Explain lab tests




Hello everyone
So i met with my doctor, talked to the young lady on the phone and everything went well. However I had also gone to pick my results for liver scan, liver function and VL but then my doctor said everything is okay and since viral load cant be detected, I am taking you off medication, i asked him lots of questions about this decision but he insisted that for 6 months, we need to try out and see.
I am going to attach the results but then I have so many questions and fears about this decision.

  1. Wont the Viral load increase
  2. Incase I stop for 6 month, wont the medication become resistant incase he is to put me back on it and has anyone ever tried it?
  3. What can be done with the veins in the liver according to the report
    Any added advise and suggestions are welcome
    Thank you all
    God bless you

Hi @Lilibet94,
The doctor’s decision to stop treatment because your viral load is low is not what the guidelines suggest. You are right about being concerned about this. Yes, your viral load can increase and can lead to other unwanted complications. When it comes to resistance the chances of those happening are low with the current antivirals being used. The liver is a vascular organ with many blood vessels, the main vein is normal. We all have that vein running through our liver. Do you have the option of seeing a different doctor if possible someone who treats hepatitis B patients to get a second opinion? This decision is contrary to what all the leading HBV organization guidelines say/recommend. I hope this helps. Bansah1

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Yes, your viral load can increase after stopping treatment, and you may be put back on anti-viral treatment again. On the other hand, your viral load may increase but remain low under 2,000 IU/ml in which case your own immune system is controlling the virus, and you do not need any medication. Stopping antiviral medication is a considered option for very experienced HBV specialists. Besides, a prerequisite of very low or undetectable viral load(hbvdna), some specialists would also insist a low serum HBsAg of less than 100 IU/ml before attempting the stopping. One of the experts here, Professor Lampertico, has investigated this option. As a layman, I think the key point about this option is more frequent testing of viral load and close consultation with the HBV specialist. All the best.

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I will see another doctor next week to get a second opinion. Thank you so much.

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Noted. I appreciate the information, is it possible to tag the specialist and we see his suggestion if he can please. Thank you

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Certainly, you can ask Professor Lampertico (@lampertico) directly for his suggestion. I enclosed a statement from his editorial comment on this topic: “In conclusion, the evidence is increasing that a finite NA treatment approach leads to higher HBsAg
loss rates compared with the current long-term NA strategy and can be considered a rational strategy to induce a functional cure in selected HBeAg-negative patients without cirrhosis who are willing to comply with close follow-up monitoring. To reduce the draw- backs associated with this approach on an individual level in terms of close monitoring, uncertainties when to start retreatment, and the potential risk of severe hepatitis flares, better definitions of the patient populations benefitting from the finite approach are needed. If we were able to exclude the 40%-50% of patients who restart NA therapy, then the current observed functional cure rates—which will then reach approximately 40%—would be well worth the effort. Ongoing large trials evaluating the finite NA approach prospectively in HBeAg-negative patients will hopefully answer most of the unanswered questions. This will have a major impact on the study design and the off-treatment endpoints of studies involving new therapeutic strategies.”
LAMPERTICO AND BERG EDITORIALS | HEPATOLOGY, VOL. , NO. 2, 2018.
Less Can Be More: A Finite Treatment Approach for HBeAg-Negative Chronic Hepatitis B
[https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.29821](https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/
hep.29821)
Since then there are many papers in this area. You can search for them in Google using search terms: HBV, NA, STOPPING

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Hi @Lilibet94,

This forum is not here to replace going to a specialist yourself, but indeed the rationale for stopping medication based on undetectable viral load is not in line with best practice.

Thomas

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