HBV DNA guided treatment protocol

Patient was tested HBsAG positive 2 years ago but did not seek any treatment. Now patient came with complaint of pain abdomen. Following tests were done. Please advise whether any Antiviral medicine to be started or not? What should be the measures to be taken for treatment?

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Atleast a LFT and CBC is required. But taking the HBV DNA report into consideration that is also likely to be normal. If they are normal, follow up the patient with LFT 6-12 monthly and HBV DNA every 2-3 years. Ask for family screening and vaccination of negative members.

If viral load is below 40000 SGOT SGPT NOT DOUBL OF NORMAL NO ANTIVIRSL DRUG NEEDED FIBRO SCAN SLSO INDICATED GASTRENTERLOGIST5 OP YOBE CONTINUE

I think Liver biopsy / ALT study /CT Scan study impressions must be reviewd before proceeding further.

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As the patient is 30 years female with normal USG and although significantly raised HBASG- 4557 But there are other factors which need to be considered before starting anti - viral therapy 1.If ALT is 2 times more than normal 2.A significant histological disease 3.HBe Ag negative ( HBV more than 2000 IU / ml 4 HBe Ag positive ( HBV DNA more than 20000 IU/ ml Aim is to prevent progression of disease to cirrhosis, liver failure and HCC In this case - Patient needs a follow up after investigations for LFT , HBeAg testing and if required a liver biopsy for histopathology

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High HBSAg titres Long history Chronic active hepatitis . Abdominal ultrasound normal Need to check viral load , antibodies to hepatitis E antigen , core antigen Need hepatologist consultation Antivirals should be started Alcohol history should be asked for.

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