Hepatitis b mutant infection please help

Hello all,

I am 30 years old male. I am really scared as I was diagnosed with hep b last month. I tried talking to my doctor but she is unavailable hope anyone here can help.
My fibrscan and Alt levels are normal with HBV load of 16500 iu. I am HBeAg negative so my doctor ordered additional genotype tests. It showed BCP and Pecora mutation. I am really scared seeing that. My doctors say she will follow up after 3 months and let me know if I need antivirals. Is the mutant something to be worried off? Can I live long if I take antivirals everyday without fail? I am dead inside please help

Hi
Ash_malhotra
Welcome to the forum, I’m not a specialist.
I hope you will get the help you need here.

Hi Ash_Malhorta,

Currently approved antiviral drugs like ETV, TDF and TAF work well to suppress viral replication and restore normal liver function, even in patients with your mutations. I would not worry here.

HBeAg loss and seroconversion are usually used to gauge immunological progression from an immune active (HBeAg positive) phase to an immunotolerant phase (HBeAg negative). The only issue in your case is this marker cannot be used in this way.

Again no concern.

With normal liver function and fibroscan results and a relatively low HBV DNA titer, your doctor is doing the right thing by seeing you again in three months.

Best regards,

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Hello @availlant

Thanks a lot for the information. This does make me less anxious. I wanted to know if i take really good care of my liver and not drink or smoke and take antivirals as my doc says can i live a normal life? I am about to get married and i suddenly was in trauma with this.
I am really into fitness and i can alter my diet easily. Please suggest if you know anyone who have been taking antivirals for 15+years and still no issues with hep b?

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I been there. Facing one’s own mortality after finding out being told by Dr Google (internet) that I ll die likely from liver cancer.

Calm down. You have decades to live. Take care of yourself and just don’t keep your hepatitis #1 in your life. Maybe keep at # 5. Lol.

It sucks and I my heart still stops every time I get an ultrasound and blood work. It’s been over 5 years.

Better you find out now than later though, so that’s a blessing

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Hi @Ash_Malhotra,

Many of these drugs have only been available for HBV only fairly recently (Entecavir for 17 years, Tenofovir for 10 years) so people having taken them for 15+ years are quite rare. But, there are other threads here where people talk about their experiences with antiviral treatment over years (I myself have not felt any side-effects over the last years that I’ve been on Tenofovir).

Also these drugs were developed first for HIV, and people have been taking these (in combination with other drugs) for many decades without many side-effects and limited progression of their disease.

Hope this helps,
Thomas

Hello Ash,

Calm down. Its normal to feel low like this when its your first time. I have been there in 2016.
With Good health, you can lead a normal life.

I don’t know about Mutations but I can tell you 16500IU is not that High. In Kenya, my Doctors advised that I don’t need to start medication if viral load is less 20,000 iu.

Take your time, consult well, see different Doctors, compare notes and dont rush to lifetime medications.

Proceed with your life Plans, Marry. Share the Marriage plans with your Doctors, they will advise you more.

Be well.

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Hello @Osmanmusedahir, hope you are well, how long can someone live with the virus without taking drugs?

When I was diagnosed of HBV positive, my doctor only used the results of my Lft to place me on Tenofovir Lamivudine 300 gms. I wasn’t feeling any sickness nor showing any symptoms of the virus apart from my swollen legs which were later confirmed to be varicose veins.

Starting on therapy, I got so much sick that my life couldn’t continue normally. The effects were so much that I stopped and since then, have not experienced such effects again.

Do I stand a chance of living normally without the medication? Kindly advise. I’m so much confused. I don’t know if I’ll ever have peace again. Have been through Dr. Google everyday the little moment I’m free, I’m always asking google about HBV :thinking::thinking: this thing is eating my mind more than it’s doing to my liver. Please I need help.

Hi Vera,

Not an expert by any chance but i can explain what i learned so far on hep b. You can look it up here

www.hepbpositive.org.uk/understanding-viral-loads

You need to do tests to figure out your HBV viral load and Surface antigen HBsAG. Along with this your doctor should check ALT and AST to determine if there is active inflammation of your liver. Sometimes viral load can be high but if your ALT and AST stay normal you dont need medication.
Once your ALT fluctuates a lot then usually doctors start treatment antivirals which stops replication of virus. You will live normal and happy life if you take your pill everyday. Only issue with lambvudine is virus do get drug resistant so probably Tenofovir or Entecavir is your best bet. People have been taking antivirals and living for decades on this site so you are safe.

Please follow your doctors supervision and follow up every 6 months or 12 months to check for liver damage. Hope this takes some anxiety off of you :slight_smile:
Please dont google stuff since it leads to unnecessary anxiety and your mind will pick worst outcomes

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Thanks so much @Ash_Malhotra, yes my Alt was 78 and AST 57. A viral load at Lancet lab showed a HBV -DNA 2.234 n 174 IU/ML. (I don’t even understand what this means):weary:. HbeAg is negative. Please help me understand the meaning of these lab results.

Hi Vera,

Your viral load does seem normal. Below 2000IU is always a good sign. You doctor might have seen your ALT levels which again are 2x your normal levels which might have prompted him to put you on medicine.
Also another possibility is you have an acute hep b case where ALT jumps and typically we call them ALT flares which signifies clearance of infected liver cells. Generally too much fluctuation of ALT are sign virus is attacking liver cells and bodys immune response to it.
In this case you dont have to worry and keep monitoring if ALT fluctuates a lot and maybe even talk to doctor about his rationale to put you on meds and try to get second opinion. I myself have 16800IU but normal ALT and so doctor did not put me on meds yet and asked me to visit in February.

