Confusing Lab result and statement

Very confused about this lab result. Can someone decipher this please.

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Just means you haven’t been exposed and aren’t vaccinated. Go get a Heb B vaccine and you’ll be protected.

Thanks for your reply, Scott.
Oh that it were that simple. I’ve been CHB for more than 56 years and have cirrhosis. That’s why that lab result is so confusing. It shows that I had <2.0 HBsAb 24 years ago but now I have a low viral load and HBsAg reactive and no HBsAb at all. It’s all a bit of a shock and very stressful since I only found out that I had cirrhosis and steatosis in December. My wife has one more Hep B vaccine to go.; hopefully, it will protect her.

Hi @karp,

If you are still HBsAg positive, then it is expected that your anti-HBs antibody levels are low.


Ah. Thank you, Thomas.
That old lab report made no mention of HBsAg, but my recent labs show HBsAg positive. It’s discouraging to see that the small HBsAb that showed up, has now seemingly disappeared. Does this make it less likely for me to produce HBsAb again?
This is all so complicated and stressful. Back in 2000, I was never told how serious this would be. Nor was I retested. Until last December, I was never evaluated for fibrosis/cirrhosis. Does the persistence of HBsAg mean my cirrhosis will inevitably get worse? Thank you again for your kind dedication to all of us.

Hi @Karp,

I’m sorry to hear that you had not been evaluated for liver fibrosis until recently; this should be a routine test for everyone with Hep B.

As far as I know, blips in anti-HBs happen from time to time and do not have any bearing on whether you are likely to produce it again in the future. The more important value is your quantitative HBsAg level: the lower this is, the more likely you are to get anti-HBs in the future.

Persistence of HBsAg does not mean that your cirrhosis will inevitably get worse. It has been shown that antiviral therapy slows and even allows reversal of fibrosis and early cirrhosis.

Hope this helps,

Thanks, again Thomas. Today, I asked the hepatologist to order a quantitative HBsAg and the reply I got was that “The HBV DNA titre (which is on the requisition) will show the amount of the virus, if that is what you’re looking for.” Before I pursue this with her, am I getting confused again – I thought HBsAg was different from viral load? My HBV DNA is 6.55E+1 IU/ml.

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Hi @Karp,

Yes, HBsAg level is different from viral load.

Generally speaking, HBV DNA is a measure of how much infectious virus is in the blood.

HBsAg is more of a measure of how likely it is your body is to clearing the infection, the lower this is, the more likely you are to clear it.


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Thanks Thomas. I’ll see if I can persuade the doctor to order a quantitative HBsAg.

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Hi Thomas. I followed your advice and my doctor included HBsAg quantification on the requisition, but no public lab locally here in Ontario seems to offer quantification. Is this a complicated or special test? Perhaps this is a question for Andrew Vaillant: where can one get a HBsAg quantification test in Canada? Thanks again to you all for your commitment to helping all of us in this community.

I’m actually not sure about the general availability of quantitative HBsAg in Canada. Perhaps some of our Canadian colleagues can help (@cscoffin, @availlant, @A7xImpulse, @kk9) or there are hotlines you can try here: Hepatitis B - Canadian Liver Foundation


Thanks, yet again, Thomas.
My last lab showed a slight increase in ALT from 23 to 29, and my AST went up from 31 to 39. It may not seem like much but like most people on this forum, my nerves are jangled and I feel so stressed. If anything, I was hoping for an improvement rather than more AST and ALT leaking into my blood.
I have recently got back into oil painting to calm my nerves, and it does work. However, I’m realising, only now, that I may not be as well protected from the solvents as I thought. So, something I thought was benefitting my mental health, might be adversely affecting my liver. I wanted to put that out there in case other people, like me, are not paying enough attention to the many ways harmful substances can reach the liver (such as through contact with skin, ingestion, inhalation, etc.). I’m not saying that solvents caused the rise in serum AST/ALT but, maybe.
There is a slim chance that it’s not a rise in serum enzymes. It could be that they’re on their way down from a recent flare.
A month ago, I had a bout of what I think of as an acute “dry flu”: strange muscle and joint aches, sensitive skin, nerve pains, swelling of both hands, development of a petechiae rash on both legs, shivering while my body temp was normal and while wearing heavy clothing, including a winter coat, with outdoor temps around 20C. It only lasted for a few days or so.
I read that infections can also increase AST levels. So it is possible that mine may be coming back down again following some kind of infection, but I wasn’t tested during that “dry flu” so no way to know.
Apologies for the long email but perhaps others will find this and any follow-up commentary useful. As usual, many thanks.

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qHBSAG is available in Alberta, Quebec and some hospital labs in Ontario.

Otherwise your Dr can request the sample be sent from the provincial lab to the National Microbiology Laboratory in Winnipeg c/o the Blood Borne Pathogens / Viral Hepatitis Testing Division (
The requisition forms are available online

Best regards

Carla Coffin

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Thank so much, Carla, this is very helpful. I’ll look into it and see if my GP or hepatologist can determine which Ontario hospital labs near Hamilton might accept samples or collect blood. Failing that, I guess shipping blood out of province by PHO might be an option. Thanks, again.

