Hep B Blog

New Hepatitis B Treatment Guidelines Revealed at AASLD 2015 Conference

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The American Association for the Study of Liver Disease (AASLD), the organization that defines how doctors should treat hepatitis B and other liver ailments, unveiled new hepatitis B treatment guidelines this week at its annual conference in San Francisco.

The new guidelines are published here.  Patients should review them and discuss any updates that address their individual conditions with their physicians.

The experts addressed important issues in the updated guidelines, including whether to treat children and young adults who are in the immune-tolerant stage of hepatitis B–with high viral load but no signs of liver damage, and when it is safe to stop antiviral treatment. They also made it “official” that pregnant women with high viral loads should be treated with tenofovir (Viread) during pregnancy to avoid infecting their newborns.

Other issues tackled in the updated guidelines are listed below, along with some observations by Joan Block, executive director and cofounder of the Hepatitis B Foundation. We’ll be featuring other news from AASLD in this blog in the days ahead.

Issues address in AASLD’s updated hepatitis B treatment  guidelines:

  1. Should adults with immune active chronic hepatitis B be treated with antivirals to decrease liver-related complications?
  2. Should adults and children with immune-tolerant infection — high viral load and normal ALTs (alanine aminotransferase) — meaning no signs of liver damage–be treated with antivirals to decrease liver-related complications?
  3. Should antivirals be discontinued in people who have lost the hepatitis B e antigen (HBeAg) while on treatment?
  4. Should antivirals be discontinued in people with HBeAg-negative infection who have achieved sustained, low viral load (HBV DNA) during treatment?
  5. Does the antiviral entecavir (Baraclude) have a different impact on kidney and bone health than tenofovir?
  6. Is there a benefit to adding a second antiviral in people with persistently low viral load who are being treated with either tenofovir or entecavir?
  7. Should people with compensated cirrhosis (liver scarring) and low viral load be treated with antivirals?
  8. Should pregnant women who are hepatitis B surface antigen (HBsAg) positive with high viral load receive antivirals during their third trimester of pregnancy to prevent perinatal (mother-to-child) transmission of hepatitis B?
  9. Should children with HBeAg-positive hepatitis B be treated with antivirals to decrease liver-related complications?

Reports from Joan Block about AASLD:

–Hepatitis B Foundation medical director Dr. Bob Gish will be featured at a special session – Beyond the Walls of the Clinic – sponsored by Project Inform, which will discuss the importance of collaboration between clinicians and the community to address viral hepatitis.

— Dr. Anna Lok spoke on Sunday about treatment options for tricky situations such as pregnancy. The updated AASLD HBV guidelines recommend if an infected pregnant woman’s viral load is greater than 1 million IU/mL she should be treated with tenofovir to prevent perinatal transmission. Tenofovir is preferred, but clinical trials have shown that lamivudine and telbivudine are also safe.

— “Within the next decade most liver disease in the U.S. will be self-inflicted, not the result of viral infection or some outside cause,” according to Dr. Ramon Batalier at University of North Carolina.

— Currently, viral hepatitis is a huge silent epidemic in the U.S.; however, fatty liver disease is going to be an enormous liver disease tsunami if steps aren’t taken now to address it.

Final thoughts from the foundation’s President, Dr. Tim Block:

The focus at AASLD is on hepatitis C because there’s truly a revolution going on in regards to the treatment of this virus. But interest in hepatitis B treatment is growing as evidenced by the packed meeting sessions, which is significantly different from years past.

Speakers are noting that there is definitely a shift of scientists moving from hepatitis C to hepatitis B because that’s where the need is now.

 

 

Comments on this blog are closed. If you have questions about hepatitis B or this blog post, please email info@hepb.org or call 215-489-4900.

66 thoughts on “New Hepatitis B Treatment Guidelines Revealed at AASLD 2015 Conference”

  1. Hi
    What test to be done in sequence to diagnose lever decease including A, B and C Virus?
    Rajendra Shah
    919821743140

    1. Hello: Hepatitis A, B and C are all very different viruses, the only thing they have in common is they all infect the liver.
      Each hepatitis infection has unique lab tests that look for different viral proteins (antigens) and antibodies. These tests all require a blood draw to find out if someone has ever been exposed to the viruses. I hope this helps, good luck.

