EXPLAINER: Lab results and their interpretation

Hello @ThomasTu and everyone,

I am checking in to share the latest in my first 6 month check up since March 2021 diagnosis of chronic HepB. I’d like to also get some insight on comments my doctor noted in a well-written summary cover letter (have never, ever received such thoughtful comments from any doctor in my lifetime, so I am very grateful).

  1. I am fine. No treatment is needed. The doctor wrote, “I am pleased to let you know the results of your labs are very reassuring!” My viral count is still less than 400 but increased by 30 from the first HBV DNA Quant.

  2. My doctor consulted with an infectious disease expert and they all agree with my previous primary: every 6 months, get an ultrasound, repeat liver enzymes tests, and get the viral load test.

But here is where I’d appreciate some insight:

  1. The doctor wrote: “Because you are negative for the Hep Be antigen, your risk of progression is less.” What is the relationship between negative Hep Be antigent and progression?

  2. The infectious disease expert “suggested a viral load of 2 million as when to start treatment.” I am at 350. I thought treatment is typically activated at 2,000 viral count. Is 2 million too late?

  3. Some results: ALT (11), AST (22), Bilirubin (0.2). Are these numbers just okay, good, really good, barely good, or close to the edge of potential trouble? On my lab results, the numbers appear to be in the column between “low” and “normal,” but I don’t know if that’s a formatting problem with printing or a way to actually read and interpret the data.

My ultrasound is in January 2022 for the 2nd check-up.

Thank you as always!

Hi everyone,

This is why reading the internet is so confusing and exhausting. I came across this info from “Healthline” dot com site: Clear urine can also indicate liver problems like cirrhosis and viral hepatitis. If you are not consuming large amounts of water and have ongoing clear urine, you should see your doctor.

I’ve never in my life heard that clear urine could actually be a bad thing in some cases. I/we can’t keep worrying about all these medical/biological nuances. We have to actually LIVE! I will just focus on general wellness habits, good nutrition and diet, and let the urine, ultrasound, and blood test results have the final say on what’s happening to me.

Hi @hopefulone,

You’re right that there’s just so much stuff on the internet and it’s partly the reason I started these forums up in the first place.

Great to hear about your results! Looks like things are pretty stable for you, which is fantastic.

Re your questions.

  1. e-antigen negative (without raised ALTs) is a pretty stable state and the rate of liver disease progression is quite low.
  2. This seems to be quite a high threshold according to the current guidelines. About 2000 you should think about treatment, over 20000 it is recommended if you have raised ALTs.
  3. These seem good to me, levels are low to normal. Raised levels in these values can indicate some liver injury.

Hope this helps,
TT

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hello everyone!
I was looking through my past exams and notice that 6 years ago both HBeAg and anti-Hbe were negative. Is this common? I was under the impression that one if one is negative the other one is positive. A few years before I had negative HbeAg and positive anti-Hbe.

Hi Drew,

This can happen as someone transitions from HBeAg-positive to HBeAg-negative. While this transition is happening, it is possible both of these fluctuate as the virus and the immune system both react and counteract each other.

Thomas

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I was first diagnosed with Hep b 2002 when I was in college ass I volunteered to donate blood for I didn’t even know. I think God I knew about my state early.
In 2012,a GP put me on TDF/3TC and stopped me after 1 yeay haphazardly.In 2017 I visited a gastroenterologist and I had a viral load of 147991IU/ml and f3 fibrosis.I restarted TDF/3Tc and the viral load was undetected 3months later until today.
On 9.9.2021 I did the following tests and the results were as follows:
MULTIPLANAR TRIPHASIC IV CONTRAST:
FiNDINGS: "The liver is normal in size and parenchymal pattern.MCL span 12 cm… No hypervascular or other focal hepatic lession detected.No steatosis or parenchymal coarsening.Liver density is normal at 56HU.No dyaphorphism, irregularity, atrophy or other cirrhotic changes noted.No periportal oedema or fibrosis noted.Portal vein(12mm) is not enlarged and has normal contrasting filling.No enlarged portosystemic collaterals.Hepatic veins are normal.

