EXPLAINER: Lab results and their interpretation

I may be have HBsAg Reactive, but it could be not detected at same time ?..and this is when I can say that I have funtional cure?

How long does immune control last sir?

@availlant Would you be able to advise me on the above?

Thanks @availlant for explanation and your time and off course to all experts who try find new medications and cure for CHB…

Dear @JohnLangston,

It can take months to get to complete suppression (undetectable), though it does vary from person to person. I’m not sure what you need to get to for the doctors to clear you for this sort of therapy. Viral loads can reactivate quite quickly after immunosuppression, so it’s important to know that the antivirals work before going ahead.

Regarding survival of the virus, yes it can survive these low temperatures.

Hope these answers help,

Hrmm, sounds like your immune system is on the edge of suppressing the virus and there’s a lot of change going on. It’s worthwhile to keep monitoring to see what happens.


Hi guys,

It’s good to be here…
My name is Christian and i am from Nigeria…

I was first diagnosed of HBV in 2014… have had no treatment as my Gastroenterologist mentioned that i had a dormant HBV…

I indulged alcoholic consumption which led to liver inflammation…

Scan revealed Grade 1 fatty liver disease,. while live enzymes were said to have gone high… I administered tocotrienols for 2 weeks and Lft indicated normal enzyme level…

I have had two DNA tests conducted within two months…
A: (168UI/ML ) Nov. 22
B: (Copies 448ml) Jan 22

I really desire to fathom:

1: What has changed within this two months.
2: Is there any call for concern?

I’m currently taking Sylibon as recommended by my doctor and hope to reverse the fatty liver to normal as soon i can.


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Welcome to the forum @Christianc2 ,

Can you confirm the units reported for these tests?

IU/mL and copies / mL are not the same.

For HBV DNA, 1 IU/mL = 5.6 copies/mL.

Best regards,

Dear @Christianc2,

Even if the units are different, I wouldn’t see this as a very big change and it can be affected by things like hydration levels, time of day, or different person running the test. Ongoing monitoring every 6 months should be done just to keep an eye on what is happening and if there are trends over time.


Dear @availlant

Thanks for your response… I tried uploading the pix of the tests but all to no avail…

Here’s what’s captured on the results exactly…

Nov 2023 result :
IU/ml = 1.68×10^2
Log 10 IU/ml= 2.23
Lod 10 IU/ml = 5
Essay Range: 10^8

January 2023 Result:
Lod 10 IU/ml = 1.8
Load in copies/ml= 442
Lower limit of detection
10IU/ML= 670 copies/ml


Please note correction…

Nov 2022 and January 2023 results respectively…

Many thanks @ThomasTu for your kind response… I’ve shared exactly what was captured on the results for a better understanding and your review…


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Dear @Christianc2

Thomas is right on the mark with his comments.

Hi to everyone.I just got my new results 3 months after I started my therapy.Because I am new with my CHB status do I need some more testing and does my doctor doing good job ?I have next appointment in 3 months.He told me after that every 6 months and I need new Fibroscan in 2 years.Do you think 2 years is too long?

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Hi @Max ,

So there is a good HBV DNA response (baseline was 1,600,000 now 443 IU/mL) and your liver function is normal. How are you feeling?

You will normally have a surveillance visit every 3-6 months to monitor your response to therapy. You doctor may increase the time between visits as therapy progresses. So your next visit in 3 months makes sense and afterwards every 6 months.

NUC therapy does a very good job at halting the progression of liver disease. Additionally, changes in liver disease significant enough to be captured by fibroscan can take some time to occur. This is why you doctor is waiting this long to take a look again. He is not worried (and neither should you be) that your liver disease will progress as you are successfully responding to NUC therapy.


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Thanks @availlant for quick respond.I feel great mentally and physically with no another health issues.I don’t have any side effects from therapy or didn’t pass enough time because I am only using them 3 months.Thanks again to this great community for supporting people with HBV.Stay all healthy…

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I sent the below under introduction topic, but I do have a question about lab result and start of treatment and so decided to re-post the same in this thread. My main question is at the bottom of this post.

