NEW USER: Singaporean Male, 32 - Started Treatment Recently & Relieved I Found this Space!

General Discussion
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Hi everyone, I recently found this space and am so relieved that there exists such a forum and discussion board fro people to share more about this nasty virus! I feel this first post of mine is going to be quite a lengthly one, so I’ll break it up into sections for easier reading, hope everyone bears with my anxiety!

  1. Introduction
  2. Timeline of Events
  3. Lab Results
  4. Concerns & Questions
  1. Introduction

Hi, I am J, a 32-year-old Singaporean male. Have been living with Hepatitis B for pretty much my entire life, although it was only discovered when I was in my early 20s. I have been living without symptons until a flare up recently, which made me Google a lot and eventually discovering this forum. I am generally quite healthy, with no high blood pressure, no high cholesterol, and no diabetes. I neither smoke nor drink, but my diet can be healthier (I do enjoy my burgers, pizzas, chips and chocolates). My liver doctor said I likely got HepB through my mum at birth, as I do not have any tattoos, never did drugs, don’t engage in casual sex and never had any blood transfusions.

I feel very fortunate to be living in Singapore, where medical technology are quite advanced and healthcare can be relatively affordable due to subsidies. Treatment is also readily available.

In more uplifting news, I enjoy cooking and eating, and support Chelsea Football Club in the Barclays Premier League.

  1. Timeline of Events

2012 - 2014 (thereabouts):

  • discovered I had the virus while doing a health screeening prior to entering the military service ( we have a mandatory 2-year conscription here in Singapore for males)
  • freaked out, did a ton of research online, and was put on follow-up with a liver specialist to monitor

2014 - 2016:

  • did my military service, with regular follow-ups with the doctors
  • doctors always said my viral load is very high, but my other bloodwork came out normal so I wasn’t started on any treatment
  • exited military service in February 2016

2016 - 2019:

  • have to do blood tests twice a year, and 1 ultrasound annually
  • up to this period, every result came back normal, and my initial worry about HepB left my mind
  • due to work and other issues, I missed 1 appointment, then 2, and subsequently more
  • eventually I stopped visiting the doctor and had my last ultrasound in 2019

2021:

  • suffered from a stroke and was hospitalized
  • doctors found out I have a PFO (a hole in the heart) which is likely to have caused the stroke
  • was given Aspirin (blood thinners) & Statins (cholesterol lowering medication, a preventive measure despite me not having high cholesterol) to reduce the chance of getting a second stroke

2022 - 2023:

  • seeing the neurologist and cardiologist regularly for my stroke follow-up (at this point HepB was completely off my mind)
  • Cardiologist reccomended a closure for the PFO to further reduce the risk of a second stroke

July 2023

  • did a routine blood test for stroke follow-up, but cardiologist added in Liver tests as I haven’t gotten any done for a while
  • results showed I had very elevated liver enzymes levels
  • cardiologist instructed me to stop statins immediately and go for another blood test
  • went to get another blood test, liver enzyme levels went up further
  • went to emergency department of the hospital
  • discharged after 3 days in the hospital because my liver enzyme levels went down and doctor said it’s a good sign that my body is trying to fight and clear the virus
  • went home without any treatment, but was told to visit liver doctor in 2 days to monitor
  • returned to liver doctor, blood tests showed liver enzymes went up again
  • started on Entecavir
  1. Lab Results

Here are some of my blood tests results to share with the community for possible advice and discussion. I will only be including ALT, AST and Bilirubin levels or else there will be too much information to process and type.

18 June 2021 (I was hospitalized for stroke so they did tests for everything):

Bilirubin Total - 22 umol/L
AST - 19 U/L
ALT - 36 U/L

So as per 2021, I supposed my liver inflammation has not started.

21 July 2023 (doing routine check for heart issues, but cardiologist included a liver function test):

Bilirubin Total - 46 umol/L
AST - 542 U/L
ALT - 1436 U/L

Super shocked by the numbers, was told to stop statins immediately and get another blood test ASAP.

24 July 2023, Morning (after stopping statins for 3 days):

Bilirubin Total - 57 umol/L
AST - 723 U/L
ALT - 2013 U/L

Was sent to the emergency department at the hospital after this.

24 July 2023, Evening (already hospitalized):

Bilirubin Total - 62 umol/L
AST - 691 U/L
ALT - 1903 U/L

25 July 2023 (day 2 in hospital):

Bilirubin Total - 72 umol/L
AST - 678 U/L
ALT - 1859 U/L

Hepatitis B Virus DNA Load
Results:

  • DETECTED
    Ref. Range:
    N/A
    Remarks:
    34,900,000 IU/mL (7.54 LOG)

Also did an ultrasound, but no Fibroscan.

