Q: I am 55 years old man and a chronic hepatitis B (HBV) carrier. My HBV-DNA is 20,00,000 copies/ml. Liver function test (LFT) result are borderline high. Ultrasound and endoscopy tests are normal. HbeAg was positive and anti-HBe was negative. AFT is 4.0. I have started taking Sebivo - 600 mg daily. Can you suggest me a better treatment? Is there any chance of cure?

A:Chronic hepatitis B patients are HBsAg positive and have anti-HBc. They may have chronic inactive hepatitis (carriers) or chronic active hepatitis. The presence of HBeAg and HBV DNA reflects a state of active viral replication. HBV DNA levels are typically low or absent in inactive carriers though HBV DNA levels are higher (upto 30,000 copies/ml). Patients with chronic hepatitis are HBeAg-positive and have high HBV DNA level which is greater than 105 copies (genomes) per milliliter. High HBV DNA levels are associated with increased infectivity. The aminotransferases are about 5 times the upper limit of normal with ALT levels being higher than the AST levels. If AST levels are higher than ALT, cirrhosis must be excluded. There is no effective antiviral therapy for inactive carrier state and treatment is indicated for patients with chronic active hepatitis when HBV DNA levels are >10,000 copies/ml (if HBeAg negative) and >100,000/ml (if HBeAg positive) and elevated aminotransferases for 3-6 months. The aim of therapy is to inhibit viral replication and delay progression to cirrhosis or carcinoma as drugs rarely eradicate the virus. Among the drugs used are interferon alfa (IFN-a), lamivudine, telbivudine (Sebivo), adefovir, entecavir, and tenofovir. Some studies suggest that lamivudine and telbivudine should not be used as first-line drugs. Drug trials are on with newer agents, combination therapies and vaccines. Most medical college hospitals and major private hospitals have a department of gastroenterology or hepatology. You need to discuss these issues with your treating physician and be guided by his advice.