Hi- I posted a year ago about my young adult daughter who contracted HBV as an infant, likely from her birth mother in Asia. I have been having trouble getting gastro/hepatologists to seriously consider antivirals because of her young age, and because paradoxically her ALT and DNA levels seesaw, sometimes in opposite directions.
- Her DNA in the past 5 years has varied from a low of 700 to a current 4300.
- Her ALT has varied from 49 to a current 23 (it seems to be lower with one particular lab).
- Fibroscan score of 4.4 and “0” fibrosis. The ultrasound showed fatty liver and “probable fibrosis,” but no lesions. Her doc said the fibroscan is more accurate about the fibrosis.
- She has been e-antigen negative and e-antigen positive for about 10 years, after gaining and losing clinically significant surface antibodies in her teens.
- Her quantitative surface antigen (drawn for the first time after I pressed for it) was more than 14,000 !!!
Based on these labs, her current doc is willing to start antivirals. I have a few questions:
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He would like to do another liver biopsy first, just to get a better picture of her liver. Her previous biopsy around 4 years ago was normal and showed no inflammation. Would anything be gained by putting her through this again? She is resistant to it and it is of course not risk free.
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I’m concerned about the extremely high quantitative surface antigen level. (It is odd because the lab took 6 weeks to deliver the result, so I wonder if it is accurate.) Does the SAg titer track the DNA level (which was 1200-1600 in the past year, and now jumped to 4300)?
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Once started, we understand that she will likely have to take antivirals for decades. Is there any evidence that antivirals will not be effective in reducing the odds of HCC or fibrosis with a surface antigen titer that high? I’ve tried to research studies online, but haven’t found anything directly on point.
Sorry about the long post. Any thoughts will be so appreciated.