国外医生是如何治疗前C变异的

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Subject: Chronic Hepatitis B - Is it possible?
Topic Area: Hepatitis B
Forum: The Hepatitis Forum
Question Posted By: TN on Thursday, December 14, 2000


to have HBeAg NEGATIVE and HBV-DNA positive (117.87 pg/ml - 33,357.600 copies/ml)? I am confused. Since I tested negative for HBeAg, my doctor decided to hold off with the treatment and wait another 6 months with another battery of test. My other results are :

Liver ultrasound normal
HBsAg positive
HB surface AB negative
HB core AB positive
AST 40 high
ALT 75 high

1. Is my condition/result unique or possible? What do these conflicting results meant?
2. How high is HBV-DNA of 117.87 pg/ml? Since my DNA is positive, should I go back to my doctor and request him to start my treatment before it's too late? My doctor was about to treat me with lamivudine.
Thanks in advance for you response and help.

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Answer Posted By: HFHSM.D.-D.M. on Saturday, December 23, 2000

Dear TN.

I appreciate hearing from you. I always stress that hepatitis B I can be difficult to understand and certainly appreciate your questions and desire to figure out what is going on with your situation.

A positive hepatitis B surface antigen (HBsAg) usually means that some one is infected with hepatitis B. However, hepatitis B infections come in two flavors. The first is an active or replicating infection. The second is a non-replicating form. Patients with the non-replicating form of infection are often called "carriers".

There are two major tests that we use to determine if some one with a positive HBsAg has an active form of infection. They are the Hepatitis B DNA (HBV DNA) level and the hepatitis e antigen (HBeAg). Both these tests are considered "markers of active viral replication" and they are very important in determining how active a hepatitis B infection is. If both are positive, some one almost always has an active infection.

However, in your case, one test is positive (HBV DNA) and the other (HBeAg) is negative. This usually means that there is an active form of infection. The positive HBV DNA suggests that. However, the HbeAg is negative usually means there is a variation of the usual infection called a pre-core mutant infection.

Pre-core mutant infections are not that unusual and people with the pre-core mutant form of hepatitis B are a little more resistant to interferon that people with the more common, regular infection. A lot of times we do consider lamivudine instead of interferon in these individuals for that reason.

Your level of virus is a little on the high side and we often see that much virus in some one who has been infected for a long time, often since birth. However, we do not always base the decision on lamivudine just based on the HBV DNA level. We often include the results of a liver biopsy in the decision making. Lamivudine is very good at improving the liver biopsy so we often like to use in some one who has a liver biopsy with very active infection and scarring (fibrosis).

I hope this information is helpful to you. I wish you luck with your condition. Because hepatitis B can be a complex infection, it is important that you see some one with experience with hepatitis B. If you have additional questions or concerns, you can post them back to MedHelp. The direct number to our liver clinic at Henry Ford for appointments is: (313) 916-8865. We have an active group of liver specialists with experience with hepatitis B.

This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.