    1. Hello: Unfortunately there is currently no cure for hepatitis B, however there are effective treatments, including antivirals such as tenofovir (Viread) or entecavir (Baraclude) that can reduce the amount of virus in your body and also lower your risk of liver damage. Experts predict that within a few years that a cure will be developed for hepatitis B. Good luck.

  2. Hello: Excellent question! Historically in the United States, there have been many more people actively infected with hepatitis C than B. Also, because there is a vaccine against hepatitis B, researchers may have thought the virus would simply go away, which we all know is not true. The good news is that researchers are making great advances in the study of hepatitis B and they predict there should be a cure in a few years. Good luck.

  3. Please can somebody know when exactly he is infected with Hepatitis B virus for the first time? When is the appropriate time for Hepatitis B medication?
    Thank you.

    1. Hello: When people are infected with hepatitis B, the majority never experience any symptoms, so it’s usually impossible to tell exactly when we became infected. According to medical guidelines, treatment is recommended if viral load (HBV DNA) increases and if your ALT/SGPT tests show signs of liver damage. Good luck.

  4. Hi ,I am a hep b patient though the viral load is note detectable from 2008 ,I am on tenofovir.my fibroscan is 8.5kpa ..which stage of cirrhosis I am in ??my Lft now is normal though my direct bilirubin is 0.32…albumin-4.30,sgpt-37…

    1. Hello: It is very hard for me to comment on the fibroscan score. It can suggest some fibrosis, but a true analysis of your health needs to be made by a doctor who can look at all of your lab results, as well as the fibroscan results. The fact your liver function test results are normal is good news, and shows the tenofovir is working, especially with an undetectable viral load. I’m sorry I cannot be of more help. Thank you.

  5. ON READING THIS REPORT I WAS AND CONTINUE TO BE DISAPPOINTED BY THE EFFORTS OF SPECIALISTS WHO DEEM IT APPROPRIATE TO CONTINUE FINDING NEW WAYS TO TREAT THE SYMPTOMS RATHER THAN GOING AFTER A CURE. BIRINIPANT WAS USED IN CLINICAL TRIALS TO GREAT EFFECT IN AUSTRALIA……….THEN ONCE AGAIN, HALTED; NOW INDIA ARE SUPPOSEDLY MAKING A STATEMENT TO ERADICATE THIS DISEASE WITHIN THE NEXT TEN YRS . CHECK REPORTS OVER THE PAST TWO YEARS ALL OF WHICH PROMISING A CURE WITH IMPENDING DATE LINES ALL IN THE FUTURE….. ?, WHEN;

    1. Hello: While there is no cure, there are very effective antiviral treatments (tenofovir and entecavir) that will reduce your viral load (amount of virus in your body) and lower your risk of liver damage. Experts predict they will be able to develop a cure in the next few years, so we are hopeful! Keep in mind treatment is recommended only if you have liver damage and a high viral load, so talk to your doctor. Many people live with hepatitis B without ever requiring treatment. Good luck.

  6. Hi sir. I am 32 years old. On 14th of september 2015, I came to know through urine test that there are numerous red blood cells and puss cells are found in my urine. Ultrasound showed a 6 mm stone and on very next day I passed the stone easily. Few days ago I went for urine test again and found that red blood cells are still present in my urine. Now doctor advised me to get tested for hepatitis b and c. according to test report I am HCV Ab negative and hep Bs Ag Qualitative) positive (Patient S/CO 2231.12). Then doctor recommended me LFT and abdomen ultrasound. according to LFT, serum bilirubin-total, serum alkaline phosphatase and serum albumin are within the reference ranges except Serum ALT (SGPT) 65 u/L. My ultrasound report was ok. impression was unremarkable study. According to ultrasound report my liver is normal in size with smooth echotexture. Parenchymal echogenecity is normal. No focal mass or lesion is seen. Portal vein appears normal in diameter. Intrahepatic biliary channels are not dilated and CBD appears normal. Now doctor has given me 60 tablets of Silliver (Silymarin-200mg) for one month use and asked me to get LFT test again after one month and Hep Bs Ag test after six months. Please give your opinion about all this. Am I going towards a right direction?

