EXPLAINER: Lab results and their interpretation

Hi all,

Just share your opinion, in our country we recently have viral load testing, that’s why I only have 2 measurements:
last year viral load (2020) = 57000 copies / ml
this year viral load (2021) = 150.000 copies / ml
ALT levels are normal. hbeag is negative.
I was a bit disappointed seeying the viral load higher, was hoping for it to drop.

I have chronic hepb, got infected at birth, mother to child transmission.

How often does viral load fluctuate ?
When should one start antiviral treatment ?

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Dear @HepB1,

Thanks for your question. Guidelines would suggest that you consider antiviral treatment with these lab results. Viral load can fluctuate quite a bit and quite often over these sort of time scales.


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@ThomasTu (and fellow community members),

I have new HBV DNA test results and would appreciate any insights but I am guessing results are fine:

(1) HBV DNA (April 2021): 320 IU/mL (2.505 log10-IU/mL)
(2) HBV DNA (October 2021): 350 IU/mL (2.544 log10-IU/mL)

I am still waiting on other blood work results. “350” is the wrong direction, but I am grateful that it appears that my immune system is still backing me up. *A big change in my lifestyle during this time period is reduced exercise because of new job but still practicing healthy eating and good weight management.

What do these data points below mean from June 2021 (my diagnosis was March 2021 from donating blood)?

  1. HBV genotype is “D”.
  2. I have no basal core or pre-core mutations.
  3. Hep Be Ab is “positive” but the flag says “abnormal” and the reference interval is “negative.”
  4. Hep Be Ag is “negative.”
  5. My GI gave me an infographic and circled “Inactive HBsAG Carrier” which he concluded was “commonly associated with vertical transmission and at birth.”

At this point, do you recommend I get other types of tests? My second six-month ultrasound will be in January.

Thank you as always!

Dear @hopefulone,

There is no real difference in your DNA levels (if stays within 2-fold of the previous reading, you should probably interpret it as stable).

Regarding your other results:

  • Genotype reflects where the virus is geographically from, and may predict your responses to certain treatments, or progression of liver disease. Usually though, it doesn’t affect your clinical treatment very much. See here: Living with cirrhosis - #4 by ThomasTu
  • Basal core or pre-core mutations are similar, the presence of these variations in the virus are linked to different outcomes, but I’m not sure the science is really settled on this. Good to know just in case future work shows that they are really important.
  • Yes, HBeAb becomes positive when HBeAg goes negative in a chronic HBV infection. The flag says abnormal because in people without HBV infection HBeAg is negative.
  • Inactive HBsAG Carrier sounds like a reasonable interpretation of your results

Generally, part of the ongoing monitoring, you’ll be getting the HBV-specific tests (HBeAg, Anti-HBe, HBsAg, Anti-HBs, HBV DNA) and ultrasounds as you have talked about. You’d also be getting liver function tests (a panel of blood tests).

Hope this helps,

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Thank you @ThomasTu!

If you’re HBCAB positive and they say something about most of them go reactive. So what does that mean? Did they developed surface antigen clearance but still had a viral load and then they start treatment thinking that they were cleared of the virus? They say that you have to test for the HBCAB to be safe because they say most of the time they go reactive.

Hi Eddie,

Not quite sure about what you’re asking here. Maybe read the opening post here and that might answer your question: EXPLAINER: Lab results and their interpretation.


Good day @ThomasTu @PLampertico I did another profile test in a different Lab. It’s now like this HBsAg-Reactive, HBsAb-Non-reactive, HBeAg -Non-Reactive, HBeAb -Reactive, HBcAb -Non-reactive. The HBeAb that was Non-reactive is now Reactive but HBcAb remain Non-reactive. I will appreciate if more light can be thrown on the sudden appearance of HBeAb. Further more, I read a couple of articles online that report the possibility of false positive as you suspected to be attributed to heterophilic antibody and autoimmune disease. Does the presence of heterophilic antibody means the test was influenced? Thank you for always providing answers to out questions.

Dear @Smart55,

This is another strange result. I am not sure what would be causing this and I defer to @PLampertico or @MarkDouglas on possible future steps to try to sort out what’s going on.


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Yes this is unusual, but if HBsAg and HBeAg are both positive this probably reflects a false negative for HBcAb.

I would order a HBV DNA and if this is positive then it would confirm chronic hepatitis B and you could consider treatment after discussion with your doctor.

