FWD Mail: About seeing my liver Doc on Thursday

liver411

Hi Ian,



It is not uncommon for someone taking Lamivudine to seroconvert (HBeAg ->  HBeAb) even after they have developed the mutant.  This would mean that you  would have a loss of HBe if this were to happen.  You might even develop the  antibodies HBeAb too. The surface antigen test is likely to remain positive  regardless of whether or not you develop the YMDD mutation.  So the only test  that is likely to give it away is the ALT/AST levels.  (Of course as you  yourself said, if you had the HBV DNA test run you would know for certain if

there were any kind of HBV DNA circulating).  If you had a loss of HBe or  levels were low enough, your ALT/AST would approach normal levels.  If you  then saw a consistent spike in ALT, one would then assume that there was a  mutation.  Even during this time, it is possible to have a loss of HBe



Here's a scenario that could happen:

You go on LAM.  Your HBV DNA will decrease significantly while on LAM.  This  nearly always happens.  Perhaps your ALT will elevate indicating that your  immune system is fighting the virus.  Maybe it will stay like that for a few  months.  If you're lucky you'll have a loss of HBe and maybe even develop the  antibody.  If this happens, your ALT will continue dropping down to normal  which would be great.  Maybe even your HBV DNA will be undetectable.  This is  what happened with my daughter.  



Another scenario could be like this.  This information is from Ed and since  he let me use it before on-line I figured he wouldn't mind if I used it  again. It's always nice to see what someone else's labs look like:



From Ed:

I started Lam treatment in November of 1996.



Here's the way it went:



DATE        ALT     AST     DNA



12/11/96    168     130     2390.00

12/23/96    248     166     63.31

01/08/97    307     235     4.9

2/5/97      202     111     1.9

3/5/97      79  59  <0.7



The numbers came down a little bit more and actually

reached the normal range for a while. During this

time e-antigen +, anti-e -, surface +, anti-s -.



Then:



10/15/97    213     163     286.6

11/13/97    266     166     279.2



Virus mutation. e-antigen +, anti-e -, surface +,

anti-s -



Went off the drug for six months. Then started again

with 300 mg daily. Had been taking 100 mg daily

before. Numbers flopped around. Alt between 388 and

52 Ast 214 and 47 DNA between <0.7 and 473.4 S

antigen +, anti-s -, e antigen + anti-e -. I was on

the 300 mg for six months. Basically the same thing

happened. They took me off the drug for the six

months to allow the "wild type" virus to become

dominant. But the mutation occurred again.



Resumed 100 mg daily in November of 1998, numbers

flopped around as before and then:



DATE        ALT     AST     DNA

2/9/00      510     431     177.355

3/8/00      258     145     no test

5/10/00    117     85  <.160

7/12/00      81  55  <.110

9/6/00      43  36  <.160

11/07/00    30  33  <.160



On 9/06/00 The e antigen went NEGATIVE. While the

anti-e remained neg and the surface antigen was Pos

and the anti-s was neg.



The same results were seen on the 11/07/00 testing.



Ed





I hope seeing some of this answers some of your questions Ian.  It certainly  would be nice if you could receive the HBV DNA test occasionally.  Maren got  her's three times during the course of her one year therapy: Pre-treatment,  middle of treatment, and just prior to end of treatment.  Maybe you could  just get your's pre- and end of treatment?  Certainly it's not essential, but  it always makes you feel better if you know what's going on during your  treatment.



Hope this wasn't too confusing!  Good luck to you at the doctor and with your  treatment.



Maureen

Mommy to Kate and Maren



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