    1. Hello: Was the positive hepatitis B test after your kidney stone episode the first time you’ve ever been screened for hepatitis B, and tested positive for the hepatitis B surface antigen (HBsAg)? Your moderately elevated ALT levels at 65 are not alarming — normal for men is 30 or less and for women it is 19 or less. Each lab has its own normal range, which can reach up to 50 due to technical variations. Your doctor has given you an herbal supplement that is supposed to help protect the liver, though there is not much scientific evidence for that. It is good that he is testing you again in a month to monitor your liver damage, and he may be testing you again in six months to find out if this is a new, acute (and hopefully short-lived) infection or if you have had this since you were a child and have a long-term, chronic infection.
      I am glad all your liver tests and ultrasounds are normal. It will be hard, but now you’ll have to wait and see what the tests reveal in six months. Good luck.

      1. Thank you very much sir for the detailed answer. yes I was screened for hep b test for the first time and I went for it after removal of kidney stone.

          1. Dear Sir, Hope you are doing well. I went for HBsAg test again after almost one and half year. Was hoping for a negative result but it came positive with the value 2789.85 (Hep Bs Ag qualitative). My previous result was S/CO 2231.12 in Jan 2016. My LFT report shows that high ALT value (65), While normal range was upto 40 u/l as per lab reference range. So It shows that I am a chronic Hep B patient.
            Do I need to have some other tests as well or start any medication with doctor advise? I am not married but expecting to be married soon and I don’t know how to tell my future partner about this. how to convince her that it is safe if she gets herself vaccinated or should I forget the idea of getting married? Hoping for a Hep B cure soon.

          2. Hello: I am sorry to hear about your hepatitis B. First, of course you can marry and have children if you have hepatitis B. But there are some important steps to take to make sure your partner and your future children do not become infected.
            Before you marry or have sexual relations, you must make sure your partner is vaccinated against hepatitis B and has enough hepatitis B antibodies (HBsAb) to protect them. Have them go to a doctor and get screened for hepatitis B. If they are not infected and haven’t been vaccinated in the past, they should get the three shots of the vaccine. (They may have been immunized during childhood.) The second shot is given 30 days after the first, and the third shot is given six months after the first shot.
            About one or two months after the third vaccine shot, have your partner screened for hepatitis B antibodies/titers. Or, if they were immunized in the past, have them tested now to make sure they have enough antibodies to protect them. The number of antibodies should be more than 10 mIU/mL. That means they have enough antibodies to fight off infection.
            If they were immunized long ago, their antibody levels may be under 10, if that is the case talk to your doctor and get one more hepatitis B vaccine shot (called a booster), and then test again to see if the antibodies have increased.
            Until you are certain that your partner has enough titers to fully protect them from hepatitis B, you must practice safe sex and use a condom.
            If you’re wondering how to disclose to a potential partner about your hepatitis B, here is a column addressing that topic: http://www.hepb.org/blog/romance-in-the-air-take-a-deep-breath-and-disclose/
            Your liver enzymes (ALT) are moderately elevated. Do you drink alcohol or smoke? It is very important to lead a healthy lifestyle, and to avoid becoming overweight and developing fatty liver, which can increase your risk of liver damage.
            Depending where you live, you may also want to get tested for hepatitis D. And, have you had a viral load (HBV DNA) test? This can also help explain what stage of infection you are at.
            Good luck.

  7. Gp told me I have got acute hepb.my test results hbsurface antigen detected,hbcore IgM detected,hbeAb detected.this result making me confused.please sir can you tell me what this results mean.i have been recommend for ultrasound too.I m very stressed out.

    1. Hello: Hepatitis B is a very confusing infection, as are lab tests. There are two types of hepatitis B, acute (short-term) and chronic (long-term). When a healthy adults is infected, it can take up to six months for our immune systems to clear the virus. When we are infected as newborns or young children, our immature immune systems don’t recognize and fight the infection, and it becomes long-term or chronic. If you are infected with hepatitis B (no matter if it’s acute or chronic), you test positive or reactive for the hepatitis B surface antigen (HBsAg). Once our bodies clear the virus, we test positive or reactive for the hepatitis B surface antibody (HBsAb or antiHBs). During the infection, we also test positive for the hepatitis B core antibody and the hepatitis B “e” antigen and antibody. Your doctor will keep testing you to see if the infection is cleared within six months. The doctor is ordering the ultrasound as a precaution to make sure the infection is not damaging your liver. You probably have also had your liver enzymes (ALT or SGPT) tested through a blood test to see if your liver is damaged. Liver cells release ALT when they are damaged. Good luck.

