Good afternoon. I have been living with hepatitis B virus (HBV) since birth (my entire life). As my condition is considered “controlled,” I undergo annual blood tests to determine whether it’s time to start treatment or continue monitoring. Typically, my test results have remained relatively stable year to year: HBV DNA quantitative levels between 350–4,000 IU/mL, quantitative HBsAg between 1,000–2,000 IU/mL, liver fibrosis stage F0–F1, and HBeAg negative (all time).
Recently, I developed a common cold (with symptoms including a temperature of 37.5°C, sore throat, runny nose, and dizziness). As usual, I allowed my body to recover naturally—drinking warm fluids, eating fruits, taking vitamin C, and resting in bed. After the illness, I experienced dull, pulling pains radiating to the right hypochondrium, which resolved spontaneously within a couple of weeks.
Since my hepatitis B is “controlled” and it’s crucial to catch the precise moment when treatment should begin, I decided to get tested one week after recovering—checking both liver function and HBV markers (HBV DNA and HBsAg). Deep down, I hoped everything would be normal. To my great surprise, instead of elevated HBV and HBsAg levels, they were actually lower than usual: HBV DNA 1.9 × 10² IU/mL, HBsAg 854 IU/mL, ALT 22 U/L, and AST 21 U/L. The only elevated parameters were gamma globulin at 15.10 g/L (reference range: 8–13.5 g/L) and total protein at 89.32 g/L (reference range: 64–83 g/L).
Why did my hepatitis B markers decrease, and how does another concurrent infection (like a common cold) affect the course of chronic hepatitis B?
What might have caused the elevated gamma globulin and total protein levels? Could this be related to hepatitis B?
I would greatly appreciate it if you could find the time to answer my questions.
Thanks for sharing your story and what a great question! My understanding is that this is more of an immunology question, so invite any @ScienceExperts or @HealthExperts in the immunology field to comment.
I’ll start with my understanding though: when you feel some of the symptoms of a cold (or other infections) such as tiredness, body aches, chills, fever, etc. - this is not directly caused by the virus itself, but your body’s reaction to it.
The immune system gets activated to fight it off (you can see this by the raised gamma globulins - these are antibodies) and in doing so it produces signals called cytokines. Cytokines are essentially alarm messages for the body to respond to any external threats and one of these cytokines is interferon - the same used to treat Hepatitis B. So it’s likely that the small reduction in your HBV markers are due to the effect of the interferons stimulated by your cold infection.
Hope this helps and makes sense. Again, happy for any immunologists or clinicians to weigh in here.
I’m also not an immunologist (my training is in molecular virology, very similar to Thomas’). I think Thomas’ evaluation is probably right. Your immune system got turned up by the cold, and it caused a dip in HBV levels. Cold viruses induce release of interferon (some of which becomes “systemic”, ie, spreads through the blood stream), and they could have been enough to suppress HBV a bit. Note that the name “interferon” came about because they were molecules released in response to one infection that “interfered” with spread of the infection and reduction in sensitivity to other infections.
That being said, I’m also curious to hear what someone with a better understanding of immunology thinks.
You are quite right, the small reduction in HBV markers is most probably because of the interferons stimulated by the patient’s cold infection.
Actually, fighting fire with fire – harnessing viruses to fight viruses, has already been developed into a host-directed post-infection therapy for viral diseases. The immunostimulatory repurposed dsRNA vaccine virus, the Infectious Bursal Disease Virus (IBDV) could be developed into an off-the-shelf “antibiotic” for viruses. This is a scalable, disruptive paradigm changing approach to antiviral therapy poised for rapid growth.
FYI, IBDV superinfection therapy was effective even in severe decompensated chronic hepatitis patients with life-threatening complications. Therefore, IBDV could offer a compassionate lifeline to a critical subset of chronic HBV patients who currently remain entirely without therapeutic options. These are an estimated 8–10 million patients with advanced decompensated liver disease and high HBV titers, for whom even liver transplantation is contraindicated or inaccessible and for whom there is no approved curative or stabilizing therapy. They are invisible in most global health strategies, despite their numbers. This population faces a therapeutic dead end—a condition that is both medically urgent and ethically untenable.
Hello everyone, I’d like to share my case with you. I don’t know if it will be of any use, but here’s what happened to me.
Four years ago, when COVID vaccinations were still being evaluated, it was my turn to get the third dose (Moderna).
A week later, I caught COVID. I never had any symptoms, maybe because I’m on tenofovir treatment.
My HBsAg (qualitative) was over 8000, and in the follow-up tests, which were two months later, my HBsAg dropped to 10.
Since then, my HBsAg (qualitative) has always fluctuated between 10 and 70.
This is my story that I wanted to share with all of you.
Best regards.