If HBV DNA is negative then this may be a false positive serology, depending on risk and other factors.

Dear @MarkDouglas ,thank you for your reply. It is HBeAb that is positive not HBeAg. HBeAg is negative. Thanks again.

Hi @Smart55, the same point stands if HBeAb is positive and it is probable that it is a HBcAb false negative (if HBV DNA is positive).


Thank you for your answers.

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Hello everyone iam from India,on Sept 2021 while I was doing medical test for job to my suprised the doctor told me I have hep b positive. Its horizontal transmission because no one from my family has hep b, maybe I get in 2019&2020. Please if anyone of you have some explanation of my viral load, also I will be doing LFT and some other test.

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Welcome to the community @12345678!

You are amongst fellow hepB fighters, educators, researchers, and survivors. I found a lot of peace, comfort, knowledge, and hope through this community. I hope you find the same. I was diagnosed with chronic hepB in March 2021 after donating blood. And in that moment, it seems as if my entire life (or outlook on life) changed.

I hope you have access to really good health care which is important. Eat and live in good health to help prevent added problems we don’t need.

Take care of yourself and stay hopeful!


Hi 12345678,

I second the welcome from hopefulone. One of the @HealthExperts will be able to give you insight into your lab results. Thank you for your patience and please know that the handful of experts we have volunteer their time and can get busy. Rest assured that someone will respond to you as soon as they are available to do so.

Please have a look around the community forums and as hopefulone mentioned you will find a lot of information and support within this community,



It is important to determine whether the Hepatitis B virus is causing any inflammation in the liver and whether treatment is needed. In many people, even when the level of virus is high as it is in your case, it is not causing liver damage. Your doctor will take into account your age, how long you might have had infection, whether the HBeAg is positive (which it probably will be), the results of the liver enzymes (ALT in particular) and platelet count and may recommend further tests such as a liver ultrasound, and then discuss with you whether you should consider taking medication to suppress the virus in your body. Your doctor will also discuss how often you will need regular checkups.


Thank you everyone for your kind words and for awnsering my question, luckily my state govt is giving free treatment and medicine for hep b patient however since there is so many people the doctor couldn’t give us enough time or could not comfort us as we expect,however in this group I feel people are very compassion and helpful to one another,this group definitely help us ease our pain to extend. Also since I am from the most extreme part of India,the health care system in my state is not so good and the doctors are not so expert in hep b so I will be needing an advice many time from all of you,sorry in advance for I will be asking many thing in future.
One thing I would like to ask,since my viral is very very high(48,891,483 iu/ml) does this indicate liver damage, or there’s some case were the viral load is very high but no liver damage. Also please enlighten me what factors decide to start medicine, is it high viral or liver damage that decide the med.
P.s my liver function test result is coming in the nest 3 days.

Thank you.

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Welcome and I really hope this community will help you a lot. We are here to support each other in every way that we can. Here you can find many very useful and reliable resourches while also talking with some of the top experts regarding Hep B around the world.

Now, about your question let me start by saying that I am not a doctor or anything close to that. I am just a chronic carrier of Hep B so I can only tell you what I’ve read. I am sure that a health expert will answer soon.

Hep B has different stages. During one of them called Immune tolerant stage the viral load can be high but a treatment may not be needed (https://www.who.int/docs/default-source/searo/hiv-hepatitis/training-modules/07-hbv-natural-history.pdf?sfvrsn=520b7c01_2). There are propably a few more tests you need to do.

Keep in mind that even if you need treatment, the available options are higly effective with minimal side effects.

Lastly, I would reccoment finding a hepatologist. It would be better to have someone nearby but I think it’s also possible to do everything remotely as Hepatitis B mostly does not require physical examination. The monitoring is based on blood tests that (s)he can send you via email and you send back the results.

I hope this helps till an expert joins the discussion.

Stay strong. We are here to support each other.



Hi @12345678,

I too welcome you to the forum and hope you find what you need here. There is no need to be sorry about asking questions; it is what this forum is here for.

As for your question about your viral load, @Drew_rous is correct and viral loads this high usually indicate that you’re in immune tolerance phase where there is no significant liver damage (as @simone.strasser has mentioned in her reply). I explain this in a couple of presentations: here and here. You will need to wait for your liver function tests (and possibly liver ultrasound) to confirm this.

Hope this helps,