  8. hello ! i am 38 yrs old with chronic hepa b. please inform me if there are good improvements
    for the treatment. i live in rosario, la union, philippines, i cannot afford high cost medication . i am only a construction worker. my salary is 400 pesos or 8 us dollers a day. i have wife and 3 children. i wish i could live long enough for the cure. its good hope that there are team out there developing a cure. i wish you goodluck. you will save my life and the future of my 3 children. you will also save 2 billion people along with their 6 billion sons and daughters future. thankyou very much.

    1. Hello: We are sorry to hear about your hepatitis B, have your wife and children been tested and vaccinated against hepatitis B? It is very important to do all we can to prevent the spread of infection. There is no complete cure discovered yet for hepatitis B, however experts predict one should be developed in the next few years. There are effective antiviral treatments to reduce the amount of virus in your body and reduce the risk of liver damage. Are you certain you need treatment at this time? Experts recommend treatment only if you have high viral load and signs of liver damage (shown through a liver enzyme test.)
      In the Philippines, there are several organizations that may be able to help you with treatment. They are listed below, good luck.
      Hepatology Society of the Philippines:
      https://www.facebook.com/BeAwarePH?fref=ts
      http://www.liverphil.org
      Yellow Warriors Society of the Philippines
      https://www.facebook.com/YellowWarriors?fref=ts

  9. Hello,

    I am poor 30 year-old woman in Nigeria with no job. My mother and her siblings got Hepb from their mother and me and my siblings got Hepb from her. How do we get free medication in Nigeria? I have been in the hospital several times. I started medication earlier but quit due to lack of money to buy.

    1. Hello: I am sorry to hear about your hepatitis B and current circumstances. There are several organizations in Nigeria that might be able to assist you. The World Hepatitis Alliance (http://www.worldhepatitisalliance.org/en/our-members) list organizations that work on hepatitis in each country, including Nigeria. If you go to the link above and search on Nigeria, you will see organizations that you can contact for assistance. Good luck.

    1. Hello: Experts predict a cure will be discovered in the next few years, one does not exist at this time. A viral load of 1,600 IU/mL (HBV DNA) is not high, have your had ALT/SGPT tests performed to see if the virus is harming your liver? Make sure you have that done, and then consult with your doctor to see if you need treatment. Good luck.

    1. Hello: A very small percentage of people with chronic hepatitis B lose the hepatitis B surface antigen and develop the surface antibody–which indicates they have cleared the infection–each year. Usually, these people have had “inactive” hepatitis B beforehand. Good luck.

  10. Hi, I live in Ireland and am of African descent , I was diagonised with hep b in 2007 . I was told that I do not need treatment . I asked what to look for in the future but was given evasive answers!! I am now 46years old and sometimes don’t know if my aches and pains are old age or hep b. I am embarrassed to go to the STI unit as the last time I went for one in 2012 in Ballinasloe I was humiliated, threatened, embarrassed !! Humiliated by being addressed by name all the time after being told that numbers are used for identification . Embarrassed by being told that I should give names of people I slept with lest I infected them. Threatened by being told that my name will be sent to all the relevant departments!! I still asked the doctor in question if I was in any danger of the disease but she simply told me they will get in touch with me and that was the last I heard of them!!! Please advice on the next step!

    1. Hello: I am so sorry to hear about the humiliating treatment you were subjected to. Unfortunately, because hepatitis B is considered an STI, officials assume this was a new diagnosis and try to track sexual contacts to get tested. We recommend that you see a liver specialist and explain this is a chronic infection. You should get screened for the various hepatitis B antigens and antibodies to see what stage of infection you are in, and also have the liver enzyme ALT/SGPT tested (which is a blood test) to make sure the infection is not harming your liver. Ideally, you should be tested at least every six or 12 months, depending on your medical history.
      I recommend you search online for a gastroenterologist or medical department that specializes in hepatitis B, are you in Dublin? There is no reason to return to the STI clinic, your doctor should simply refer you to a liver specialist.
      Good luck.

