The attached test results and DNA level are consistent with a patient in an immune tolerant phase of chronic hepatitis B infection. This phase indicates an active viral replication without an immune reaction against the virus. A person in such a phase with high viral counts is highly infectious although relatively well most times.
Treatment decisions usually rely on factors such as the person's age, evidence of liver scarring (fibrosis) or hardening (cirrhosis), liver enzyme fluctuations, HBe antigen status as well as family history of liver cancer.
If the decision is to start treatment, do expect to be on the anti-viral agent for at least the next few years; possibly life long. In some cases with good response, treatment may be stopped after a few years.
These cases usually require very close monitoring by your specialist to detect any potential flaring-up. Very occasionally, a patient may achieved functional cure and clear the virus from their blood circulation.
Regardless on the decision on treatment, what is more important, in my opinion, is regular clinic reviews and evaluation of liver enzymes and DNA counts, as well as regular surveillance scans to look out for liver cancer. This especially so when no anti-viral treatment has been implemented.
Dr Quan
