Concerned with progress of test results

Dear @Caraline,

You live a healthier life than I do (and we’re about the same age)!

Your question is beyond my expertise (I’m a molecular virologist specializing in HBV replication mechanisms). I recommend speaking with a hepatologist who specializes in viral hepatitis, and getting a second opinion if the answer you get is unclear. Until then, continuing regular screening is very likely merited.

I wish you the best.


Hi @Caraline,
I read about your concern regarding a recent ultrasound. I understand your frustration, stemming from the fact that you have been doing everything to protect your liver and stay healthy but results from tests sometimes goes the other way. You are not alone here. About 9 years on treatment here and I have similar problem. Some patients seem to deal with this problem while others don’t. The good thing here is that it is not cirrhosis or liver cancer. I understand that fatty liver can sometimes complicate hepatitis B treatment at least that is what my provider thinks in my case. We just have to keep doing what we know how to do and let the results fall where they will fall. I understand how concerning this can be but we cannot control some of these test results. Don’t let this keep you down, keep up with the good work you have been doing. Take it one day at a time. Cheers, Bansah1.


Dear @Caraline ,

As John mentioned, following up with your physician is important. This is especially true given your description of a “protuding stomach” with a normal body mass index (based on your height and weight this is 22.3 which is in the normal range for adult women). This protrusion in your abdomen may not actually be your stomach but your liver as sometimes the presentation of liver issues is not obvious to the layperson (the liver actually sits on top of your stomach).

Again your most recent ALT is normal so this is at odds with severe fatty liver. You may also want to consult a dietitian. It may be that you also need to think about removing foods with a high glycemic index from your diet. These foods contain starches which are easily broken down by the body and lead to fat accumulation similar to the other foods you have already excluded from your diet. High glycemic foods include potatoes, parboiled rice, any baked goods prepared with enriched white flower, and well cooked pasta and root vegetables (like carrots).


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Thank you for your advice. I really appreciate it and the picture helps too.

Thank you @Bansah1.
My rebellious side wants to go and undo all my hard work. It’s like…what’s the point. I might as well go out eat, drink smoke and me merry😂
But I won’t.
KFC for breakfast lunch and dinner :grin:
Take one day at a time.
I’m noticing a pattern here.
Every six months, after test results, I get depressed and anxious for about a month!
Then I move on. Say, whatever will be , will be.
It’s hard not being able to tell my friends too. For me, I will never be able to tell them. It’s like telling them I have an STI. I sometimes think it will be easier if I have cancer and I could tell people. But I do not wish that.
Thank you everyone for pitching in. I appreciate it all.

Hi @ Caraline,
I hear you and I do empathize with you.
While I understand the notion that we take one pill a day and all will be fine, but that is not always true. Some people with this disease deal with anxiety, depression, among other mental and psychological issues. Don’t even mention the physical ordeal some patients go through. It’s a lot to deal with. Whenever I tell people about my condition I see them looking at me like I am stupid or something. They don’t believe me because to them I look good on the outside. It’s difficult to explain/share what we deal with.

We all have to do the best we can and take things one day at a time. Lets continue to remain hopeful for a cure whenever that happens. We cannot give up now, we have come too far to relent. I know it’s not easy to continue to hold on. But we all have to try.
Take a deep breath, tomorrow might be a better day. I send some strength your way.
Best, Bansah1.

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4 posts were merged into an existing topic: Lifestyle changes, nutrition, and supplements for hep b

Aww thank you @gregory your words have encouraged me greatly.
To be understood is healing.

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Hi John,

Just curious about hep B virus. I understand that the cccDNA exist inside the hepatocytes . Recently, I learn that they are also found in the telomere. I am not sure how the virus find their way to telomere. And any of those two could cause HCC? Which will be more likely that cause HCC

Thanks very much


Dear @Ccheng8346,

The cccDNA does indeed exist in the nucleus. It remains as an “episome”, or small circle that is not integrated into the cell’s DNA. This contrasts it from integrated DNA that accumulates in HBV+ cells, where the HBV DNA is inserted into the cell’s DNA, literally becoming part of the cell’s chromosomal DNA (ie, “covalently linked” into the cell DNA). Integration happens during a failure to convert the relaxed circular DNA found in viruses into cccDNA. The HBV DNA is vastly smaller than the cell’s DNA, and it inserts into the cell DNA more or less randomly. Sometimes by pure chance it inserts near one of the chromosome ends (the “telomeres”).

The cccDNA itself does not directly induce cancer, although it certainly contributes to it by being the DNA that makes the viral proteins (some of which have tumor-promoting abilities, especially HBx). HBV proteins also trigger the inflammatory environment in the liver as the immune system tries to get rid of HBV. It is the long-term inflammation in the liver that is believed to be the major (but not only) way HBV causes cancer.

