New in this travel and very scared

I want to apologize for the courage, but 1.5 years ago I tested positive for hepatitis B and I have gone crazy. im 38 years old. I have fallen into severe depression and my last tests have some elevated values and I don’t know what to do, I think I will get something and i die. I took the courage to ask you because I don’t have easy access to a doctor and we’re essentially following up on my own. I take Viread daily. The dna is less than 50 IU/ml and HBsAg 1424 and HBsBe possetive but I have raised SGPT/ALT to 69, SGOT/AST 35, TBIL 1.36 Direct bilirubin 0.58 and Indirect bilirubin 0.78. I have an INR of 1.02 but an elevated aPTT of 48.8 is this normal(i mean aPTT), do you think this is the cause of the disease or for drug? HCT 46.2 and PLT 245, my ultrasound 2 months ago was absolutely clear in both size and sound. Do you think I should ask for any further tests for aPTT or bilirubin?

Sorry for my english. ι am hoping for an answer that will ease my anxiety because I am in a desperate situation.

Hi gvit
Welcome to the forum and thank you for sharing your story.
I hope you will get the help you need here.
Kinoti

Hi gvit,

We are glad that you reached out to us.

You are taking a very effective and safe medication for your chronic HBV infection. Please relax and do not be scared! Can you tell us how long you have been taking Viread?

Best regards

Thank you for your time. I have been taking the medicine all this time and as I understand it, my progress is quite good.
I started with Dna 25000000 copies and now, as I told you, it is below the limit, and the image of the liver on the ultrasound is like day and night, but it is normal.
I am very saddened because the ALT/AST not becoming normal and the ALT is rising.
and I’m quite stressed about the aPTT measurement and I’m looking to see what’s to blame for that as well. I am also very afraid of the side effects of our medicine and of course kirosis and HCC.
From the HBV and my dad death i have acquired problems with depression and health anxiety, headaches, joint and muscle pain, etc. and the doctor told me to take anti-depressants, do you think I can take them? and the cardiologist told me to take cholesterol pills (pitavastatin)and can I take these?

  • Before start my drug i have E mean= 7,65kPa is this very bad?
1 Like

Dear gvit,

Based on the data you provided you had little or no fibrosis when you started therapy (liver stiffness 7.65 kPa) which is very good.

I agree that you have had a very good response to Viread and your viremia is well under control. It is normal that HBsAg remains elevated with this kind of medication as it does not target HBsAg (which comes from non-infectious particles produced by a separate mechanism) but instead the production of virus. The targeting of viral replication is an effective means of reducing liver inflammation and normalizing liver function and preventing the development of cirrhosis. Can you let us know your HBeAg and anti-HBe antibody status?

While overall effect of Viread is to normalize ALT, your body’s immune response may be attempting to remove infected cells from the liver which can lead to ALT elevations on therapy (this is also a good thing). Your ALT elevation is VERY mild as is your elevated total bilirubin. These results are not cause for concern, especially with your normal liver ultrasound finding.

Its very understandable that you have a lot of anxiety over your infection and its treatment. Many patients do but this always stems at least in good part from a lack of understanding of the disease and the impact of therapy. Here are some facts to consider:

  1. You have started treatment with Viread before the development of fibrosis or cirrhosis. We know that patients such as yourself do VERY WELL and lead long and healthy, happy and productive lives with this therapy. You will too!

  2. Your viral infection is under control and your liver appears fine from the results you have shared.

3… Viread is a very very safe medication, you should not be worried about taking this medication. Your doctor will be following you regularly while you are on this medication so again you should not be anxious or concerned.

I hope these these facts help you to remove some of the anxiety from your life. I would try to see if you can stop worrying about your HBV infection and therapy for it and see if this helps.

Do not hesitate to reach out as often as you need to.

Best regards,

2 Likes

Dear @gvit,

Thanks for sharing your story and trusting the community with your concerns.

Yes, your ALTs and aPTT are higher than usual. There are many other causes for this than the HepB, which sounds like it is well controlled. If you have a fibroscan value of 7.65kPa, this is not cirrhosis.

You would need to see a doctor to find out what are the likely causes for these measurements. They will have access to your medical history and can perform tests.

I think if your doctor is well informed about your medical history, then you should be able to trust them that the drugs they are prescribing will not harm you. If you are in doubt, you should talk to them or the pharmacist.

Hope this helps and keep us updated,
Thomas

Thank you for your interest and time for me. I am very worried about the increase in aPTT to be honest, maybe there is some serious hematological problem and not so much the ALT value in this time .the readings you asked about before at the start of the treatment were
Anti-HBc +
Anti-HBs -
HBsAg +
Anti-Hbe -
HBeAg +

Hi givt,

What is your HBeAg status now?

A few months ago it was positive again is it this bad? I have exams scheduled tomorrow and should I ask for a check?
do you think that the results I told you above are not good?

Hi gvit,

As Thomas said your elevated APTT is likely not related to your HBV infection.