I newly joined this community. I’ve read through a number of the postings and I’m glad that I came across this, the exchanges among members are valuable.

A background on my HepB case. (This post ended up long as I wanted to document as much as I can, please bear with it).

- I am female, 49 years old. Asian (Filipina), currently based in the US.

- I was not sure if I got diagnosed in 2003 or 2005. I was remembering 2003 but when I searched for old records the earliest I can find is from a 2005 paperwork where there is an HBsAg reactive. In any case, I was 29-31 years old when I got diagnosed. It was during a routine job health clearance.  The hepatitis B positive result was a surprise, I didn't know how I got it. The usual questions- did I get it from health clinics(dentist.. Etc..), from sexual partners? from when I was a kid? (I remember that I got sick(flu-like) a lot of times when I  was a kid, I was also anemic have joint pains), or did I get it from birth? I don't know.

- Family health history 
	○ Mother at 57 years old died of cancer. Diagnosed at a late stage. The cancer spreads to the stomach, kidney, and liver. We never knew where it started. We don't know what type of cancer she died from. We don't know if she even had HepB. What we know is before the cancer she had hypertension.
	○ I have 2 siblings and both told me they don't have HepB
	○ Father died of complications from Type2 Diabetes at 65 years old. I don’t know if he had Hepatitis B. 
- When I was first diagnosed, I didn't get to talk about this to anybody. I didn't understand the full implication of this virus. I never had a regular, primary care doctor or annual checkups when I was growing up in the Philippines. At 21 years old after graduating from University, I got a job and got busy during my early career, at 25 years old I began to travel outside the Philippines for work. So when I was diagnosed at 30, I was busy with these that I didn't give Hepatitis B much thought in terms of following up on it. Although, of course, I did feel guilt, shame, and fear that goes with first learning about it. The doctor who told me about my result, when I asked what it means told me that later on, it can develop into liver Cirrhosis. After I got the job clearance, I started a new job, traveled again, and didn't look into Hepatitis B. It's just at the back of my mind, it gives me a little nag from time to time but I don't remember myself being too worried about it. I guess because I didn't have a doctor, I didn't educate myself at that time on this disease and also didn't talk about it with anyone. My health in general I would say is average if not below average, or I'd say not optimal, I get sick with colds easily. I get fatigued easily. I feel sick, especially during my monthly period. I'm also susceptible to feeling low during my period. I also have migraine (left-sided migraine) a few times a month. I also have gastro issues for example bloating and gas. All these symptoms still happen today. 

- Fast forward to 2010 (5 years passed after my initial diagnosis)-  I got married in 2007(my husband is vaccinated). I gave birth to my first (and only) child in 2010. I made sure during the time I was pregnant that proper measures are taken to avoid giving hepatitis to my child. Also, at this time I am already living in the US and more routine tests are being made especially during pregnancy. I started to adopt a healthier diet after I gave birth- I removed soda, dairy, and sugar. I educated myself on nutrition and tried various cleanses and diets. I also started to have doctors look into my hepatitis b although I was not regular in monitoring at least twice a year as suggested. 

It- Only in 2015 that I started to be followed by a gastroenterologist. I get my regular bloodwork- liver and hepatic panel, as well as abdominal ultrasound every 6 mos. There are times when I can do it only once a year, and during the pandemic in 2020, I am not able to do a checkup.  

