My Lab Results

Here are my lab results time after time. What do you think of these?

05/19/1990
HBsAg positive, abs: 1.085/cf: 0.092
HBsAb negative, abs: 1.516/cf: 0.390

06/06/1990
AST 119
ALT 87
IGM Anti HBc negative, abs: 0.034/cf: 0.247
Albumin 3.7
Globulin 3.1
Gamma globulin 1.65
Total protein 6.8
Direct bilirubin 0.22
Total bilirubin 0.43

06/23/1990
AST 19
ALT 13
Direct bilirubin 0.17
Total bilirubin 0.32.

04/30/1993
AST 23
ALT 19
HBsAg positive abs: >2/cf: 0.1801
HBsAb negative abs: 0.200/cf 0.254
Anti HBc positive abs: 0.093/cf: 0.330

04/09/1994
AST 22
ALT 18
HBsAg positive abs: >2/cf: 0.370
HBsAb negative abs: 0.076; cf: 0.197
Anti HBc positive abs 0.265/cf: 0.449
HBeAg negative abs 0.024/cf: 0.085
Direct bilirubin 0.11
Total bilirubin 0.48
Gross titration 1.8
TTT 0.9

05/06/1995
AST 34.9
ALT 27.0
HBsAg positive abs 0.992/cf 0.056
HbsAb negative abs 10.1/cf 30.8
Direct bilirubin 0.17
Total bilirubin 0.45

09/19/2001
AST 12
ALT 16
HBs Ag positive abs: >2/cf: 0.052
Anti HBs negative abs: 0.011/cf 0.067

06/18/2005
AST 26
ALT 25
HBsAg positive
HBsAb negative

Note:
AST = aspartate transaminase = SGOT
ALT = alanine transaminase = SGPT
HBsAg = hepatitis B surface antigen
HBsAb = hepatitis B surface antibody
HBc = hepatitis B core
HbeAg = hepatitis B envelope antigen
IGM = immunoglobulin M

No Hepatitis?

Last week a naturopath named Ir. Donny Hosea MBA PhD N.D. visited this page and dropped an email to me. Since the time we developed an interesting discussion about my disease. I sent my lab’s results to him –oh, I forgot to share them with you… I’ll do it in a few days….

Do you want to know what he said?

Opposed to my mind (and the doctors I've met before), he said that I might have no chronic hepatitis due to no sign of any liver damage nor failure. The lab’s results showing that my HbsAg (hepatitis B surface antigen) was positive while my HbsAb (hepatitis B surface antibody) was negative might be caused by another infection or just malnutrition.

He wrote, “I need to set your mind to just start from the beginning, analyze your problem by indicating all the possibilities of what happened to your body. Human is human. If there are any symptoms appear, then you must check all the possibilities, what made the symptoms. Eliminate the problems, and let the body do the natural way by his/her system to cure the problems.”

His opinion really makes me in two minds. Am I a chronic hepatitis B sufferer? Or not at all? I’ve been sure –and fear– that I suffered from chronic hepatitis B for more than 16 years. But his opinion gives me a glitter of hope. I’m preparing to change my mind, of great hopes it will be true.

But which one is true? Wait, I’m still discussing with him….

Preventive Treatment for Hepatocelullar Carcinoma

Patients who develop hepatocellular carcinoma (HCC), a type of liver cancer caused by the hepatitis B virus, have up to a 55 percent chance of having the virus reactivated during chemotherapy. The idea of preemptively treating these patients with the antiviral drug lamivudine in order to prevent hepatitis B relapse and it varying complications is promising but has never been investigated in patients with HCC.

Researchers led by Jeong Won Jang of the Department of Internal Medicine at the Catholic University of Korea in Seoul, conducted a prospective randomized study on pretreating HCC patients undergoing chemotherapy with lamivudine between January 2004 and February 2005. The study involved 36 patients with HCC who were given the drug while undergoing transarterial chemo-lipiodolization (TACL) chemotherapy and a control group of 37 patients who underwent the chemotherapy without receiving lamivudine.

The chemotherapy was continued every month without any limit on the number of cycles until the tumors disappeared, while treatment with lamivudine began with the chemotherapy and continued for 12 months following its completion.In total, 43 percent of the patients in the control group developed overall clinical hepatitis during the follow-up period, compared to 17 percent of the patients who took lamivudine.

In addition, there was a significantly higher incidence of severe hepatitis in the control group and the researchers established the level of viral load (>104 copies/ml) that predicted whether a patient would have a relapse of hepatitis B.In addition to demonstrating that treatment with lamivudine significantly reduced hepatitis B reactivation, allowing chemotherapy to continue in these cancer patients, the study suggests that lamivudine therapy decreases the severity of clinical hepatitis if it develops during chemotherapy.

"The beneficial effects of preemptive therapy on the severity of hepatitis most probably result from an elimination of any potential risk arising from viral reactivation," the authors state.

While previous studies have shown a higher viral load as a predictor of hepatitis B reactivation, the lower cutoff in the current study was identified as a better predictor and the authors urge the use of a highly sensitive test to detect and measure viral load in order to identify patients at the greatest risk of hepatitis B reactivation.

In those patients with lower viral loads, it would still be beneficial to closely monitor virological and biochemical changes when they are undergoing repeated courses of chemotherapy, since the study demonstrated that even lower viral loads are associated with an approximately 30 percent risk of viral reactivation.

Although the study did not examine long-term survival in the patients who took lamivudine, the authors conclude: "Given that preemptive antiviral therapy ameliorates the hepatic morbidity seen during transarterial chemotherapy and facilitates further chemotherapy without disruptions in the treatment schedules, the expectation would be for an increased chance of survival with this approach."

(From the February 2006 issue of Hepatology, the official journal of the American Association for the Study of Liver Diseases (AASLD). http://www.interscience.wiley.com/journal/hepatology.)