Hepatitis B & High level viral load

Based on the complaints and elevated bilirubin levels you seem to be suffering from a type of liver disorder, a condition wherein excess accumulation of bilirubin (a brown yellow coloured compound formed in breaking down of red blood cells) occurs. With loss of appetite, vomiting, stomach tightness and bloating; fever, extreme fatigue and abdominal pain can also be seen in liver diseases.

• There are multiple causes for development of liver dysfunction such as infection, autoimmune liver diseases like cholangitis, Wilson’s disease, cancer, alcoholic liver (due to alcohol abuse) and non-alcoholic (due to excessive consumption of fats) and drug induced.

• When using a medicine that is known to have the potential to cause liver damage, your doctor may recommend you to have blood tests done on a routine basis after starting the medication so that any signs of liver damage may be recognised before symptoms develop.

• Common medications that can cause damage to the liver include Paracetamol, Statins – drugs for lowering cholesterol levels and certain herbs.

• Other liver function parameters such as AST(aspartate aminotransferase), ALT(alanine transaminase), ALP(alkaline phosphatase) and GGT(gamma-glutamyl transpeptidase) bilirubin are required to be evaluated and additional to this for determining the exact cause of dysfunction especially to confirm presence of jaundice; urinalysis, CT (for distinguishing between biliary obstruction and liver disease including cancer) and liver biopsy (for ruling out concern about possible liver cancer) needs to performed.

• The treatment is based on the underlying cause and damage levels and can range from dietary changes, medications such as antibiotics, sedatives, etc to liver transplants.

• Hepatitis B carriers are persons who carry the hepatitis B virus in their blood but do not experience symptoms. Between 6% and 10% of persons infected with the virus will become carriers and will be able to infect others without knowing it.

• A considerable proportion of chronic hepatitis B (HBV) patients are in the inactive carrier state, which is characterised by normal transaminase levels, limited viral replication, and little liver necroinflammatory activity. After at least one year of frequent monitoring, a diagnosis is made, and lifelong follow-up is required to ensure that this status is maintained.

• In case there is no improvement in HBVDNA levels, consult your expert but do not stop the medication on your own.

• Drugs prescribed such as Tafero (tenofovir) acts by ceasing the production of new viruses, blocks or slows viral proliferation in human cells, and eliminates the infection and also boost the level of CD4 cells (white blood cells that fight infection) in your blood. Entaliv (entecavir) acts by inhibiting the viral replications processes like reverse transcription, DNA replication and transcription.

• Cirrhosis is a late stage of liver scarring (fibrosis) induced by a variety of liver disorders and conditions, including hepatitis and persistent drinking. When your liver is damaged, whether through illness, excessive alcohol intake, or another cause, it attempts to restore itself. Scar tissue arises as a result of the procedure.

• It causes scar tissue to grow, making it harder for the liver to function (decompensated cirrhosis) and is considered to be potentially fatal by nature. The liver damage is often irreversible. However, if detected early and the underlying cause is addressed, additional damage can be reduced and, in rare cases, reversed.

• It often has no signs or symptoms until liver damage is extensive.

• On damage the following signs/symptoms can be seen  - Fatigue , easy bleeding/bruising , Loss of appetite, Nausea, pedal/ankle odema, Weight loss, Itchy skin, Yellow coloured eyes and skin, ascites(fluid accumulation in abdomen), spiderlike blood vessels, redness of palms, absence/loss of periods (not related to menopause), libido and gynecomastia(breast growth in males)/testicular atrophy, Confusion, sleepiness, and slurred speech (hepatic encephalopathy)

• Usually, the total bilirubin test shows 1.2 mg/dL for adults and 1 mg/dL for children under the age of 18. The normal value for direct bilirubin is 0.3 mg/dL.

• Normal findings may differ somewhat between men and women, and results may be influenced by particular diets, drugs, or severe activity. Bilirubin levels that are lower than normal are typically not a cause for worry. Elevated levels might be a sign of liver injury or illness.

• Higher-than-normal amounts of direct bilirubin in your blood may suggest that your liver isn't adequately removing bilirubin. Elevated indirect bilirubin levels may signal other issues.

• Gilbert's syndrome, a lack in an enzyme that aids in the breakdown of bilirubin, is a frequent and innocuous cause of high bilirubin. Further tests may be ordered by your doctor to explore your situation. Bilirubin test results can also be used to track the evolution of specific illnesses like jaundice.

• Further laboratory investigations such as AST(aspartate aminotransferase), ALT(alanine transaminase), ALP(alkaline phosphatase) and GGT(gamma-glutamyl transpeptidase); Total Albumin, Lactic Dehydrogenase, Alpha protein, 5’nucleotide, mitochondrial antibody and PTT levels need to be determined and procedures such as CT scan, MRI (for liver tissue damage) and biopsy (in case of chance of any cancerous growth) need to be performed.