- Here are numbers that I could find from some years of previous bloodwork.
	○ 2006
           HBsAg 3.027 positive (cut-off .039)

	○ 2008
	ALT 18 (0-45 u/l)
	AST 19 (0-41 u/l)
	○ 2009
	ALT 13 (6-40 u/l)
	AST 15 (10-30 u/l)
	○ 2013
	ALT 17 (6-29 u/l)
	AST 17 (1-30 u/l)
	○ 2014
	HBsAg- positive
	HBcAb- positive
	HBsAb quant 0.11 miU/ml  (-<=999.99)
	HB DNA quantification 600 iU/ml (0-19)
	HB DNA quant Log 2.78 LogIU/ml  (0.00-1.29)
	HBeAg- negative
	HBeAb- positive
	ALT 24 (-<=33 u/L)
	AST 26 (15-41 u/L)
	○ 2015
	ALT 11 (6-29 u/l)
	AST 14 (10-30 u/l)
	○ 2017
	ALT 13 (6-29 u/l)
	AST 14 (10-30 u/l)
	○ 2018
	ALT 16 ((6-29 U/L)
	AST 16 (10-30 U/L)
	○ 2019
	ALT 15
	AST 16
	○ 2021
	Feb 1, 2021
	HBsAb - <5L (>OR =10 mIU/ml)
	HBsAg reactive
	HB virus DNA 2370
	HB virus DNA 3.37 logiU/ml real-time PCR
	HBeAg non-reactive
	AFT 3.5 ng/ml (>6.1)
	○ 2022
	July 2022
	ALT SGPT 12 (7-52)
	AST SGOT 15 (13-39)
	HB DNA 3970  iu/ml
	HB DNA 3.60 log iu/ml
	HBSag reactive
	HBeAg non-reactive
	HBsAb <5 L (>OR = 10mIU/mL)
	○ Nov. 2022
	Vit. D 18 (insufficient <20 ng/ml, optimal 30-100 ng/ml,)
	ALT 14 (5-40 )
	AST 20 (9-40 )
	dsDNA antibody 16 iu/ml (positive >= 10.0)
	○ 2023
	Jan. 2023
	ALT 52 (6-29 u/l)
	AST 193 (10-35 u/l)
	HB DNA 1330 iu/ml
	HB DNA 3.12  log iu/ml  real-time PCR
	HBsAg quant >25,000 (<0.05 iu/ml)
	AFT ng/ml 3.4 (<6.1)
- Present time, from recent results- I've got elevated AST/ALT (esp. AST) from the test last month. Last year's test shows 3970 HB DNA, down to 1330 last month. HBsAg quantification is >25,000 from last month's test. These numbers, plus the 20 years that passed since my initial diagnosis, and my age at 49 years old, are all the reasons for my doctor to begin treatment. He believes that my chronic hepatitis b is active and that my immune system is continuously fighting this cycle of keeping the viral load low, thus an up and down on my HB DNA numbers which he thinks is only damaging my liver. I don't have a comparison of my HBsAG quant from the current >25,000 to previous years. I am waiting for the result of my abdominal ultrasound. My recent fibro scan result though is normal (161 cap dB/m, 3.7 E kPa)

- For the start of the treatment, my doctor prescribed Vemlidy. I just received the 30-day supply by mail after going through the process of requesting co-pay assistance. The cost of the 30-day supply is 1088 USD. With the co-pay assistance, I was told that I can get a maximum of 5,000 USD per year to assist with the total annual cost. I plan to start taking Vemlidy in the next coming days. 

- Question: What is your opinion about the decision of my doctor to begin treatment, are the biomarker numbers above give a good indication to begin treatment? I very much welcome your thoughts on this. 

- On a different but maybe correlated note, is a marker that I was recently diagnosed on from Nov. last year test that is dsDNA antibody positive. This marker was ordered as part of a comprehensive bloodwork by a neurologist due to my migraine. The result of my neurologist appointment showed a deficiency in Vitamin D and this positive dsDNA. Also, I found out that I have high blood pressure. It was the first time that I get to have a high bp. My primary care physician prescribed Lisinopril 5 mg. I've been taking it for the past 2 months. Back to the positive dsDNA, I was told by the neurologist to make an appointment with a rheumatologist to further look at this for a possible auto-immune disease that may not be related to hepatitis B (e.g. lupus SLE, although my ANA result is negative). My hepatologist does not correlate the dsDNA positive with my chronic hepatitis. My rheumatologist appointment is next week. 
- Question: if anyone came across a positive dsDNA, what can be the main points or clarifications I can discuss during my rheumatologist appointment?  
- Question: Does anyone have a dsDNA positive due to hepatitis B, or is this simply not a marker for hepatitis B at all?  

