EXPLAINER: Lab results and their interpretation

So the discussion we talked about were talking about the same thing right? about the HBeag being negative and HBeab positive not about Hbsag hbsab right because that link doesn’t talk about Hbeag an Hbeab Just making sure what you said is right I do have advantages because of my HBeag- an Hbeab+
that gives me a better prognosis and led progression to any liver disease just to clarify

Yes, the advantage is from being anti-HBe positive and HBeAg-negative. Sorry, I included the wrong link. I meant this one: EXPLAINER: Lab results and their interpretation - #158 by Drew_rous.

Thomas

Thanx Thomas for the reply if it is not too much to ask I live in the states and when they sent me my results my dna load is 841(h) an my viral load is 2.92 can you break this down for me to understand?

Yes, 841 means that the approximate number of viruses per mL of blood. 2.92 is just another way of expressing the value (841 = 10 to the power of 2.92).

Thomas

So correct me if I’m wrong so that means out of being under the 2000 copies and US standards of treatment I’m only 841 copies pretty much from 2000 or viral load?

Yes, see a more detailed description of treatment criteria here: Why HBV DNA and HbsAg count - #5 by ThomasTu or

Thomas

Thanks for that but this part caught me off guard does that mean this person doesn’t have an antibody for it? * If you’re HBeAg-negative and have a virus load over 2000 IU/mL, you should consider treatment

No, people are either:

  1. HBeAg-positive and Anti-HBe negative, or
  2. HBeAg-negative and Anti-HBe positive.

You are number 2.

Thomas

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I see. the part that confused me is that if you were HBeag negative you still can get over the thresh hold viral load

Yes, correct. That’s why it’s important to keep monitoring to make sure you are under the threshold, or are treated if you go over the threshold.

So how often does that happen in people or do they usually stay at the number there at for a long time?

Chances are low: about 1% of people in this phase go over the threshold per year.

Thanks Thomas I’m just really stressed about this I’m trying to collect all this that you’re telling me which I greatly appreciate and make sense of things and trying to get a bigger picture of it I just wanna feel normal again and not stress so much it’s hard

No problem, @Eddie. This is what this community is for. Many of us have been in the exact same situation you are in and we slowly work out how best to live with our condition. The good news is that there is usually no reason we should stop living normal lives (apart from the occasional blood test or ultrasound).

I am sorry that this is so stressful for you. But know that this is temporary and better days are ahead. I hope you are getting the support you need to get through this (either here or among your own community).

Thomas

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Right on Thomas thanks for that man you made me feel a whole lot better over the last few days I’m still a bit stressed but being able to talk to somebody that knows about this and is going through it too at the same time I really appreciat that :pray: I know that I could leave you a message and you’ll get back to me for sure and tell me the truth An let me know what’s going on. thanx for this platform you put together to help people deal with this situation an help us more understand. i’ll be reaching out to you for sure in the future if I have any questions thanks Thomas you’re a good man

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Hi Everyone,

Just wondering if anyone has any ideas on the cause of elevated liver enzymes that don’t seem to be caused by HBV.

I’ve been on Vemlidy since 2018 and have had an undetectable viral load and normal liver enzymes until this year. In June 20201, I had a mild acute elevation of my liver enzymes (ALT 112) noted on routine lab check. My enzymes worsened after I took Macrobid for a suspected UTI (culture came back negative) in mid June but then decreased again by the end of July. In Sept 2021, my enzymes were mildly elevated again and repeat work up ruled out autoimmune hepatitis, hepatitis A/C/D/E infection, and CMV/EBV/HIV infection. Ultrasound, fibroscan, and other testing ruled out fatty liver and my HBV viral load continues to be undetectable.

I don’t know if this is at all related but I also came down with sudden fatigue, nausea/GERD symptoms, with upper abdominal pain after eating certain foods in late May and am still trying to figure out the cause for this sudden GI distress. It might be important to note that I had a liver nodule scare at the end of 2020 and have been under alot of stress leading up to my sudden health decline in May. So fast-forward to today, my ALT is currently at 123 but my liver function is fine. I declined to have a liver biopsy, since I doubt it will be useful, but will to continue to monitor through bloodwork monthly for improvement. Any ideas on why this might be happening? My doc seems certain it is not due to HBV. I just saw a GI doc and am currently being tested for celiac, Wilson’s diease, h pylori, and SIBO.

I don’t really expect any miracle answers but more so wanted to share my experience as a HBV patient who often worries everything comes back to my HBV status. I certainly hope my doctor is right and it is not the case, but I can’t help but wonder.

On a positive note, I have been feeling much better lately, almost “normal” on some days so I am hopeful that I will back to my old self again soon!

Thanks for reading.

Rebecca

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Hello everyone,
I guess my case in somewhat similar to @Rebecca.
I am not on any medication. I do my monitoring twice per year. Six months ago I did my usual blood tests. My alt levels were mildly (?) elevated (69), while my viral load decreased from 3200 to 1700.

We did a follow up test 3 months after that. My alt levels were again a bit elevated (67). In the meantime I did a fibroscan. The result was good (6kPa)

Six months pasted so I went for my scheduled blood tests this week. My alt levels were a bit higher (75) while my viral load fell to 437 which by the way is the lowest since I started monitoring my HBV.
I haven’t talked to my doctor yet. I just sent him the tests and I guess we will talk after the weekend. Do you have any thoughts?

Best regards,
Drew

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Hi @Rebecca, there are many other viruses that can induce an ALT flare, including flu or cold viruses. You mention that you have been stressed, and that can definitely influence things. It’s great that you’re on top of it and actively trying to figure out what’s going on. Sorry this doesn’t really help, but I hope you get some sort of answers soon.

These sound like your immune response is actively responding against the virus. It’s during these flares that you have the best chances for HBeAg- or HBsAg-loss, so there are benefits to it. I guess this is what your chat with the doctor will be about.

Cheers,
Thomas

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Hi @ThomasTu,
Thank you for your prompt and detailed response. I am quite relieved with what you said.

Six months ago, my doctor told me that if alt levels remain elevated in the next scheduled blood tests, he will order a series of tests (he even mentioned biopsy) to check for other causes. I am glad he is so thorough but can’t help to be a bit worried.

I have already been tested for HDV and HCV. The results came negative.

Speaking of alt levels. What is considered mild and high elevation? Does the rise from 69 to 75 contitutes a big rise? Are those numbers alone something to worry about?

Best regards,
Drew

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Hi Drew,

This is a very mild rise. The generally accepted (but arbitrary) definitions are:

Mild elevation = < 5 times upper limit normal (i.e. up to 275 in males or 95 in females)
Intermediate elevation = 5–10 times upper limit normal
High elevation = > 10 times upper limit normal (more than 550 in males or 190 in females)

Many ALT flares can come without any long-term issues, but can become an issue if they are persistently high over long periods of time (on the order of years) or if they are very high (>10 times ULN). Given your fibroscan seems to be good, I would imagine it should not be too much of a worry, but it’s best to get on top of it before it leads to anything serious. Of course, I don’t know anything about your medical history, so it’s best to take your doctor’s advice.

Cheers,
Thomas

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