  11. Hi, i am beeing treated with entecavir for almost 6 years and still don’t have antybodies yet/ but no viral load anymore . I am thinking to have a baby, can I change medication with tenofovir ? Would tenofovir have effect if I had entecavir before ? Would it be safe for me and fetus ?
    Thank you in advance ,
    Victoria

    1. Hello: I’m glad entecavir has worked well in helping you achieve undetectable viral load. The American Association for the Study of Liver Disease has just issued new guidelines for managing pregnancy and hepatitis B at http://onlinelibrary.wiley.com/doi/10.1002/hep.28302/full You should discuss their recommendations with your doctor. The guidelines recommend the use of tenofovir (Viread) in pregnant women with high viral loads, or who require ongoing treatment. Antivirals have been used safely over the course of an entire pregnancy. This is important to review carefully with your doctor, you want to make sure your health (and liver!) are protected, and you want to make sure your baby is not put at risk of infection. Remember, when you give birth, it is critical that your baby is given the first hepatitis B vaccine dose within 12 hours of birth, and also a dose of HBIG (hepatitis B antibodies) because babies born to women with HBV are at high risk of infection. Good luck!

  12. Hi …doctor told me to start with tenofovir. …and my ALT report is 48…51…49….for three month …it came out different in every month what does it means .

    1. Hello: Our ALT (liver enzyme) levels can vary. When liver cells are damaged, they release ALT into the bloodstream. Normal ALT levels are 30 and less for men and 19 and less for women. Hepatitis B infection can damage liver cells, as can other illness or even drinking alcohol. Because your ALT levels have been elevated for a while, your doctor is probably concerned. Also taken into consideration is your age, gender, and how many years you’ve been infected. Your doctor takes many factors into consideration when recommending treatment. Tenofovir (Viread) is one of the top two recommended antivirals. Good luck.

  13. I still hope for the cure ….. we all where happy when birinapant is 100 percent to cure hbsag ..But what happen to the clinical trial. ..last medicine (tenofovir) hbsag is released on 2008..after that till now no medicine has discover so far…it is almost 8 years.is there any possibility to realise new medicine for hbsag in 2016.

    1. Hello: We too are anxiously awaiting a cure. The new treatments under development today are very different than antivirals, many of them use a new approach using micro RNAs to block the infection cycle and production of antibodies. Because this technology and approach is radically different, it has taken years to develop and fine-tune. Have hope, experts predict a cure will be developed in the next several years. Good luck.

  14. When …….when …….when ……. and when .. hbsag will be cure….please help us to cure from hbsag…

    1. We agree completely and are supporting research and the exchange of ideas in any way we can. Hopefully within a few years. Good luck.

  15. Hello. First of all I should say you people are doing good Job. Keep it up. Secondly I am now 31 year old Male and diagnosed HEP B patient in 1995 when I was 10 year old. I started HEPSERA tab treatment in 2008 till 2010 for 18months and since July 2009 My PCR HBV DNA was negative uptill 2011. I didn’t tested PCR after that but I regularly did LFT (ALT/SGPT) and blood complete profile tests and all were always normal. Last week i took test of PCR HBV DNA ( Viral Load 9736 IU/Ml) detected, LFT (ALT) 26 , HBeAG non reactive, HBeAB Postive (0.003), Alpha Feto Protein 1.56 ng/ml & Hepatitis Delta Virus Antibody Negative 2.098. My Abdomen Ultra sound is normal.

    In view of above what you recommend for treatment and which medicine? Does this medicine have any side effect specially when I am planning to get married? Do I have to avoid my wife pregnancy during this treatment to avoid any abnormalities in child?Does Hepatitis cause sperm issue & infertility issues in men in respective to my reports and in general as well?Does Vaccination of Hepatitis B help developing antibody to reduce chances of increase in DNA viral load?or is there any other way by which it kept negative or low?