Reversion of HBeAg status is not typical during Viread therapy but not unheard of either. You are taking the 300mg dose and compliant with daily therapy?

I would check HBV DNA HBeAg ALT total bili albumin INR and platelets again.

Good luck!

Thank you again for your time. I take 245mg Agardon (Viread in my country) daily, my HBV DNA I did it on 7/28/22 and it was <50IU/ml. Tomorrow I will do the other tests you mentioned and I will tell you the results as soon as I have them. Μy HBeAg is possitive from the start until now never turned negative.

2 Likes

Great gvit,

Thanks for clarifying the HBeAg situation. So this is normal then. Your dose (245mg) is also 300mg depending on which part of the molecule is used to calculate the dose. This is the correct dosage.

Best regards,

1 Like

I sincerely thank you for your time and interest.

1 Like

Yes I agree with Thomas and Andrew’s comments.
it sounds like things are going well and the virus is well under control.
The APTT is only mildly elevated so this is probably not important, but double check with your doctor as they know all your health details.
The increased ALT is very unlikely related to your hepatitis B. There are a range of possible causes for this but the most common we see is fatty liver disease. Do you have fatty liver? Are you overweight? If so this is likely the cause, in which case lifestyle changes are the best treatment, but please discuss with your doctor to make sure there are no other causes. Also make sure they have checked to make sure you don’t have another hepatitis virus like Hepatitis C or Hepatitis D. If so they need different treatment.
Best wishes,
Mark (Infectious Diseases specialist)

3 Likes

Hi Andrew,

tomorrow afternoon I will get the results and inform you.
From what I’ve read, those with ΗΒeAg positive have more chances for HCC right? could the increase in ALT lead to his converted?
thank you very much for your interest.

Στις Κυρ 21 Αυγ 2022 στις 2:00 μ.μ., ο/η Andrew Vaillant via Hep B Community <info@hepbcommunity.org> έγραψε:

Thank you for your time.
I have lost a lot of weight since then as my doctor told me to help the situation and I have no regrets in my liver. If I remember correctly, we did a test for a, c and hiv and they were negative, but I don’t remember correctly for D. I will however do a test to be sure.

1 Like

Hi gvit,

If left untreated, HBV infection can result in a greater chance of getting HCC then in a healthy adult but this only happens in a minority of infected individuals.

In general, treatment with drugs like Viread works well to lower the chance of getting HCC and the earlier you start therapy, the better the treatment works to prevent HCC.

In your case, you stared early in the natural history of the infection (HBeAg positive and no liver disease) which is good news.

The fact that you are still HBeAg positive while on therapy does not mean that you will get HCC. In some individuals, HBeAg loss and seroconversion takes longer. The most important factor in the HCC equation getting good suppression of viral replication (which you have).

There is no relationship between the very mild ALT elevation you have and a potential for HCC.

Having a good diet and no excess body weight is good because it lowers the accumulation of fat in the liver which in turn lowers liver inflammation (always a good thing). Starvation on the on the other hand does not have any demonstrated benefits for HBV.

Getting a test for HDV can’t hurt.

Best regards,

1 Like

Hi givt
If the doctor said to take cholesterol tablets then you should. They stop your arteries from blocking up, causing a heart attack. Although if you have lost weight recently, you could ask for another cholesterol blood test, before starting.
I’m on cholesterol and antiviral tablets. No obvious side-effects.
My high cholesterol is family related not diet. I tried my best to lower it.
You can work on you depression and anxiety. I’m sure there is apps you could use to calm yourself. Count your blessings, not your worries.
Several of us, including me, have anxiety and depression too.
We are all in this HepB bubble together.:blush:

3 Likes

Hi Andrew,
Today I got my results and they are as follows:
HCT: 44.3
PLT:202
AST:38
ALT: 66
total bili: 1.83 (0.48 & 1.35) I HAVE GILBERT I THINK
ALB:4.4
INR: 1.08
aPTT: 39.7
HBeAg NEGATIVE 0.6 (FIRST TIME NEGATIVE)
Do you think my results are good?
The negative HBeAg without nornal AST/ALT is good or not?

Hi gvit,

Congrats on transition to HBeAg negativity - this is indeed a good sign of improved control of viral replication. This is a sign that not only has the viral replication been controlled but that your immune system has also inactivated the genetic reservoir of HBV production. You will still see HBsAg even while you are HBeAg negative. This is normal but now that you have HBeAg negativity you should check also HBsAg during your regular check up. If HBsAg becomes negative, this is a sign of functional cure which allows removal of therapy.

Your bilirubin being mildly elevated and mostly uncongjugated would be consistent with Gilbert’s syndrome but not the persistently mild elevation of ALT - this feels more like liver inflammation from fat accumulation in the liver (steatosis). This can be present even with a normal body mass index (ratio of fat to tissue).

The article will provide some good reading for you Evaluating Elevated Bilirubin Levels in Asymptomatic Adults - PMC.

Best regards,