Do viral load levels fluctuate a lot and easily?

After some input from experts on here, I learned there’s really no certain way to keep viral load levels low - but I was curious to know, is this one of those things that fluctuates all the time? For example, if my levels are low now, if I went to check a month from now, could they suddenly have gone up?

Or does it, for the most part, stay consistent so long that there have been no drastic changes in one’s condition?

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I am not a healthcare worker, but a chronic HBV carrier.
You may be able to find ample amount of information around viral load from the Internet already.
After no changes to viral load for over 20 years, I experienced an increase in viral load a few years ago, and was referred to a specialist who put me on medication.
I would recommend consulting a specialist, and I am pretty sure you will be taken good care of.

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I’d be interested in knowing more about this, too. Also, are there any signs to show it gone up? Assuming this would also lend itself to resulting in a greater possibility of spreading this to so done else?
Are these upward fluctuations are what they call flare-ups?
This would add credence to my wife’s concerns about possible transmission at such times. I’d rather KNOW the truth than not …
Denny

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It’s not the viral load you look after . It’s the value of your surface antigen , you need to have Hsbv at < 100 to consider yourself functional cure . There still chance of your liver becoming cirrhotic or getting HCC .

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Hi @Anon2023, @Starr_Lennon, and @Denny,
This is my view and I will take this in two ways: In the first instance using myself as an example, I am a chronic carrier and have been on treatment since 2015. The only fluctuation I see or experience has not been with my viral load/HBV DNA, but rather with my liver function test (ALT and AST). I have stayed undetectable through out all the periods of liver function fluctuations. I will assume this is the case for most patients on treatment. This is more leaning towards your second question (@Anon2023), where viral load stays consistent, liver function test might fluctuate once in a while at least for me. (Note: Each individual case might be different).

In the second instance, people with inactive infection can at some point become active. This can happen without having any symptoms. It is also possible for someone with a functional cure to experience this as well. This might be likely possible when the immune system becomes weaker due to either cancer treatments such as chemo, or other medications that can suppress one’s immune system. Being under a prolonged stressed life can have an impact on one’s immune system and could trigger something like this. If possible we should try and avoid anything that can suppress our immune system.

The advice is everyone with either active or inactive case must remain monitored, with either once a year or every 6 months follow-ups. These changes can be seen through labs/imaging and the person might not have any symptoms. HBV is a complex disease.
i hope this helps. Bansah1.

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Thanks, Bright. Hey, on a lighter note, don’t STRESS over the allergies…your body chemistry will change someday. In the meantime, enjoy the winters more or consider relocating to Arizona? (Hope these words give you a chuckle, my friend)
Denny

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Thanks Denny. We just need some rain to get rid of the pollens. I am managing as best as I can. Arizona, sorry I will pass. I can spend a week or two there but not live there. Not for me lol. I spent a week or so there during a cross country trip 6-7 years ago. Maybe Colorado, but not their winter lol. You see, I am picky too lol. You made me chuckle, Denny. Best, Bansah1.

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Hi @Anon2023,

Just like a lot of biological systems, the answer is “it depends”.

There are phases which are quite stable. One example is the “immune tolerance” phase, when people are infected with HBV from a very young age. In this phase of infection, you have very high viral load (>100000000/mL of blood) but not much liver disease. The immune system doesn’t recognise the virus-infected cells and so there is not much inflammation. You can be in this state for many decades without change.

The other major stable phase is “immune control” when the virus load is very low or undetectable. The immune system has controlled the infection and has raised an anti-HBe antibody response. There is generally very low rates of disease progression in this phase. Again, you can be in this state for many decades without change.

Quite a bit of fluctuation (of virus DNA and ALT) can occur when the virus and your immune system are battling it out. Sometimes this is asymptomatic and impossible to notice unless you do blood tests, which is why the recommendation is to get blood tests every 6 months to monitor your status.

Hope this helps a bit,
Thomas

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@ThomasTu Interesting - thanks for the input! I recently got a viral load test done and it noted my viral load was 49 H IU/mL (it also noted it as 1.69 H Log IU/mL). I assumed I’m in the “immune control” phase. To be honest, this was the first viral load I got as an adult. Perhaps I got one as a teenager, but I don’t recall…better late than never and I’ll certainly begin to monitor more closely and get tested 2x a year, instead of just yearly to ensure I’m monitoring my health as closely as possible and that I’ll be able to spot any changes or progressions in my status.

How about my fiance - she’s negative and got her vaccine this year. She’s adequately vaccinated but we’re curious to know how often she should check to see if her vaccine is still effective or not. Is 1x a year during her annual checkup sufficient? Or should she get her titers checked 2x a year? Moreover, is a change in her vaccination status something that can happen over night? For example, if she gets her status checked tomorrow and it shows that she’s fully and adequately vaccinated, is there a chance her protective levels could suddenly drop within a few weeks or months prior to her next check-in, or is this something that happens slowly overtime? I’m a bit nervous that maybe one day it can drop without her knowing and I may compromise her health…

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@Ccheng8346 Hmmm I don’t know that I’ve ever seen my hsbv values. I’ll have to see about getting those tested

@Starr_Lennon I’m glad you were able to catch the increase in viral load and be put on meds! Best of luck in your health journey. The advances in medicine make me hopeful

@Denny I too would be interested in knowing if there are any signs to indicate it’s gone up! However, like with many other illnesses, so many things are “silent” so even if there are signs, I’ll probably rely more on getting myself tested 2x a year in addition to looking out for any signs

@Bansah1 this does help, thank you! You along with many others like @ThomasTu always give the most helpful and valuable insight!

@Bansah1 I don’t blame you! AZ is nice to visit but too hot to live year-round. I’m not sure how full time residents do it! And agreed on CO - their winters are too long, they get snow even into May!

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Hi @Anon2023,

I am not sure that there is a strict timeline that your partner should be tested. It is generally assumed in the clinical world that you are protected for decades or for life after your antibodies reach protective levels. It would be great to hear from some @HealthExperts to see if they would think annual checks would be fine (I would think this is reasonable). This is not something that is likely to change overnight, barring some severe immunocompromising event.

Hope this helps,
Thomas

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Thanks. We try to do the best we can to help and support everyone on the platform. You are right about AZ, I wonder how anyone survives those heat. It feels like the sun is inches from touching you And CO is the opposite. Nice during summer with great blue skies but their winters are brutal. Only a place to drive through or spend a few days lol.

Thanks, Bansah1.

Hi @Anon2023,

  1. We normally only monitor HBV DNA once a year in this setting (partly due to government funding restrictions in Australia) and this is usually sufficient. If your liver function tests (ALT) remain normal that is also a good sign. We usually monitor those every 6 months.

  2. If your partner has completed a full course of Hepatitis B vaccinations and has had a confirmed antibody response (i.e. detectable anti-HBs antibody) then that is considered to provide life-long immunity and no further testing is required. The antibody level usually falls over time but the immune system retains good memory cells so it can produce antibody again rapidly if she is exposed in future.

As Thomas mentioned this should be re-evaluated if they had a significant change in their immune status, such as organ transplant or chemotherapy. Otherwise I would not repeat.

Best wishes
Mark

Infectious Disease specialist

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