    1. Hello: It is good news that your viral load is relatively low and your ALT levels and ultrasound show everything is normal. Usually, doctors do not recommend treatment unless your viral load is elevated and you have signs of liver damage. However, your doctor is the best judge. I am not aware of any sperm abnormalities caused by antivirals used to treat hepatitis B. Yes, you can marry and have children if you have hepatitis B. But there are some important steps to take to make sure your partner and your future children do not become infected.
      Before you marry or have sexual relations, you must make sure your partner is vaccinated against hepatitis B and has enough hepatitis B antibodies (also called titers) to protect them.
      Have them go to a doctor and get screened for hepatitis B. If they are not infected and haven’t been vaccinated in the past, they should get the three shots of the vaccine. (They may have been immunized during childhood.) The second shot is given 30 days after the first, and the third shot is given six months after the first shot.
      About one or two months after the third vaccine shot, have your partner screened for hepatitis B antibodies/titers. Or, if they were immunized in the past, have them tested now to make sure they have enough antibodies to protect them. The number of antibodies should be more than 10 mIU/mL. That means they have enough antibodies to fight off infection.
      If they were immunized long ago, their titer levels may be under 10, if that is the case talk to your doctor and get one more hepatitis B vaccine shot (called a booster), and then test again to see if the antibodies have increased.
      Until you are certain that your partner has enough titers to fully protect them from hepatitis B, you must practice safe sex and use a condom.
      Because you are already infected, the vaccine will not help lower your viral load. The best thing to do is eat healthy foods and avoid alcohol and cigarettes. Also, make sure your family is also tested for hepatitis B and vaccinated if needed. Good luck.

      1. Yes the cure of hbsag Is expected by next few years ..but does chronic hbsag patients can survive…yet not fixed duration for the cure to discover…….

        1. Hello: People with chronic hepatitis B often live long and healthy lives, even without treatment, if they avoid smoking, alcohol, and eat healthy foods. Thank you.

      2. Thank you for your detail response. Few question left unanswered which I appreciate if you can answer me.
        In view of above which medicine is best suited (if treatment required)? Does Hepatitis cause sperm issue & infertility issues in men in respective to my reports and in general as well? What type of healthy food should I take and what should I avoid? I don’t take alcohol neither smoke.

        1. Hello: Medical guidelines currently recommend two antivirals, tenofovir (brand name Viread) and entecavir (a generic drug) for hepatitis B treatment.
          There have been some studies that suggest hepatitis B may lower sperm count moderately, but there is not a lot of research that has been performed in this area.
          As for diet, simply eat healthy foods with lots of food and vegetables, and congratulations for avoiding alcohol and cigarettes. Good luck.

  16. Hi….thanks for your answer…as I start to tread with tenofovir. .hope there won’t be drugs resistance in future..

  17. Hi….I am 34 years with bhsag….I digonise hbsag 6 months ago when I went to check the gastraties. ..I ask doctor about the diseases whether it is acute or chronic. ..doctor told me it is chronic…but how does doctor know about it…and I am going to start tenofovir from next week …

    1. Hello: Keep in mind that not everyone with hepatitis B require treatment, many people live long and healthy lives with hepatitis B. Generally, medical guidelines recommend treatment if you are experiencing liver damage. This is indicated by an ultrasound and a simple blood test for the liver enzyme ALT (also called SGPT). Have you had this blood test? Our liver cells release ALT when they are damaged or die. Healthy ALT levels for men are up to 30, and for women they are up to 19. Consult with your doctor and see what your ALT levels are to determine if you require treatment. If you ever do, there are two very effective antiviral medications that are recommended: tenofovir (Viread) and entecavir. Good luck.

  18. I was testes positive to HB in Dec. 2016. After which I went for LFT last week and my result is: total bilirubin 0.82 (normal range: up to 1mg/dl), direct bilirubin 0.1 (normal range: up to 0.25mg/dl), AST(SGOT) 8.0 (normal range: up to 12U/L), ALT(SGPT) 10.0 (normal range: up to 12U/L), ALK.PHOS 115 (normal range 60-170lu/L. Please, I dont understand this result, kindly interprete the result and let me know if my liver is normal. I am currently being treated wirh Lamivudine 100mg and easential forte cap. for about aix weeks now. Please, whats your take on this drug. I still feel some temperature and slight bone and joints pains, I dont know if this is connected to HB.though my doctor told me those pains will disappear soon. Thanks for kind response.

