EXPLAINER: Lab results and their interpretation

Hi Tsbs
I have walked with you for sometime. I remember you had taken a biopsy because of your steatosis and hep b infection. I have longed to hear your progress and would appreciate if you update us.
Meanwhile, I wish you all the best of luck.

Just saw the liver biopsy result which is metavir score F3A2. The pathologist diagnosis was moderate necroinflammation and moderate fibrosis and also NAFLD Brunt score 8/9.
Will see my gastroenterologist next week to commence treatment.
My hope and prayer is that it will regress on treatment.

I don’t know what brunt score of 8/9 is, I have searched online to no avail. Anybody with idea should let me know.

Hi @Tsbs
I must admit that I am extremely happy to hear your progress.
I can assure you steatosis and fibrosis are reversable from my own personal experience. You just need some small discipline. Eat well and exercise.
Some of the expressions in your medical report are strange to me. I am looking forward to somebody expounding them for us.

Dear @Tsbs,

The Brunt scoring system is a way to trying to determine the severity of fatty liver disease: https://aspe.vb.it/it/downloads/Brunt%20classificazione%20NASH.pdf. This way you can more objectively know if it is getting better or worse.


Hi I need help could you tell me what this means?
I can’t post but it’s from Quest Diagnostics it’s pre employment lab test

For hepatitis B it says


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Hi @Dabgirlie,

Positivity for Hep B Surface Antibody means you have been vaccinated (or have cleared a previous infection) and are protected against any further infections.

Hope this helps,

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Last year in May my HBV DNA viral load was 9540 iu/ml

On 7th of Sep 2022 my HBSAG was 795 ui/ml

Today on 29th of Sep HBV DNA is negative.

I was diagnoves with chronic hep B last year in may and have been taking Tenofovir daily.

Please how do you interpret this results?

Dear @Aleksi12,

These results indicate that your antiviral meds are suppressing the virus successfully. As you continue to take the medication, you should expect to have much lower liver disease progression/inflammation.

Hope this helps,

After been tested positive for Hbsag, 5 months later a combo test was administered and the result is below;
Hbsag positive
Hbsab negative
Hbeag negative
Hbeab negative
Hbcab negative

Please explain plainly to me, is the results still at acute or chronic stage. Thank you.

Dear @Anasaladan,

Thank you for your question. The results suggest a chronic infection as HBsAg is detected. However, what phase you are in is difficult to determine, as it does not fit the usual profile of any of the phases. This is not dangerous for you in itself, but just not a standard presentation. Perhaps one of our @HealthExperts would be able to suggest what they would do in these cases?


It is possible that the HBcAb report is reporting IgM rather than total HBcAb - worth checking what was reported .
If indeed the total (IgG) HBcAb is negative and the only marker positive is HBsAg it is very unusual and would wait perhaps 4-6 weeks and repeat all tests including HBV DNA.

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@Anasaladan I had similar profile before but I got to know that most lab technician read the combo test like PT which is incorrect. The last two markers are indirect test from what I read from a test kit manual. If the HBeAb and HBcAb T-band is negative, it means you are reactive and vice-versa.

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Hello Forum,
I was recently diagnosed with hep b…live in the States. I have been reading this forum in last 2 weeks and I learn a lot!! Thnx to the scientists and management of the forum…especially Thomas, Andrew and others…thanks for what you do!!
My results are as follows
AST 25
ALT 45
All other labs normal… ( high cholesterol)
My hep b is positive… and I am hep E antigen Negative
Anti HBE positive…
The alarming part is my AFP value is 16. I need help to understand this…
My HBV viral is 6290iu/ml

Am I considered inactive? What about treatment?
My doctor will schedule fibroscan soon…

Does alcohol contribute to AFP level?
Again thnx for your time and help


I am from India and this is regarding my father. He recently diagnosed with hep b. He had no symptoms and we suspect its chronic. We dont know how long he had it. We( myself and family (2 year old) and sisters) had been in close contact with him.
I am hep -b vaccinated. But my husband had only one dose when he was kid. My kid was in close contact with my father fro the day she was born. We vaccinated her as per norms .
Now with father being diagnosed ( he is 66 years old) we are worried about his health . we are not able to get right diagnosis here.
Here are his results
HBsAg - Positive - 6.63
ASP -199
ALT- 187
He is scheduled to get an ultrasound.

Can you please help me understand the results and his state. What more tests do we need to do.

And how much risk are we in as family , who are partially vaccinated.

Please help us.

Thank you

Thanks @Smart55, that is a fantastic point. @Anasaladan, It is worth getting a blood test and making sure that the results coming back are appropriately interpreted.

Dear @nass,
Welcome to the forum and thanks for asking your questions.

Your blood results are consistent with the “immune active” phase as your ALTs are elevated and HBV DNA moderately high. The fibroscan results will indicate whether you should be considered treatment or not; if there is fibrosis, then under current AASLD guidelines you should be considered treatment (happy to be corrected here, @norah.terrault).

Alcohol has been associated with increased AFP levels (https://www.tandfonline.com/doi/pdf/10.3109/00365519409088427) but I’m unsure about how common this is.

Normal AFP has been reported to be within 0-40ng/mL (though this may depend on the lab, best to look at your results and consult the normal range). These levels can also increase if you are pregnant.

Hope this helps,

Dear @sajdale,

Sorry to hear about your circumstances and the worry that your father’s diagnosis has caused. The blood tests indicate that there is some liver inflammation happening. There are ways to reduce this (for example, antiviral treatment), but you will need to discuss this with your doctor to see what is right for him.

Simply living with someone with Hepatitis B is not a high risk of transmission. Sharing meals and other casual contact holds no risk. It is a risk if there is blood to blood transmission.

If you are successfully vaccinated, then this is complete protection. You can see if you are successfully vaccinated by getting a anti-HBs antibody test. If it is above 10, then you are considered to be protected.

Hope this helps,


Thanks for your immense help, does your “reactive” means I’m still in acute stage?


Thanks Thomas
The lab range for ALT is 10-46
And my level is 45. Is it high because of value selected by AASLD?

What is you opinion about Fib-calculator and APRI accuracy and comparison to fibrosure?
Probability for results to match?

I’m 43 yr male, I believe I had this since child cause my brothers had it too…


Apologies, I had in my mind you were female for some reason (in whom the normal ALT levels are lower). I think 45 is borderline (though various labs have different tests that have different “normal” ranges), but also depends on your baseline levels in the past.

My understanding is that Fib 4 and APRI are good for diagnosing advanced fibrosis, but don’t do so well with lower levels of fibrosis (F1-F2). I think Fibroscan is more sensitive in these cases.