- And repeating my question above, as this is my main question and may be lost due to the length of this post, I'd appreciate your comments on this question: 

Question: What is your opinion about the decision of my doctor to begin treatment, are the hepatitis B biomarker numbers above gives a good indication to begin treatment? I very much welcome your thoughts on this. Thank you very much for this forum.

Dear @crifid2023,

Welcome to the forum! Thanks for sharing your story and your questions.

Your age and raised ALT/AST levels are indicators for treatment consideration. If this is being caused by the body’s response to the virus infection, it will help reduce liver damage.

In my research, I haven’t read anything about any link between autoimmunity being caused by chronic HBV infection. It is still worthwhile mentioning it to your rheumatologist so that they have a complete history.

Hope this helps,

Thank you, Dr. Thomas. I appreciate your response. I decided to heed the recommendation of my doctor to start treatment. I’ve started with his prescription of Vemlidy this week. I am hoping for the best. Just like most people who are starting with treatment decisions, I’ve been through a lot of questions and anxieties to make the decision. But these also made me more proactive in dealing with my CHB, learning to advocate for myself, researching available materials, and knowing more about the science of the disease. Because of this I also end up being in this community. I appreciate being here.


Hi @ThomasTu and @availlant
Thank you very much for all your effort in this forum.

I am getting some inconsistent laboratory results and i was hopping with your experience you can provide some feedback.

I have done HBV DNA test in 2 different countries and i am getting totally different results. In the UK they they show high HBV DNA 2.9E4 IU/ML and in Greece they show HBV DNA 20 IU/ML so i wanted to understand what could be happening as there is a treatment decision to be taken based on this.

Just a bit about the background.

I am 35yo chronic HBV carrier since childhood i am not taking any treatment. i regularly monitor the results and I live between Greece and London so i do tests in both countries.
I am Antigen E negative, Genotype D with normal or liver function, Fibroscan range between 3.6kpa to 6.4kpa

  • In 2018 (london hospital) the HBV DNA was found to be 11200 IU/ml and surface antigen 2592 IU/ml
  • In August 2022 in Greece in a private lab i did HBV DNA Test and found only 184.5 IU/ml and surface antigen 4852 IU/ml
  • In November 2022 in London Hospital they found HBV DNA 2.93E4 IU/ml (29300IU/ml) and Surface antigen 1574 IU/ml
  • In January 2022 in Greece i went to a different private laboratory from previous and repeated the same test 2 times with HBV DNA 20IU/ml and 2 weeks later same laboratory 25IU/ml

My issue is that in the UK based on their viral load they recommend for treatment and in Greece they they don’t recommend. So i wanted to understand if there is any reason for this massive difference in the HBV DNA.

Any feedback will be more than welcome.

Dear @Andrew ,

Welcome to the forum!

It could be possible that there is something different about the HBV DNA test in Greece (assuming that the test performed in London UK is reliable). However, these lab results may not necessarily be inconsistent as they are temporally separated (except for the last two tests in Greece).

They could be indicating that your HBV infection has entered the inactive phase (HBV DNA < 2000 IU/mL) where treatment is not normally prescribed. The decision to initiate treatment is a composite of both viral load and liver disease status. When was your fibroscan done? What do your latest liver function tests show?

I would first ensure that the test results from Greece are performed by an accredited lab using an approved HBV DNA test which is calibrated to an international standard. Alternatively, you could repeat your HBV DNA test in Greece at a lab where they use a well recognized test platform like Abbott Realtime or Roche Cobas Taqman. Output from these tests is calibrated to an international standard.

I agree your situation appears a bit confusing.

Get back to us.