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!
- Timeline of Events
- Lab Results
- Concerns & Questions
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.
- 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
- 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
- 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
- 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
34,900,000 IU/mL (7.54 LOG)
Also did an ultrasound, but no Fibroscan.
- Echogenicity: Normal
- Echotexture: Normal
- Contour: Smooth
- No suspicious focal lesion.
- Normal hepatopetal flow
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.
- 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!