HEPATOBLIARY U/S, FIBROSCAN WITH CAP
FINDINGS:"The liver is echogenic with a heterogenous hypoechoic appearance.Multiple rounded echogenic lessions are seen and may represent haemoangiomata or focal fatty areas.No mass or nodule was shown.It has a reduced span of 10.9cm.Cpsular outline appears smooth.There is no ascites seen around the liver.Portar vein diameter is 8.5mm with hepatopetal flow.The CBD is normal in diametre.GB is acalculous.
Fibrosis score is F0-F1 (7.0kPa)no or mild fibrosis.CAP score is 238dB/m(steatosis grade S1)
AFP :0.956ng/ml
ENDOSCOPY:
FINDINGS,"varices grade 1, early portal HTN.
SALMONELLA ANTIGEN: negative.
VITAMIN D3:61.06.
LVER FUNCTIONS TEST,:only GGT is slightly elevated at 55.2UL
My concerns are:
1.Does early portal HTN really cause varices or there is an error here?
2.I have never had CIRRHOSIS,how did I get varices and portal HTN?
3.US finds steatosis which is missed by CT scan, which is accurate?
4.CT says the liver parenchymal is normal while US gives a different picture. Which is accurate?
5.CT scan finds no liver atrophy while US finds one. Which is factual?
In Africa (Kenya)getting a gastroenterologist leave alone an available one is an uphill task. Can somebody give me a summary of what these findings imply.
I have lived with Hep b for a very long time that it never stresses me. It’s part of my life.

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Dear @Kinoti,

Welcome to the forum and thanks for your questions. These are quite specific health-related questions, so I will leave it to some of our Hep B specialists: @simone.strasser, @PLampertico, or @MarkDouglas.

Thanks,
Thomas

Hi Kinoti
I suspect the endoscopy report is not accurate as there are no other features of portal hypertension as you mentioned. The ultrasound is probably more reliable than CT scan for steatosis (fatty infiltration), and the CAP score was possibly very mildly elevated although this is not a very accurate test at this level. The slightly high GGT level is also commonly seen when there is some fat in the liver. Fat in the liver can be related to diet, body weight, exercise levels, alcohol or genetics. The CT is probably more accurate than ultrasound for excluding any lumps in the liver. The most important thing is to continue the antiviral medication and not suddenly stop it. You should discuss how often to do imaging of your liver with your specialist.

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Thanks alot Simone for affording your expertise and time to me for free.
You have confirmed my thinking as far as endoscopy report is concerned. You have also enlightened me on the importance of CT in lump evaluation.
In my country (Kenya) majority of specialists deal with report writing. They don’t entertain discussion as they normally have long ques of patients waiting and operate many clinics.
I will definitely follow your advice. Moreover, I will revert to my former gastroenterologist who had time for me.

With regards
Kinoti.

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Good morning.

I have recently tested positive for Hep B. It’s chronic infection. I was born and raised in Somalia which high prevalence of Hep B. I went through many other blood tests and waiting to see hep B doctor. I also have done liver scan and results are very good and no abnormalities. I now live and work in Canada. Can someone explain to me what does it mean Hapitats B virus DNA not detected and Geonotype cancelled due to insufficient viral load to perform testing. Additionally, my hep Be Ag is negative while my hep Be Ab is positive. My appointment to see a specialist is way too long and just can’t wait. All my other tests appear to be ok as I googled what they meant. Finally, my mother died of liver disease but can’t confirm if she was ever infected of hep B for your information. I am learning as much as I can about this disease and joined this org for guidance
Thank you,
Mohamud Aden
Edmonton, Alberta

Mohamud Aden

I am sincerely sorry for having tested positive for chronic Hep b. Majority of us felt the same when we first tested positive but we have lived long enough to be a testimony that there’s life beyond positive chronic Hep.
I may not tell you what exactly your results stand for as you have asked, but I chose to encourage you on what suggested is going through your mind.

As you wait for your appointment, chose not to be disappointed by what you not seen and know. Moreover, all your results are encouraging.

Be encouraged and remember knowledge is power.
Regards
Kinoti

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Dear @Moses999, thanks so much for sharing your situation. I’m really glad that you’re in Canada and have access to a hep b doctor. The fact that your liver scan is normal is great. So in answer to your questions, let me help. But please know that I’m not a doctor, just a knowledgeable nurse. Generally Thomas Tu is the best at answering these types of questions but until he has a chance to read your message then let me reassure you with some simple answers first.

  1. “…what does it mean Hapitats B virus DNA not detected and Geonotype cancelled due to insufficient viral load to perform testing.” So the good news is that your viral load is undetectable in you blood. This means that the hep b virus is not replicating at a fast rate, which ideally means your liver is not being aggressively attacked by the virus. This is also confirmed because your hep b e-antigen is negative. Finally, your genotype could not be determined because there wasn’t enough viral DNA in your blood to test.
  2. “…my mother died of liver disease but can’t confirm if she was ever infected of hep B for your information.” It would be good to know what the cause of your mother’s liver disease was, but do you know whether your mother died from liver cancer? If not, is it possible for your siblings to get tested for hep b? Or maybe you’re not comfortable yet sharing your hep b diagnosis with your family?