Welcome to hepbcommunity forum. In my opinion,the cold symptom you have may be contributing to your body immune responses to the virus and then it makes an impact on HBV DNA to be reduced and has gamma globulin transiently increasing as Thomas Tu has mentioned.
Another explanation is common cold symptoms that occur may be from HBV in our body that increases replication and the body immune systems need to fight the virus results in mild flu symptoms like common cold.These clinical symptoms differ from chronic active hepatitis B patients which may have intermittent hepatitis flares and markedly increased HBV DNA and liver enzymes and the symptoms may like influenza illness eg. fever , headache, malaise, myalgia,anorexia etc and gradually improve when the body immune system reacts with the virus.
In general, most people with chronic HBV infection don’t have symptoms but I think that if we try to ask these patients in detail, we may find that some of them have symptoms of fatigue similar to common cold that come and go . These symptoms are common to the patients and they think it may be caused by insufficient rest or work hard and some patients has never had a blood test to check for HBV DNA or immune markers.This is an impact of chronic HBV infection on quality of life. I hope this may help you.
I’ve had chronic hepatitis B (HBV) since I was 5 years old. For the last 15 years, I was on Viread (tenofovir), and my lab results and ultrasounds—done every six months—were always normal.
After moving to the U.S., I had to find a new doctor. After reviewing my labs and ultrasound, which were still normal, she told me to stop taking Viread immediately. I was scared and skeptical. I even suggested tapering off slowly, but she insisted I stop the medication the very next day—and I did.
Six months later, during a routine ultrasound, they found one small polyp on my gallbladder. The doctor said it was nothing to worry about. But six months after that, another ultrasound showed 5–10 small polyps, which means they’re increasing and growing.
For context, I’m 30 years old, weigh 70 kg, don’t drink alcohol, don’t eat junk or fast food, and follow a fully organic diet. I’m also physically active—I walk, run, and play tennis regularly.
Now I’m wondering: Could stopping Viread have caused or contributed to the appearance and growth of these gallbladder polyps? I can’t stop blaming myself for trusting this doctor’s advice.
If you know anything about a similar situation, or if anyone has experienced something like this, please let me know I will do another ultrasound in 2 months, and I’m very scared. I would truly appreciate any insights or experiences.
Hello, thank you for the response. I haven’t started my therapy yet; my doctor said that’s not the reason. When I asked what the other reason for these polyps could be, she said she didn’t know; they just come to some people. But I can’t wait to hear what other people have to say.
Its interesting common cold-HBV beneficial scenario to come across but it do happens in several disease interplays
I do agree with Thomas, John and Tibor, that this is likely type 1 interferon driven HBV viral load suppression.
Common cold viruses like rhinoviruses and coronaviruses, are powerful activators of natural immune sensor proteins like Toll-like receptor 7 (TLR7). These natural immune responses-trigger promotes the release of type I interferons (IFN-α/β) as Thomas explained. These interferons circulate in the blood and can exercise antiviral effects beyond your respiratory tract, including in your liver.
Well, HBV is equally sensitive to interferon activation pathways, and this is the basis of pegylated IFN-α therapy for chronic HBV patients. So, your coincidental infection with common cold turned beneficial in chronic HBV infection is probably due to the induced interferon surge and this temporarily suppressed HBV replication, thereby lowering HBV DNA and HBsAg levels. This suggests that the abnormality caused by chronic HBV infection in our immune system to work poorly is rather temporary and its basis for emerging therapies such as 1L2 cytokine therapy and TLR7 triggers.
Taking plenty of fluids, eating fruits and taking vitamin C could have also boasted your immunity.
The elevated gamma globulin and total protein levels observed after your common cold is most likely due to temporary or short-term immune response from multiple B cells families.
It would be interesting to see how durable this HBV viral load suppression is in your subsequent check ups.
Hi @Steve1,
Welcome to the community, and I am sorry to hear about your situation. It is difficult to say exactly why you are seeing these polyps now. Polyps can be found at any time an imaging is done.
Hmmm, I find it interesting that you were asked to stop treatment because your labs and ultrasound were normal. That is not the recommendation for cessation of treatment. Are you able to get a second opinion from another doctor on this matter?
Please, try not to be hard on yourself. These polyps may end up being nothing to worry about. I will consult with another provider to get a second opinion on this. Here is a link you can check out, as it talks more about gallbladder polyps.
I’ve seen two doctors in the Chicago suburbs regarding my condition, but unfortunately, my experience with both has been quite similar. After the consultation, I was asked what I think should be done, rather than being given clear medical guidance. This approach is very different from what I’m used to.
Back home in Serbia, my doctor would always explain what needed to be done and take the lead in managing my treatment. Here, with all due respect, I feel that some doctors are not fully taking responsibility for guiding the care process.