Ultrasound results:

Liver

  • Echogenicity: Normal
  • Echotexture: Normal
  • Contour: Smooth
  • No suspicious focal lesion.

Portal Vein

  • Normal hepatopetal flow

CONCLUSION

No sonographic evidence of hepatic cirrhosis. No suspicious hepatic lesion detected.

26 July 2023 (day 3 in hospital):

Bilirubin Total - 63 umol/L
AST - 484 U/L
ALT - 1666 U/L

At this point, the doctor said I can be discharged and that my body is fighting off the virus. I was also not started with any treatment. Was told to see him in 2 days.

28 July 2023 (return to see liver doctor):

Bilirubin Total - 98 umol/L
AST - 576 U/L
ALT - 1942 U/L

Numbers went up again, and doctor started me on Entecavir. Told to see him in 3 days.

31 July 2023 (return to see liver doctor, started on Entecavir for 3 days):

Bilirubin Total - 104 umol/L
AST - 299 U/L
ALT - 1364 U/L

Next appointment to see liver doctor on 28 August 2023, in about 1 month.

3 August 2023 (visited a clinic on my own to make sure things are alright):

Bilirubin Total - 72 umol/L
AST - 118 U/L
ALT - 747 U/L

11 August 2023 (visited a clinic again to monitor on my own):

Bilirubin Total - 47 umol/L
AST - 49 U/L
ALT - 216 U/L

14 August 2023 (thought my eyes are slightly jaundiced so I went for a blood test again):

Bilirubin Total - 35 umol/L
AST - 48 U/L
ALT - 197 U/L

This is the latest result, and my next appointment with the liver doctor is on 28 August 2023. I have been taking Entecavir for about 3 weeks.

  1. Concerns & Questions

If you have read everything thus far, I cannot express my gratitude and appreciation enough. These past weeks have been insane for me, seeing my liver inflammation levels go up and down, and at one point my eyes were really yellow. Based on the latest blood tests I have done, I reckon the Entecavir is doing its thing, my AST are back to normal levels, and my ALT is slowly but surely dropping. Discovering this forum has been one of the highlights of the week for me, and I hope the community members and experts and chime in with their thoughts and expertise for the following concerns I have.

(i) My ultrasound results seem normal, but I have never had any Fibroscans done, even while I was at the hospital. I am not sure if it’s normal practise or that the doctors felt it was unnecessary for me to have one. I found out about Fibroscan on the internet, and there are clinics in Singapore that offer it, but I believe the scan can be quite costly. Should I request to have one done, or is the ultrasound result of “No sonographic evidence of hepatic cirrhosis. No suspicious hepatic lesion detected.” a good indicator for now?

(ii) I am quite shocked that despite my viral load being in the 3 millions and my ALTs at one point being 2000+, the doctors have decided not to start treatment then. Is this normal practice where you guys are from?

(iii) For those on Entecavir, is there anyone who experienced side effects? I understand it’s a very safe anti-viral, but carries a low percentage of the patient getting diarrhea and vomitting. I am not sure if it is psychological, but I have been having some nausea and diarrhea for the past few days after a recent food poisoning that has been resolved. In my first 2 weeks of taking Entecavir, I had no issues whatsoever though. Would the side effects appear suddenly, or am I overthinking? Not too keen on switching to Tenofovir because I read that long term usage damages the kidneys.

(iv) I am currently taking 1mg Entecavir instead of 0.5mg (which is apparently what a lot of other chronic patients are taking). Does this mean my liver damage is quite serious?

(v) Everywhere I seem to read says that Entecavir needs to be taken 2 hours before or after food. I know this is for better absorbtion. However, on my prescription from the doctor, it states that I can take Entecavir 2 hours after food or just 1 hour before. Would that affect absorbtion rates?

Thank you once again everyone and I sincerely apologize for the wall of text. Hope all of you are having a great week!

J

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Hi @GreyhoundTJX ,

Great job on your essay, it may equal or rival my own novels I have written on here. Even though you are sharing your story and inquiring for information, I know how much effort and time it can take to write so much, so I give you props and kudos!

I will let the experts give you the proper technical and clinical answers you seek but just wanted to welcome you to the community and commend you on the effort you put towards your first post. Give the experts a bit to answer as you have multiple questions and a good amount to read. In the meanwhile, continue perusing through the posts as it may give you answers to questions you didn’t even know you had and give you questions to answers you thought you knew. :thinking:

-Paul

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Hi Paul

Thanks for being the first to reply and welcoming me here! I have read some of your posts here and understand you are currently living with cirrhosis (please do kindly forgive me if I have gotten it mixed up), hope everything is well.