One more thing even i am HbeAG negative but i have a mutant strain of HBV which does not produce HbeAg so try to get a genotype of HBV done to rule out this possibility

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Thanks once again dear, indeed this platform is one of a kind. If only you knew what Dr.google has done to my mental health since I learned of HBV in me, only God has been my strength.

Kindly advise, the impacts of Tenofovir Lamivudine 300 gms were so much that I stopped coz I’m living alone. I took the drugs for 1 month but it was heal. I’m a blood group 0+ apart from the varicos veins that subjects me to drugs, generally I hardly fall sick but when I was under the antivirals for the said 1 month, I was demn sick.

Incase I’m a candidate of medication in the future, will it work or the virus are already resistant?

I’m having an appointment with my surgeon in January coz they have to do ablation for the varicos veins. I’ll also consider another Lft hope it turns out well.

For the case of whether my HBV is acute, it’s not coz the first time I was tested positive was in 2010 when I first went for a blood test but none explained to me it’s danger so me I just continued with my life until this year again when a blood test confirmed that indeed I’m HBV+ but HCV -.

Sincere

Vera

Not sure why the doctor asked both TAF and lamvudine. The issue with stopping anti virals is virus do get resistant (33% times with lambvudine) to it if you miss doses so please dont stop medication once you start it unless your doctors says. Entecavir and Tenofovir are best option since very few drug resistance <1% resistance is seen in these drugs.
Even for drug resistant virus doctor can suggest ETV since their functioning is different and it is hard for virus to mutate to all the anti virals. So dont worry if doctor sees lambvudine doesnt work on you he will give you entecavir or any other combination or increase dosage.
Side effects of HBV anti virals is normal but if it really affect you then doctor will change your medications. There are ETV, TDF and newest is TAF so doctor can switch to other drugs to see if that reduces your side effects.
Again it is crucial to know the genotypes and subtypes to see if your strain is particularly shown resistance to particular drug. This helps doctor to make proper treatment decisions

Hi @vera,

Just to clarify some of the issues here:

  • a viral load of log 2.234 (which means 10^2.234 or, in other words, 174) is low and your risk of transmission is minimal. Lower hbv dna levels are also generally linked with better outcomes, so that’s good!
  • your higher alts of 78 indicate there is some liver inflammation. If it is caused by the virus, then antivirals would help reduce this.
  • varicose veins have not generally been reported as a side effect of antivirals and may be due to other changes in your life at the moment (see this thread- Possible side-effects from antiviral therapy. Given the liver inflammation, you might want to consider changing how you take antivirals (with our without food, different times of day) or other antivirals (e.g. entecavir) to minimise any other effects. This is worth discussing with your doctor.
  • if you have been prescribed antivirals, you should keep taking them as per your doctor’s advice (even if you feel better), as reactivation of the virus can occur and could lead to severe liver injury.

Thomas

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Even though everyone else has some calming words, I’d like to share that I know exactly how you’re feeling. I was diagnosed 2 years ago at the age of 27. My levels were crazy high and I probably had it since birth, but Hep b did no damage to my body whatsoever. Be soooo glad you found out now so you can treat it and live a long healthy life.

Hi Carol,

Are you taking any medication for high viral load? I am really confused but i also dont want to die by HCC since this beast can shock you even in non cirrhosis liver.
I really dont want to die by Hcc. I am glad that i found out about my condition in my early 30s and i can probably start with anti virals to stop the progression in my liver.
My question to @ThomasTu @availlant is since i have been reading that my mutation BCP/Precore is linked to greater HCC progression should i start antiviral despite my viral load less than 20000IU and normal ALT?
I want to know your opinion so i can talk to ny doctor and explain her about my mutation and hopefully she is knowledgeable.
If i take antivirals would it reduce my risk of HCC since the infected cells with HBV integrated DNA will be less?

My fear is if i have high persistent viral load more virus will integrate and cause more chance for HCC so i want to limit it. My nights are sleepless seeing the survival rates of HCC please help.

Yes, I’ve been on Entecavir for 2 years. No side effects. I visit the gastroenterologist that specializes in Hep b. I get an ultrasound, blood work, and fibroscan every 6 months. Everything has been great.

My dna went from 999,999,999 range to 100 in about 6 months.

Read over previous posts and you’ll see lots of evidence of people living long full lives with Hep b. You’ll be just fine. I understand why you’re so scared right now, but trust me, it’ll pass and you’ll come out a lot stronger from this.

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Hello Vera,

Yes, there is life with Hepatitis B. The secret is to accept and cope with its simple living conditions. Do not start Medication without proper consultations with the Right Doctors. With my Dr., He was quite clear that no Medication if your viral load is less than 20000 iu. Mine reached 104,000 iu and i never used any drugs. Its now descending to a level of 8000 iu.

Eat healthy, sleep well, exercise, Avoid too many Drugs,

Best luck

Thanks once again, honestly for drugs I can’t tell with certainty when I won’t take any coz my varicose veins is severe that ablation must be done but that will be next year

I think it is not clear why the mutation is associated with HCC. It may be just reflective of older patients (who are more likely to have both mutations and HCC), but I’m not sure that the mutations themselves have any direct effect on HCC. There is no strong evidence to alter any treatment based on these, as far as I know.

This is a good question and one that I am actively doing research on. The simple and accurate answer is “we don’t know”.

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