The integrated DNA can have direct oncogenic effects in 2 ways. First, if it somehow inactivates a “tumor suppressor” (ie, a gene that prevents cells from dividing when they are not supposed to), for example by integrating into the gene and destroying it, then the “brakes” on cell division are weakened. Second, if the HBV DNA integrates in a way that turns on a “proto-oncogene” (ie, normal cell proteins that promote cell division when then cell needs to do it), for example by placing one of the viral enhancers near enough to turn up production of the proto-oncogene, it can push the cell towards cell division when it is not supposed to do so. HBV integration near the telomeres can affect cell cycle regulation, but I cannot remember off-hand what the mechanism is.

I hope this helps.


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Dear John,

Thank you so much for the wealth of information you provided . I appreciate it immensely, to make matter short . I have hep B with genotype C which is more virulent than genotype B. I had cirrhosis of the liver 15 yrs ago and where able to overcome it. Fibroscan shows stage 1 and my ALT is in the 15-16. AFP are always normal<3, and all tumor markers are normal. Suddenly , my ultrasound shows a 4.6 cm lesion . I was advised to get liver resection last year . Things looks fully recovered. I was talking to my hepatologist and just like what you described, he believed the HVB DNA insert itself into telomere . Not sure they found the telomere to contain the hvb DNA in the biopsy. I know there is a chance it could come back . But he believe it will be remote at this time ( he told me some of his patient has resection 15 yrs ago and going strong . I also read about to MAb that they used to prevent reoccurrence of HCC. I am hopping they can find a functional cure soon.

Thank you so much again . I remain grateful for your information

With deep appreciation,


Hello Carlos @Ccheng8346

That’s fantastic you were able to overcome cirrhosis and your fibroscan is so low.
Well done.
I hope all goes well with your liver resection and MAb treatment.
We are here for you, Carlos.

Unfortunately , after 15 yrs I came down with HCC last June 2023. Had liver resection and Just got blood work normal.

Hi @Ccheng8346, I am glad your tumor got found relatively early and was able to be resected. I wish you all the luck with remission.

Re: your question, integrations happen across the genome (including the telomeres), but perhaps the studies you were reading were referring to integration upstream of telomerase, which is the gene that maintains the telomeres. When you activate telomerase (e.g., through turning up the proto-oncogene pathway that @john.tavis describes), then you allow the cell to undergo a lot more mitosis than normal, which overcomes one barrier to cancer. This has been described in many liver cancers associated with HBV infection.

Hope this helps,


Do you think my age 77 yrs is a factor that cause the development of HCC as our immune system gets weaken and unable to stop cancer cells to develop . Perhaps I gained so much weight ( 15 yrs ago I also gained so much wait my liver developed cirrhosis).

Just curious why HCC develop. HVB integrates into telomere and stay there for years without developing HCC . Could it be trigger by mRNA ( COVID vaccine ( just speculations)

What’s your take.

Thanks thomas


dear dr. @john.tavis ,

Reading your answers, I had a question that I would be very grateful if you could clarify:

Can the type of virus influence the appearance of hcc? I ask this because I have a negative Hbeag “mutant virus”. In this type of virus, for example, could this mutation be a factor in enhancing the appearance of hcc?
Is there any study with this object

Dear @Ccheng8346,

Development of cancer is a very complex process that requires multiple changes to the cell’s genome. Even HBV cannot do it entirely by itself. HBV pushes a cell towards cancer, but the wide range of your body’s mechanisms to control cell division and to kill cancer cells before they can start expanding are too much for it to overcome alone. Therefore, almost all cancers, including those induced by HBV, include other factors that promote cancer and help get past all the protective mechanisms. For example, the background radiation that is everywhere in the world can by chance cause a mutation in a cell, or the cell could make a random mistake in its DNA when the cell divides, or an environmental toxin could help make reactive oxygen species that mutate the DNA, etc., are all known to contribute to cancer development. In short, cancer development almost always has a factor of random chance in it. HBV lowers the threshold to developing cancer, making it easier for the random effects to finish the job. That’s why cells can have HBV integrations in them for decades without becoming cancer and then suddenly transform. I know this is not a comfortable thing to contemplate, but it is the nature of oncogenesis.


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Dear @La.sciamachie,

I’m not a huge expert in this area, but I’ll share what I know.

Yes, the type of HBV can influence cancer, but figuring out how and which type of virus does it is a surprisingly difficult thing to do because cancer is influenced by so many things (a person’s genetics, their lifestyle, food types, random chance, etc…). The best available data say that genotype C (and I think the minor genotype H) are more oncogenic than the other genotypes, but this is a matter of degree, not a yes/no situation.

I’m not familiar with the literature on HBe status and cancer because that’s not what I study. However, my guess is that being HBe negative reduces risk of cancer. My rationale (and it may be wrong) is that because liver inflammation is less and viral replication is lower in HBe negative people, the oncogenic stimuli from the steady accumulation of integrated HBV DNAs and the oncogenic effects of chronic inflammation would be lower. Perhaps someone with more familiarity with this literature could shed more light on this question.



Thank you John , I know there are many factors . I hope there won’t be re occurrence of my HCC. Just need to do the best I can and wait what happen

. Thanks you very much


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Thank you very much for your explanations and attention, @john.tavis . they are very valuable to me.

God continue to bless you.