Hi Doctors,
I hope you can give me some guidance. Hep B carrier since a young age I am now 48 years old and these last 2 years my LFT AST/ALT have been elevated and flutuates. The virus is always not detectable. I have been on anti-viral tenovior for 9 years now.
Recently I did an MRI and ultrasound, both normal. Ultrasound noted a coarse texture.
Fibroscan was done 2-3 years ago and it was fine.
The specialist has now ask me to do a liver biopsy to get to the bottom of it.
I hope you can shed some light on my results. Is there any risks of liver biopsy and do you think it’s necessary?
Hello @Ellen
I’m not a doctor but it’s normal for your results to fluctuate. Yours are only just out of normal range.
Someone more experienced can help you more. @ThomasTu@Bansah1
Hi @Ellen,
You are both correct about these minor elevations; per the results, they are not far off from the normal range. Those numbers would be in the normal range if you were in the US, where the cutoffs for AST/ALT are 40 and 45. Different standards are used all across the world. Fluctuations from time to time may be experienced. Is it possible that there is a flare-up causing such recent fluctuations? It could be. I agree that your provider is trying to understand this. This is something to continue monitoring.
It can be frustrating trying to understand some of these changes. Please take it one day at a time. Hopefully, further testing will provide some answers as to why these changes are happening. Keep us posted. Bansah1
Thank you Caraline & Bansah1, I really appreciate your response.
The AST/ALT has been around these levels (slightly elevated) since 2023.
Although worried I am trying not to think too much into it. The specialist is wonderful as she have been monitoring me for many years.
I am quiet scared of the biopsy procedure as well as what it may find.
Do you think I should go ahead with the biopsy? Or wait out a bit and keep monitor by blood test & ultrasound?
Since you said this has been going on since 2023, I will say go for the test. I have had 2 liver biopsies and both experience were great. I never felt any pain nor had any bleeding issues. If that’s what your doctor recommends, then I will agree with him/her to try and understand what is happening. The unknown is always scary right? We all experience this fear. It should not stop us from taking care of ourselves. You will be fine.
I am happy to hear you like your specialist. It makes a huge difference when you have a strong working relationship with them. Good luck with the procedure and fingers crossed for some relief. Bansah1
Thank you so much @Bansah1 for your kind words and you are right. Deep down I know I should go for the procedure to find the root cause. It’s comforting to hear your experience was positive. I hope mine won’t be too bad. I am fearing the results but I will keep my self busy and try not to over think.
Thanks for sharing your story and sorry you’re going through such a tough and stressful time.
We cannot make the decision for you regarding whether to take the biopsy or not, it is something for you to talk about with your doctor and discuss the pros and cons of such a procedure for your specific case and physical condition.
Generally when ALTs remain high even on antiviral therapy (particularly if HBV DNA has been low/undetectable for some time), the first assumption will be that it is being caused by another liver disease. If these have all been ruled out by blood tests and ultrasounds, then yes, there will be the suggestion to take a liver biopsy to really see what is going on.
Liver biopsies are understandably scary to people, but a fairly common procedure. As I’ve seen it firsthand, it happens under local anaesthetic, with this injection being the most uncomfortable part - as I’ve heard it described the actual taking of the biopsy is a bit of a pinching sensation, but not necessarily pain.
I would be interested in hearing anyone else’s firsthand experiences of liver biopsies.
Thank you @ThomasTu for taking the time to reply and explain to me. I will be brave and go ahead with the biopsy which is booked in 2 weeks time. I will update you on how it went and the results which I am very anxious about.
I recently watched your YouTube interview with hep B community in the US and it was very insightful.
Thank you for the kind words. I am inspired by your bravery! I wish you all the best with your biopsy and hope all the discussion here has helped with the anxiety. Please keep us up to date with how you go.
In the meantime I have just gotten my 2 children tested as I have always worried if they have been infected at all since birth and the good news is that both my kids are not infected. I am so thankful and it goes to show vaccination at birth works.
However my older son (16 years) immunity is less than 10, meaning no immunity despite having all his childhood vaccines in Australia. He will need a vaccination. Why would his immunity be so low?
My other son (13 years) immunity is 18, is this sufficient or should he get a booster shot too?
Hi @Ellen,
Thank you for updating us. Immunity can wane over time, and there is no one simple explanation why it happens in some but not in others. It’s good you followed up on it; now he can start a new series to build his antibody levels. Anything greater than 10 IU/L is good, so 18 shows a strong immunity, and no booster is needed in his case. Best, Bansah1
