the GPT/ALT being 123, but good to know that it is a good thing for now.
Hi @ThomasTu@Joan_Block Hereās my updates: My latest (June 2022) ALT is 16 and AST 17. However I went to see a hepatologist who ordered a FibroScan (July 2022) and the results says āThe median shear wave speed corresponds to a Youngās modulus of 9.9 kPa and 1.81 m/s. The standard deviationis 0.10 kPa and 0.01 m/s. This result is suggestive of compensated advanced liver disease, but need further test for confirmationā.
My hepatologistāa comment on the results: Liver elastography was a bit stiffer than expected based on labs. Cirrhosis is possible but not confirmed. Further testing is recommended. The gold standard test would be a liver biopsy. But can also consider a MRI elastography.
My questions: how likely itās cirrhosis? Is MRI elastography as effective as liver biopsy in confirming or ruling out?
Hello letscure
Iām sorry for your situation. You must be worried. Try not to worry until you have confirmation.
I canāt answer your question as to which test would be better but Iām sure the professionals will answer soon.
The MRI would be painless.
Treatment for cirrhosis is available.
Are eating well and exercising?
Thanks @Caraline for your kind words. Yes I eat healthy with plant-bases foods plus some white meat and seafoods. I also walk about 6000 steps every day.
Yes, I agree with Caraline about it not being productive to worry before getting confirmation.
If the fibroscan is that high, whether or not it is cirrhosis or ājustā fibrosis, it would be worthwhile to consider treatment (I canāt remember how you resolved this, did you start treatment in the end?) to limit any more liver inflammation from happening.
I think your physician will provide you with the best indication for your specific needs in terms of future confirmatory tests.
@ThomasTu@Joan_Block Hereās my update #2: I had an MRI ELASTOGRAPHY after the FibroScan. So 2 different imaging tests.
MR elastography IMPRESSION:
No hepatic fibrosis.
Moderate/grade 2 hepatic steatosis.
No iron deposition in the liver.
MR elastography FINDINGS:
LIVER STIFFNESS (MR ELASTOGRAPHY):
Range of liver stiff ness values throughout entire liver: 2.1 to 3.0 kPa.
Average liver stiff ness throughout entire liver: 2.3 kPa, which is not compatible with fibrosis.
My liver specialist comments: āMR elastography showed no liver fibrosis, which agrees with your labs too. It measured moderate amount of fatty liver.ā
FibroScan IMPRESSION:
Ultrasound elastography result is suggestive of compensated advanced liver disease, but need further test for confirmation.
FibroScan FINDINGS:
Shear wave speed data are acquired intercostally in the right lobe of the liver from a region 1.9 cm. deep to the livercapsule. The median shear wave speed corresponds to a Youngās modulus of 9.9 kPa and 1.81 m/s. The standard deviationis 0.10 kPa and 0.01 m/s.
My questions for you two and other experts in this forum:
Do the two imaging test results give out different diagnosis or they sort of agree with each other?
So I have fatty liver in addition to HepB, does it make treatment more complicated?
Iām really skinny so itās lean NAFLD/MAFLD. Should I go on with no carb diet?
@ThomasTu and @availlant Good day, I have been on TDF for 8 months now, recently I started having pulsatile tinnitus, is there link between TDF and pulsatile tinnitus? Can someone switch from from TDF to Ectacavir ?