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Yes, I can confirm that there are HBsAg quantitative testing available in most lab collection sites in Alberta. I live in a small community, and the lab here only collect the sample and then ship it to Calgary, AB for the analysis.

Hope this helps.

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Thanks A7xImpulse. My GP did request quantitative testing but the lab didn’t forward samples to anyone. I’ll try to find a local hospital that does qHBsAg but might have to wait until my next requisition in November. Very stressful.

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Meanwhile, I have more confusing lab results. I find myself anxious all the time and hoping for good lab results. I thought it was a good sign when HBeAg is negative and HBeAb was positive, but the latest report says it’s abnormal. (“HEPATITIS B VIRUS LITTLE E AB. HBe ANTIBODY POS POS Abnormal”.) Why do they say it’s abnormal?

My liver ultrasound report says I have a cyst in each lobe. The last ultrasound didn’t mention them. Of course, now I have something else to worry about until I understand what it means. Also, my liver measured 12.8cm previously. Has it shrunk, can it shrink, or is this a measurement error? If it has shrunk, what does that mean? What has any of this got to do with my cirrhosis?

“The liver measures 12.3 cm. In the right lobe of the liver, there is a 0.4 x 0.7 x 0.4 cm cyst. In the left lobe, there is a 0.4 x 0.3 x 0.3 cm cyst. The liver capsule is mildly nodular. The main portal vein measures 1.2 cm and demonstrates normal directional flow.

No new solid hepatic lesion.”

On a more optimistic note, but still confusing, the HBV DNA test says, “detected below the lower limit of quantitation. Unable to quantify. <1.00E+1 IU/mL” While that is something to celebrate, at the same time, my enzymes went up 10 days ago: ALT 29 from 23 and AST 39 from 31. If my DNA load is tiny, why are my serum enzymes going up?

I’d be most grateful if someone could kindly give me some perspective on these confusing results. Thanks.

Hi Karp
According to your concern and questions about Hepatitis B profile and liver function test results.
I think that you are HBe Ag negative chronic HB infection (your HBV DNA is low and AST /ALT is in normal range)
with cirrhosis. Cirrhosis of your liver may be caused by chronic hepatitis B that damaged your liver tissues to inflammation and result in fibrosis (scarring) and eventually cirrhosis within decades .I didn’t know about your hepatitis B journey in the past but other causes of cirrhosis may be from fatty liver which can be detected by ultrasound. You should assess your anthropometry
eg. BMI, waist circumference(WC) , WC to height ratio (normal<0.5) , BP, Lipid profiles etc. it can suggest to the diagnosis of metabolic syndrome or MASLD.
1)Your concern about SGOT elevation that I think is not a problem that it may be slightly fluctuating and not significant. SGOT can be found in other organ eg. muscle,kidney , red blood cell , so it can be elevated if there is injury to these organs. If you have strenuous exercise or drinking alcohol , SGOT may be elevated but not specific to liver disease.
2) About ultrasound, it is difficult to measure size of liver due to variation in individual patients. Your portal vein size is 1.2cm(normal 9-13mm)but the crucial issues about portal vein is portal hypertension (clinical significant) which may be indirect measured by non invasive test eg. Fibroscan and platelets count(you should consult with your hepatologist).
Finally ,as your data and information, I think you are chronic hepatitis B with compensated cirrhosis and antiviral drug is indicated regardless of your HBV DNA level according to international HBV guidelines to prevent and may reverse your disease progression. I hope this may clarify your concern and questions about your condition.

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Hi Chulapong.

Thank you for taking the time to respond. Your reply really does help to keep things in some kind of perspective and it helps to relieve some of the stress.

You are correct. I was infected with HBV 56 years ago and my ALT/AST has remained steady for at least the last 25 years. Unfortunately, I was not tested for cirrhosis until last December when I had a Fibroscan, so do not know when it was developing, but likely in the years following the acute phase.

I do also have steatosis but my BMI is about 0.49 and I don’t use alcohol. I’m 1.715m and weigh 65 kilos. I have been vegetarian for more than 30 years and have just started eating fish again for the omega-3. I was careless with saturated fats but now keep my triglycerides within range.

I’m hoping the bad fats and sugars that I’ve eliminated from my diet will help reduce the stored fat in my liver. I don’t know if there’s a way to determine what has contributed most to my cirrhosis – HBV or too much fat, so don’t know if my diet has much of a chance of reducing it. It can’t hurt to be careful.

The hepatologist said nothing about hypertension in the portal vein when she did the Fibroscan. It’s possible that the report on this week’s ultrasound that said, “demonstrates normal directional flow”, may indicate no hypertension. I don’t know if an ultrasound can determine that.

I thank you again for helping me understand my situation.

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Hello friendly community!

Can someone help me understand- how can a chronic carrier not have hepatitis b show up in these results? He has had it for at least 1 year, but we suspect many years, and every test has found the virus in the sample.

Did it clear? Is it an error? Or do anti-virals work that well?