    1. Hello: The good news is your liver enzyme test for ALT (SGPT), which is 10, shows your liver is not being damaged by the infection.
      However, I must tell you that the antiviral lamivudine is no longer recommended for hepatitis B treatment because it causes a high rate of drug resistance. Medical guidelines recommend either entecavir or tenofovir.
      Keep in mind that treatment is not recommended unless you are experiencing liver damage and have a high viral load.
      The World Health Organization has published hepatitis B treatment guidelines at: http://www.who.int/hiv/pub/hepatitis/hepatitis-b-guidelines/en/ You may want to review them with your doctor.
      Also, essential forte cap is an herbal supplement that has not been clinically proven to protect the liver or cure hepatitis B.
      Where do you live? If you want to review a list of hepatitis B experts, you can visit our Liver Specialist page at: http://www.hepb.org/treatment-and-management/physician-directory/
      Good luck.

      1. Please, I dont understand what is meant by drug resistance. Kindly explain better. Also, u didnt explain other parameters in the LFT result.

        1. Hello: Drug resistance occurs when some virus, with special mutations, are able to keep replicating despite antiviral treatment. For example, the antiviral lamivudine may be able to prevent 90% of your hepatitis B virus from replicating and producing more virus, but 10% that are able to reproduce despite the antiviral continue to churn out new virus and after a while they are the “majority” virus and producing lots of new, lamivudine-resistant virus, which continue to harm the liver.
          In contrast, an antiviral like tenofovir is effective against all hepatitis B virus, even those with mutations that are able to “resist” lamivudine. If you have developed lamivudine resistance, you need to be treated with tenofovir (NOT ENTECAVIR) in order to quickly lower your viral load and reduce your risk of liver damage.
          The best liver function test result to examine is the ALT/SGPT one when assessing liver health. Healthy ALT/SGPT levels for men are up to 30 and for women they are up to 19.
          Good luck.

          1. Please, 1. how do I know if am having resistance to the lamivudine as am taking it now? 2. I still experience body temperature, slight muscle and joint pains even as am on this drug, but the doctor told me it would soon disappear, please, what do you think to that? 3. U said healthy liver for men is 30, but the maximum range in the lab I did my ALT/SGPT is up to 12u/l, while my result shows 10. So, how do we relate this result to the 30 u said?

          2. Hello:
            1. If you have been taking lamivudine for several months and your viral load (HBV DNA) does not decline (or starts to rise) and your liver enzymes (ALT or SGPT) start to rise, then it means the antiviral is no longer able to keep the virus from replicating.
            2. If you are still experiencing physical symptoms as you describe, you must talk to your doctor about changing your antiviral or seeing if the symptoms are caused by a medical problem unrelated to hepatitis B.
            3. Individual labs may have their own unique “healthy” range for ALT/SGPT. Some go up to 30, others go up to 50, it depends on the type of equipment they use. Your lab clearly has a different measuring reference range. I have not seen measurements in that low range before.
            Hope this is helpful, good luck.

    1. Hello: Antivirals, including as tenofovir or entecavir, are pills you take daily. Generally, they have very few side effects but they are effective for only as long as you take them. So when you begin treatment, be aware that you may be taking antivirals for a prolonged period of time.
      Pegylated interferon, in contrast, works by strengthening your immune system to fight the infection. It is administered through a weekly injection and generally, you take interferon for six months to one year. There are some side effects, such as flu-like symptoms and even mild depression. Also, interferon works better in certain hepatitis B genotypes, so it makes sense to know your genotype before starting treatment. Doctors should monitor your hepatitis B surface antigen (HBsAg) levels carefully in the first few weeks of treatment to determine if it’s working.
      According to medical guidelines, you must be experiencing liver damage, indicated by elevated liver enzymes ALT/SGPT, in order to need treatment. Neither of these medications are needed if you have inactive hepatitis B.
      Please talk to your doctor, good luck.

  19. Pls a patient with sgpt :14 and a Hepb virus :700000cps/ml, pCR HepB QUANT 2318IL/ML and pcr hepb virus qnt log 12.1 and is recommended treatment with tenofovir and heptovit since 3months now (with effects of abdominal pain, dizziness at intervals) what do u advise?

    1. Hello: Medical guidelines do not recommend treatment with tenofovir unless you are experiencing liver damage, which you are not. Your viral load is high, but antiviral treatment has not been found to have a good effect in your situation. Ideally, antiviral treatment is recommended when your immune system has begun to attack the infection. Lowering your viral load at a time when your immune system is fighting the infection, is ideal. Lowering your viral load when your immune system is inactive, doesn’t achieve much, according to research.
      Please be patient and continue to be monitored regularly. Good luck.

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