@availlant I am @CNN here and I am due for lab tests. Still not on treatment. I wanted to know the most useful tests to take besides lipid profile and viral load. In particular the antigens related ones are confusing me. Would love to know and if possible their significance i.e HBSAg, HBeAg, Anti-HBS. In 2022 I was HBEAg-ve
Dear @CNN ,
Normally your physician will use HBV DNA and ALT (aka SGPT) and any liver imaging tests to determine if you should have therapy. Also useful is quantitative HBsAg.
Lipid profile is important for diagnosing liver issues other than HBV infection.
HBV DNA = replication of infectious virus
qHBsAg = production of subviral particles
ALT = liver inflammation
When HBsAg is not detectable in the absence of therapy and ALT is normal, we consider this functional cure.
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Thank you @availlant. I will add ultrasound.
@Availlant forgot to ask the significance of HBeAG in the context of functional cure and if this needs routine monitoring. Thatâs all.
Dear @CNN ,
Your doctor may not be in a rush to do an ultrasound (especially if your viral load is low and ALT is normal) and I wouldnât worry if this is the case.
HBeAg is a marker of cccDNA activity which is independent from HBV DNA. For example, you can suppress HBV DNA with NUCs but still see HBeAg production (from cccDNA).
HBeAg is also used in guidelines to gauge if you should start antiviral therapy. However, HBeAg only plays a very very minor role in immunosuppression compared to HBsAg and has no real importance of the context of HBV functional cure. Restoration of immune function leading to HBsAg loss always comes with HBeAg loss as well.
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@availlant Hi. Iâm new here. Just found out about my status from my first plasma donation in January at 35 years old and have been getting new tests and info since. My mother has it and she was made aware when she was pregnant. They attempted to mitigate with early shots but apparently it didnât work and further tests were never done to check if successful unfortunately.
I just got my first viral load test last week at 204 iu/ml, hbeag negative.
My ALT has been between 40-56 since 2020 and AST has been consistently around 30.
Is this considered âpersistently normalâ? I do weight lifting and have also moderately drank beer (have quit since January). But my last ALT test was still 52 last week after alcohol abstinence. Weight lifting a cause of this higher ALT?
I do have my first ultrasound scheduled next week and another visit with gastrointerologist in couple weeks.
Dear @cholderby,
Ok so lets assume that you were maternally effected with HBV and developed breakthrough to early HBV vaccination.
Your ALT is close enough to normal to not consider this small elevation above the normal range (~ 36 IU/mL) evidence of any liver disease, especially if you lift weights regularily. Any form of strenuous exercise has the potential to dive this small elevation in ALT.
ALT can also be released into the blood stream from muscle damage (which is one of the intended goals of weight lifting). In this case, the ALT elevation does not reflect any damage occurring in the liver.
Your HBV DNA is also VERY low in the absence of therapy, which is in agreement with your ALT issue above. It would be VERY unusual for such a low level of HBV DNA to be associated with liver inflammation. It is great that you have an ultrasound scheduled for next week but I am confident it will be normal.
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Hi @John2,
Sorry not to have answered your question earlier. I would say that if your ALTs are within the normal range, any increase at a single timepoint is not cause for concern and may be due to the intrinsic variability within the measurement assay. If it is consistently higher, then it may be worth discussing with your doctor.
Thomas
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Hi @cnn, generally a fibroscan is also useful to understand if your liver has previously been injured. This can help guide the decision as to whether treatment is worthwhile for you.
Thomas
Yep, completely agree with @availlant, ALTs can be raised by weight lifting and strenuous exercise (I have seen it in my own LFTs).
As mentioned above, a fibroscan is also useful in assessing past liver damage and persisting scar tissue.
Thomas
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Thank you so much Thomas Tu
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Greetings @ThomasTu ,
No worries at all! I do understand how busy we all are.
Thank you for your help and explanations.
It means a lot to me and do have a great day.
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