Hepatitis B Case
During routine medical evaluation, a 32-year-old unmarried man was found to have abnormal liver tests. A thorough history failed to identify a clinically recognized, past episode of acute hepatitis. The patient had never received a blood transfusion. He had not used injection drugs. He had had unprotected sexual encounters with multiple partners over several years. On physical examination, he had no signs of chronic liver disease. On receiving the following results from the laboratory, the primary care physician referred him to a liver specialist.
AST: 145 IU
Alkaline phosphatase: Normal
IgG anti-HBc reactive
HBV DNA 1.5 x 107 copies/ml
Six months after his initial visit to his primary care physician, the patient presented to the liver specialist. Subsequent testing showed no substantive changes since the initial lab work. A liver biopsy showed moderately active hepatitis with a necroinflammatory histologic activity index score of 10/18 and a fibrosis score of 3/6
Which would you do at this time?
1. No treatment, monitor patient.
2. Begin treatment with antiviral therapy and with which agents?
3. And if you start treating patient with Pharmacological agents when will you start and with which agents?