Deciding when to start treatment

I have not. I was not advised to, guessing due to my ultrasound results and 6 months blood work test. Knock on wood. Every six months, my anxiety goes through the roof. I turned 47 this year and results are steady. Daily vitamin c and d, probably doesn’t help. Trying my best at my dieting but I sick at it. Did my tests about a month ago, need to make an appointment with my doctors asap so I can have test orders and probably do my next set in November

Best wishes.

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Dear @NeptuneJ

I totally understand and thanks for sharing.
It happens to me also. Every six months I get above average anxiety. Even had a bit of a meltdown last time. Lol
Seems I’m not my normal self for up to 1-2 months after results. Then go through it all again 5 months later - twice a year. I would like to lessen my anxiety/reaction.
Family don’t seem to understand. So thanks again for sharing.


Kindly help me with your eating menu coz I have truly failed to understand what to and not to eat.
Thanks in advance

I don’t have a strict diet. I just try my best to eat healthy. I try not eating fatty foods or lots of snacks. I try to exercise or walk. But fail every time. lol


I have possibly done all the blood work apart from the viral load that seems hard to perform in uganda. Good willing I post the results in two days time for advise and help.
Thanks in advance

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Here are the test result I had immediately my acute symptoms resolved. The symptoms resolved like today and I did these test the next day.

HBsAg was positive, HBsAb was negative, HBeAg was negative, HBeAb was positive, HBcAb was positive.

Viral load was 183IU/ml


Total Bilirubin 62 (<21 umol/L)

Conj Bilirubin 31 (<5 umol/L)

AST (SGOT) 831 (<35 IU/L)

ALT (SGOT) 932 (<45 IU/L)

ALK Phosphate 305

YGT 508 (<49 IU/L)

Total Protein 63 (66 - 83 g/L)

Albumin 31 (35 - 52 g/L)

My doctor prescribed an antiviral medication for me, is it necessary to take it? It’s been 2 months now and I’ve not taken the medication since I do not have the symptoms even up till now, I’m just waiting, praying and hoping that HBsAg turn negative soon.

Am I suppose to take the medication? Was I wrong not to take the medication? HBsAg is still positive.



Dear @Ossaidavid,

Your provider is in the best position to recommend treatment, as they have access to your history and have physically examined you. People on the internet are in no position to tell you to contradict the advice of your doctor in this case.


i was diagnosed of hepatitis B in 2016 and i haven’t been treating it until last week that i visited hospital due to stomach discomfort and Tenofevir was prescribed. i did scan which shows features of hepatitis on my liver but the liver is in normal sized. Is there any hope of getting rid of it using tenofevir and is the side effect manageable?

Hi @Ajpius,
Welcome to the community. Great question. To answer the first part of your question is yes and no. Yes, it is possible to gain functional cure through treatment. The chances of that happening is less than 5% I believe. And no because, majority of patients do not achieve functional cure on the current antivirals in usage. On the issue of side effects, there is a discussion on this already. Check it out here:
What are the side effects of taking tenofovir.
I hope this is helpful. Bansah1

thanks for such swift response

Thank you

This is the confusion, so far I’ve seen two different gastroenterologists in the same hospital, the first one prescribed an antiviral medication for me for 1 month, while the second one said there was no need for me to take any medication, but that the choice is ultimately mine to make.

My understanding is that treatment can help prevent further injury to your liver if you are experiencing a lot of liver inflammation during the acute phase, but there is not enough evidence to say whether treatment will alter the course of an infection (i.e. if it becomes chronic or not) if not taken within days after exposure.

Hope this helps,

2 posts were merged into an existing topic: Help me please with tenofovir in us

@Opa fresh fruit and vegetables. Lean meat. Stay away from processed food, junk takeout meals, fried food.alcohol, soda drinks, less sugar, cakes, biscuits, most of the time.


Just asking to be certain, I studied some of the treatment guidelines AASLD, APASL, EASL, now I am not so sure if I should go on treatment because my ALT is not above 2x normal value and I dont think my liver is damaged yet. My doctor said it is recommended I should go in treatment with Tenofovir.

I did liver echo scan, result is ok (date 24 nov 2023).
age = 46.

Results on 24 nov 2023
viral load = 1,744,186 IU/ml
ast = normal
alt = 51 (normal < 45)
bilirubine= 26 (normal < 17)

Results on 15 april 2024
viral load = 3,372,093 IU/ml
ast = normal
alt = 44 (normal < 45)
bilirubine = 9 (normal < 17)

Thing is my alt, ast and bilirubine has gone to normal levels, but viral load has increased.
How can viral load increase and alt,ast, biliribune go to normal levels ? I expected an increase in ALT and AST. Is the immune system sleeping ? Has the virus mutated to slip immune system detection ?

I have heard before age 30, your viral load could be higher because immune system did not detect the virus, then after age 30 the immune system detects the virus and attacks, alt and ast will increase, I experienced this already some where age 32 or something, got a bit fever and muscle pain. At age 32 in my country we did not have viral load measurement so have no idea what viral load was at that time.

Not so sure if I can do liver biopsy here in my country, as mentioned I did do a liver echo scan.

What is your opinion ? Go on treatment or wait longer until ALT > 2X normal level ?


Hi @hepb1,
I will revert to your provider’s advice here. As you can see yourself, your viral load has increased significantly within the last 6 months or so. The higher the viral load, the more damage can be done to your liver. It is possible there is a lot of viral replication going on in your body. If your provider thinks treatment is the best option for you at this point, I will not wait.

Additionally, remember that the guidelines are just guidelines, so they can be altered in different situations. Not every case is going to fit exactly as what is in the guidelines. I hope this helps. Bansah1


Hi @ hepb1
These guidelines (AASLD, EASL , APASL) used different cut off points for UNL of ALT , AASLD used 35 IU/L and 25 IU/L for male and female respectively . EASL and APASL used 40 IU/L for UNL of ALT . Recently ,WHO guidelines 2024 for HBV management used UNL of ALT at 30 and 19 IU/L for male and female respectively. So I think you should consider the UNL of ALT from standard guidelines that you follow , not from the local laboratory report of UNL of ALT at the right side of paper report. At present time, the threshold of decision making is low for start treatment in CHB patients due to evidence based supports early treatment especially patients in the gray zone or indeterminate phase.


Agreed with @Bansah1 , Hepatitis B is a carcinogen, it will increase your risk of liver cancer. Your liver enzymes may be normal, and still develop liver cancer.

Good Luck

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Hi Danny, I’m from Malaysia too. How is the decision after meeting the specialist doctor?