Ever since I learned my status, I have been seeing a physician every six months. Thanks to the support I have received from this page, I am feeling well. I have accepted my situation and am trying to focus positively on life, although the beginning was very difficult.
At the moment, I am not on medication. According to the physician managing my care, this is not yet the right time to start treatment. He explained that treatment decisions should be based on the overall clinical picture, including elastography results, platelet count, ALT levels, and other factors. He also mentioned that an increase in viral load alone is not sufficient to initiate medication.
I would appreciate your advice on this matter. I would also be grateful if you could review my results and share your thoughts.
That’s great that you are coming to more of an acceptance of your condition, and getting ongoing care. Continuing to be proactive about your health will definitely pay off in the long run.
I agree with your doctor that the decision to start treatment should be based on the full picture, though there are other things to consider as well, for example, your age, and whether or not you have a family history of liver cancer.
I went through a similar thing in 2022, where my viral load suddenly increased, and my liver enzymes were slightly elevated. After that, I decided to go on treatment, mostly because I was afraid of having another, more severe flare later on. I also think that we should be taking into consideration what you as a patient wants to do. If starting treatment helps to decrease your anxiety about having health complications due to hep B in the future, then I also think that would be a good reason to start treatment.
Thank you for your response. This aligns with the explanation provided by the doctor. However, I would like to explore the possibility of initiating treatment at an earlier stage rather than waiting for all criteria to be fully met. From a psychological and well-being perspective, commencing treatment sooner would be beneficial for me.
I intend to discuss this matter further during my next follow-up appointment. In your opinion, would it be medically acceptable to begin treatment based on patient preference, provided there are no contraindications?
I completely understand. If I was in your situation, I would want to start treatment as well. I agree that you should have this discussion with your doctor, and it’s important for a physician to listen to their patients. In my personal opinion, some of the treatment guidelines seem kind of outdated, because I suspect they were developed back when antiviral medications for hep B were available as brand-name only, and therefore very expensive. Now that they are available as inexpensive generic drugs, the cost/benefit analysis changes. Considering that we often prescribe very similar medications to healthy people as a way to prevent HIV infection, I don’t see a whole lot of risk in starting treatment now.
Hi @Kebraraw,
If you ask me, I will initiate treatment if I have regular access to antivirals and it is something I want to do. Your ALT/ASTs fluctuate, and your viral load is considered high. It is possible to have some good results, but still have liver damage ongoing, given how dense the liver is.
I agree with @et5656 that if there is a family history and being older increases the risk, so treatment should be initiated. I personally will start treatment and not wait any longer if the antivirals are readily available, adherence, and cost are not an issue. I strongly recommend discussing this with your doctor about what you want to do.
Thank you for your response and guidance. I sincerely appreciate your contributions and the valuable support you provide to this community.
I am not aware of my family’s medical history. Both of my parents passed away when I was a child, and I do not know the exact cause, as I was raised by relatives.
Regarding the antiviral medication, I am not sure about its cost, availability, or adherence requirements. I will do some research and make arrangements to discuss this with the doctor, and plan to visit soon.
Welcome to the forum and thank you so much for sharing your experiences. It is so rewarding to hear about how this site has supported you through your journey. Indeed, your clinician is accurate in that a simple increase in viral load alone is not sufficient to initiate medication. It becomes an issue when there is detectable inflammation as well.
However, the points you have made about the impacts you are feeling from hepatitis B are indeed worthwhile to talk about with your clinician. Most guidelines now (e.g., EASL and WHO) have clauses in there to allow for consideration of treatment in such cases.
