Deciding when to start treatment

Stop eating sugars and carb. It’s hard, but I cut it down to almost 80% of my previous intake. Stop eating processed sugar/sweet foods. Replace it with fruits. Stop eating processed food where it’s all carbs. If you are eating over 100gr of processed carbs a day, then it’s no good.

Change your diet, fast throughout the day, and just struggle for about a month. AND exercise (walk, run, lift weights,etc) about an hour and see how your body changes in a month

Hi Joan,

Thanks for clarifying about liver spots. After I started antivirals and I would get little bumps and whole body itching, they left little dark spots. Sometimes there would be bumps that turned into spots and sometimes there would just be spots with no bumps. Over time, a lot of the spots went away but I still have some of them. I was bedridden for the first 3 months of antivirals, so it definitely wasn’t the sun.

I just assumed that because I had “liver” disease and started getting all these “spots” with itching after starting treatment, that they must be “liver spots”… lol

You know what happens when you assume. In this case though, it only made one out of ME.

All my best,



Question? I was reading about genotypes of hep b but I think @ThomasTu said that does not matter does it?

With respect to treatment with tenofovir or entecavir, virus genotype doesn’t matter.


So basically it’s all the same risk it doesn’t really matter what types you are because they say some are at more higher risk for some reason then others

The response to antiviral treatment is the same no matter which genotype you have.

The disease progression is slightly different (for still unknown reasons) between the different genotypes. We still don’t understand the cause.

Do people start treatment even under the guidelines. I was reading some people don’t care they just wanna get the treatment because they don’t want any type of detectable load. is that bad for somebody to do that?

Good question, Eddie.

There are grey zones where treatment can be considered under the guidelines, and I’m sure that there are people who do take it outside of guidelines (particularly in places where access is less regulated).

The drugs themselves are quite safe and there is generally no harm taking them, so it’s not bad in and of itself. It can be bad if you do not keep taking them, which can result in liver flares.

The guidelines are usually concerned specifically on “Are the drugs working to reduce liver disease and death?”. As you know, this is really only one aspect of the infection. There’s also other impacts that are not usually considered when making these guidelines: the anxiety, the powerlessness of not doing anything for the infection, the concern about infecting others, etc.

So personally, I would like to have all people with hep B at least provided the opportunity to be treated (as long as they can be fully educated about the pros and cons) and that this is not limited by guidelines (or for guidelines to be a bit more lenient). There are others that disagree (with some justifiable reasons), but I think it’s worthwhile having that discussion.


interesting then why the guidelines then? If we have it we should treat?

The guidelines are important because there is evidence showing a reduction in liver disease when treatment is taken under these conditions and not for others.

For example, there is no evidence for reduction of liver disease if your viral load is less than 3000 in HBeAg-negative phase. But that’s because the rate of progression is so low to start with, it’s difficult to see any improvement.

I don’t think you should go against your health provider’s advice when it comes to this, so I can’t say what works in your situation.

So pretty much what you’re saying those guidelines you’re in the safe zone for now until you might need treatment So It could be more sufficient when you do treat

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I think viriad, entircavil and vemlidy are the latest ant Hep b drugs.

I agree with you Thomas when you say all chronic Hep b patient go through alot psychotically the period they remain untreated.
I, personally went through feeling of helplessness between 2002 when I was first diagnosed to 2014 when I was first put on treatment. I always felt one day I will not be able to wake up. I felt like a "walking dead"such that when an intern doctor though inexperienced decided to put me on treatment, I felt very relieved.


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So guys, unfortunately the doctor advised me to go on antiviral treatment, which I don’t really like. When I was first diagnosed like 10 years ago there was no viral load measurement in my country, so we only relied on ALT and AST levels, so never had I have antiviral treatment. So year 2020 viral load 57000 copies/mL, year 2021 viral load 150.000 copies/mL, ALT and AST normal. Will the viral load drop naturally after a while, could the immune system somehow learn to fight it after a while ? I am 44 year btw. This sucks…

Sorry for the news. Hope you find comfort. Keep us posted


Does anyone know or read somewhere, why the hbv viral load increase? Seems like people are fine for decades and …boom, levels go up?

Are there new recommendations on treatment of hbv level. Is it still 2000 for e- and guessing 20000 for e+?

It seems like over 90% of people on this forum are on anti viral meds.

Hi @Hepb1,

I’m sorry to hear that you are feeling so upset about starting treatment. Can I ask you what your worries are? I am taking treatment myself and I hardly think about it any more, just a pill in the morning each day.

Anyway, I agree with @NeptuneJ, keep us updated on how you’re going and keep communicating with the group here. We’re all in this together and will help each other out!

If anyone knows, please tell the scientists too! This is one of the bigger mysteries in the field. It’s probably something to do with the immune system, but since it is super-duper complicated, pinning down exactly what is driving changes in virus load is really difficult.

Basically, but it gets complicated because you have to take into account ALT levels, family history of liver cancer, age, etc…

I would estimate more like 50-50, but it is definitely more than the general HBV-positive population, I think.


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@ThomasTu , I am upset because, who likes to depends on some stupid pill right ? Also worried about the possible side effects of taking pills like being tired or something ? Ok then again, we will only know if one takes the pill what side effects can happen, it is different for everyone, some have side effects, some don’t. Also the costs of the pill, I must ask my doctor what the costs will be, havent heard from him yet.

I agree with you @ Hepb 1 when you say your worries are drug dependence,side effects and cost.These are worries for many people who are chronically ill.
Who would like to travel with drugs wherever he goes? Who would like to be spending his money on medicine instead of buying other better things? When @ Hep b 1 you start the journey you will realize how easy it is.The challenge may be only in starting. Just a tablet a day.
Moreover, to majority of us on hep b pills have negligible side effects if any at all.
Further more,have you ever stopped to think how dependent we all are on food.We eat to live and we don’t take it a burden.@ Hep b 1,the earlier you accept you need to take these drugs the faster you get used.
I wish you all the best and keep us informed.

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Yes, diabetes people also must take daily medicine pills or injections.

Hi @hepb1
Diabetes is just one of the many sickness where one takes medication on daily basis. Infact, Hep b patients like us are lucky, we have a single pill once a day.