Please know that this community is always eager to help answer questions, provide emotional support and share our collective wisdom from living with hep b. You’re just starting your journey, but you’re a fast learner and willing to seek help! Always, Joan

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Hi @Moses999,

Welcome to the forum and thank you for sharing your experiences. I have nothing much to add on top of what Joan has accurately said.

The additional good news is that people with lab results like yours have a very low rate of liver disease progression, so it is likely that you are in a good situation.

You will probably be asked to get a few more tests just to see if your liver is ok (e.g. ultrasound or fibroscan). Other than that, you can expect a simple blood test every 6 months just to confirm that everything is still going well.

Hope this helps,
Thomas

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Thank you Joan. My mother definitely died of liver cancer at the age of 82 six months ago and that is when I asked my doctor to be tested for Hep B. I have asked my two sisters and brother to get tested for Hep B, but they didn’t listened to me and asked me to keep my mouth shut. Due cultural reasons and stigma associated with Hep B “Cagaarshow” devil’s disease I felt that I was alone with this and had to fight it alone. I have always been healthy and lived in Canada since 1984 and went my yearly check up. I was shocked that regular screening in Canada isn’t included with Hep B and had to ask for it.
Thank you.

Thank you Thomas. I actually did my liver scan and there was no abnormalities. Nothing usual as the report stated. My ALT is 18 and my AST is 20. All my other blood tests associates with liver are normal.
Thanks.

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Hello everyone, sending happy diwali wishes to all of you from India.
I had my appointment with the doctor today and I was given tenofovir Disoproxil IP 300 mg for 1 month and I was told to come back after a month and get test for CBC&LFT test. I have so many doubts going on in my mind whether to start taking the meds or not, given the fact that my viral load is very high (48,891,483 iu/ml) and again my liver function test comes normal(attach LFT report below) complete haemogram and pt-inr test also comes normal.
Also some of the @heath expert from here have suggest that my stages look like in immune tolerant phase and that may not require treatment. Iam undecide with meds at the moment. Please advice me on whether I should start taking the meds or not,i want to take into account of all the expertise before taking any meds,moreover I put more weights on the expert from this group than the doctor in my state. For better understanding iam 28 years old Male and healthy,horizontal transmission between 2019&2020 I guess.

Few things I would request @heath expert to please give me some insight.

  1. Once started taking the meds how long does in take to bring the viral load down to a safe level,with discipline diet.
  2. how do I achieve HBeAg negative from HBeAg positive, does it only become negative if the viral load comes down to undetectable level. It’s very important for me to test negative for HBeAg,that’s only way I could get back my job.
  3. if started taking meds can we stop if the viral load comes down, or its gonna be lifetime. Does on/off on meds will be ineffective in fighting th

    e virus in future.
  4. how long does its takes for adult like me to change the phase from immune tolerant phase to immune active phase to inactive stages.

I am really looking forward for the advice from the expert, thank you very much to all the experts for taking out your precious time for us. I can’t imagine how my life would be without this community specially those experts,you guys are full of compassion and humanity
P.s English is not my first language not even second, I try my best I hope its understandable.

Hello
Recently went for my six month bloodwork

Alt/AST we’re 12 and 13 respectively , ultrasound came back with no concerns.

But a bit concerned about the jump in Virus DNA count: it was 16iu/ml six months ago and today I received the results and it was 1070iu/ml

The past few results were 21iu, 16iu, 387iu/ml , 16iu and now 1070iu. (All of these were taken six months apart, the most recent one yesterday)

Is that a drastic jump? I am Hbeag negative

Dear @12345678,

Happy Diwali to you too! To answer some of your questions:

  1. Viral load reduction rates are different from person to person. From my own experiences, it had taken months to years of continuous treatment to lower it to very low levels.
  2. Tenofovir will not necessarily help with going from HBeAg-positive to HBeAg-negative. Interferon treatment can stimulate the immune response and increase the chance of going from HBeAg-positive to HBeAg-negative, but it is still a low level.
  3. You should not stop the medication just because the virus load comes down because if you do, the virus level will likely come back up again. There are some indicators when you might be able to stop (for example, if your HBsAg is negative), but if you start treatment you should expect to take them for years.
  4. The phase changes are different from person to person, and we scientists do not understand exactly why and what causes them. In general, phase changes occur over years to decades.

Hope this helps,
Thomas

Welcome @Albasil808 to the forum and thanks for your question.

It’s a bit of a jump, so your doctor may recommend more frequent monitoring to understand if this is a false result or if it is part of a larger trend.

Hope this helps,
Thomas

Thank you for your response

How common is a false result? If it isn’t, what typically would cause this trend upwards?