I studied medicine myself and have considerable experience, so I deeply value a knowledgeable and proactive approach. What’s been most disappointing for me is that, during my education, we were taught that the U.S. had the best medical system and top doctors. Sadly, my experience so far has not lived up to that expectation.
That said, I’m still hopeful — and I’m reaching out to ask if you know a doctor with strong experience in treating Hepatitis B (HBV). I would greatly appreciate any recommendation you could offer.
Thanks to everyone for your highly informative contributions.
It appears there is an inconclusive/ undefined correlation between the covid vaccination and changes to the HBV parameters
While some studies reported that some chronic hepatitis B patients experienced a dramatic decrease in hepatitis B surface antigen (HBsAg) after receiving a COVID-19 vaccine. Some other studies reported possible reactivation after COVID-19 vaccination.
I guess there need for more studies required to ascertain if there be any correlation between covid vaccination and HBV profiles
Hu C Y, Tsou Y, Chung M, Lin N, Chen C, et al. Hepatitis B Virus Infection Flare Induced Acute-on-chronic Liver Failure After COVID-19 Vaccination: A Case Report.Hepat Mon.2022;21(12):e126460.https://doi.org/10.5812/hepatmon-126460.
BMC Infect Dis. 2024 Dec 18;24:1438. doi: 10.1186/s12879-024-10333-z
Association between Hepatitis B virus infection and COVID-19: outcomes from clinical analysis and online survey from Beijing, China.
Formos Med Assoc. 2023 Jun 20. Online ahead of print. doi: 10.1016/j.jfma.2023.06.007
Hepatitis B reactivation: A possible cause of coronavirus disease 2019 vaccine induced hepatitis
Hi @Steve1,
I am sorry to hear about your experiences. Your experiences, sadly, are not unique. Some providers don’t have experience in treating HBV patients. In the US, as a patient, one must be their own advocate and do the lifting. This is something I had to learn when I moved to the US as well. Unfortunately, I could not find anyone through the Hepatitis B Foundation’s physician directory. Try Googling and contacting these organizations to see if they can help you find a provider who treats HBV patients:
Midwest Asian Health Association (Chicago)- They run a clinic for HBV. Not sure how close you are to Chinatown.
Center for Asian Health Equity (Chicago)
Michael Reese Care Program at UI Health.
Northwestern Medicine (Viral Hepatitis Co-infection Program)
I suggest you have a conversation with the doctor and restart treatment. It is common for doctors to ask a patient what they want to do. This might be odd for some people. Keep us posted. Best, Bansah1
Apologies that I had missed this question, @Steve1. I am unaware of any connection between polyps and treatment cessation. I do not recall any of the many studies doing treatment cessation as this being one of the outcomes.
That said, how you explain the decision regarding treatment cessation being made is strange and I’m not sure what the reasoning behind it was. Was one given?
I agree with @Bansah1 though, that the majority of polyps are asymptomatic and nothing to worry about. It is good that you are keeping an eye on them though and hope that there will be good news at your next ultrasound.
Hi @Kassimo, great work looking up these studies. Many of them however just look at a handful of people. With so many people with hepatitis B and so many people getting vaccinated with the COVID vaccine, I would be surprised if any clinically relevant changes in hepatitis B (particularly in dramatic decompensation as described in some of these) are driven by the vaccination.
Indeed, the public health advice is for all people (including those with hepatitis B) to get vaccinated:
Thank you for your help! I’m glad to hear from someone with similar experience. The truth is, if you want to stay healthy here, you really have to manage it on your own. I can’t imagine what people go through who don’t have any medical knowledge. Hopefully, that will change one day.
I’d like to add one more thing in order to help other people — maybe there are people here who can help make a change. In Europe, hepatitis is treated by infectious disease specialists, but here it’s managed by gastroenterologists. I think that’s a big mistake — infectious diseases should be treated by infection specialists, not gastroenterologists.
Yes, you are right about that. In America as a patient you may have to speak up at times to receive the care you need.
There are hepatologist who specializes in HBV and other infectious diseases but not every state or city has enough of these specialist. It was a gastroenterologist who managed my case earlier on before my primary care provider recommended I switch to a hepatologist. The main point is not necessarily about the specialization I will say rather their experience of treating patients with hepatitis B.
Healthcare systems are so different everywhere and it be challenging trying to access care and navigating the system. Try and contact those organizations to see if they can help. Keep us posted. Bansah1
Thanks @ThomasTu for your insightful contributions. I do agree on the benefits of vaccination and the fact that existing studies have only looked at a small cohort.
There is definitely the need for more robust studies on the short term and long term effects of several things including the covid vaccines on HBV.
I really want to appreciate you for your commitment and dedication to this community. Thank you!