You seem to be a very encouraging individual and I am really glad to be in the company of such lovely people as I navigate these new waters.

Cheers and have a great week!

J

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Hi @GreyhoundTJX

Seems like not a good thing to say happy that you’re here but one way or another glad that you found your way out to us and this community. Deep story man and hoping-wishing that soon it all goes under control.
I am relatively new myself to the forum but yeah finding quite one or two every now and then to talk to and share my story with.

Welcome and be strong
We are all in this together
Cheers
Rana

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Hi @GreyhoundTJX,
Sorry I addressed my response to the wrong user name. I join @PuallyHBV in welcoming you to the platform and thanks for sharing your story with us all. Despite all that happened, we are all grateful that you are alive and recovering well. You have asked many great questions, and I wanted to chime in on some of them not as an expert but as a fellow patient. The experts will share their thoughts with you soon.

Regarding the question on Fibroscan, I don’t think it is necessary if you have a normal ultrasound and markers. Unless your other markers are abnormal for some time and your doctor wants to make sure he/she is not missing anything so they might order it. For example, I was diagnosed in 2014 but did not have a Fibroscan done until last year. I have always gotten my ultrasound and labs done every 6 months. But in this case, my ALT has been all over the place. Other markers including the ultrasound have not shown anything new or that something is getting worse. For my doctor to be sure we were not missing anything, he ordered a Fibroscan. So one wouldn’t necessarily get a Fibroscan if they have normal ultrasound and other markers.

Starting treatment depends on the guidelines, your test results and the doctor. Some doctors might have put you on treatment with those numbers, but maybe because you have not been seen by a liver specialist for some years your doctor decided to wait and get more test done before deciding on treatment. One round of test might not be enough to start treatment.

I took entecavir for a number of years, and I did not experience any side effects. I struggled at the begging finding the time to take it, but I figured it out and never had an issue. I remember the instruction was 2 hours before or 2 hours after a meal. If that is not what your instruction says, consult your doctor or pharmacist about this to get clarification if needed. I am not sure how much it will affect the absorption rate but double check with your doctor.

Please keep your appointments and try not to skip them as these follow-ups are equally important. Remember you are not alone in this battle, we are millions and we are stronger. Best, bansah1.

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Are there any @HealthExperts or @ScienceExperts who can advise on my original post? Appreciate it very much thank you.

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Dear @GreyhoundTJX,

Welcome to the forum and great to see you so engaged with your health. Glad to hear you appear to be recovering from the liver flare and thanks for your questions.

  1. A fibroscan is likely to be more sensitive for earlier stages of fibrosis, so it may be worth asking your doctor about.
  2. Generally such a high ALT is an indication to start antivirals. However, not all doctors are across best management of Hepatitis B and so may not immediately think about it. Possibly since you were already on medicines, there might have been a worry that it was the medications causing liver injury.
  3. Some side effects are reported from antivirals, but these either resolve by themselves over time or can be managed otherwise (changing formulations or when you take them, etc.).
  4. My understanding is that 1mg is a high dose used to quickly decrease viral load and possibly to quickly prevent your liver injury from getting worse (which it has done). It is likely (given no indication of cirrhosis or decompensation) that you may be switched over to a 0.5mg after you recover, but this is something to be discussed with your doctor.
  5. I’m not too sure about Entecavir and food and the real difference between 1 hour vs 2 hours before food but perhaps one of our @PharmacyExperts can provide some details.
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Hi @GreyhoundTJX,

First, I would like to welcome you to the community and want to let you know that you are not alone living with HepB. I am not specialist. I am just a patient living with Hep B for nearly 20 years. What I want to advice is that as long you as you are still here fighting with HepB you will have hope. It is good that you started on treatment and your liver enzyme went lower. Hope it will continue to be lower.

From my experience, diet and lifestyle play a very important role in HepB management. You shall consider changing your lifestyle so that you body immune system can fight the virus. Things you shall do:

1- Stop consuming alcohol completely ( if you currently do ). Alcohol is the number one factor that will lead to damaging the liver
2-earting whole food ( reduce junk food / processed food or completely avoid them )
3-Regular exercise mild to moderate like, gym, running, walking, swimming
4-Try to reduce stress
5-Sleep well at least from 6-8 hours a day
6-Take your HepB medicine onetime everyday
7- Be sure to visit your doctor for follow up ( make this priority schedule over any other tasks )

Good luck on your journey for fighting HepB. Remember, We are are as community, you are not a lone. Do not loss hope

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