EXPLAINER: Lab results and their interpretation

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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These two are dissimilar to my profile, in my case, only HBsAg is reactive, HBsAb, HBeAg, HBeAb and HbcAb are all non-reactive, sometimes, the HBsAg become non-reactive then later turns reactive. I have had this flip flop for 15 years with normal liver enzymes and normal liver function, but recently, my ALP shoots to 219 while my ALT is 58 just the border marks based on the lab, Direct bilirubin and total bilirubin are below normal range base on the Lab’s reference range, but total protein is 62 and AST is 22 which are within the normal range. How can you explain this to me? I have never done viral load count.

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This is a fairly unusual case, I’m not sure what the reason might be. Perhaps @PLampertico @simone.strasser @Suwang88 @rgish or @MarkDouglas could provide some insight and maybe some suggestions?

Yes, indeed, quite unusual. Did you check the hbsag levels? They will be probably very low… Maybe a false positive test?

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Thanks, @PLampertico. Would you also be thinking about vaccination/booster in this case?

Thomas

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I find it interesting that they don’t treat if you have a low load I’m sure it still affects your liver someway somehow

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Why not, no robust data supporting this strategy in this speific setting but i do not foresee any major disadvantage…

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Agree with @PLampertico. Sounds like false positive as all other markers, particularly anti-HBc, are not detected, and the HBsAg is intermittently not detected. The elevated ALP and ALT are not likely related to hepatitis B - more likely something else such as fatty liver disease.

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Hi Eddie,

Yes, as I mentioned at the virtual meet up today, there are still conversations happening in the field about this. The trouble is getting the evidence to back this up: people with low viral loads have very low progression of their liver disease. So to show any benefit to treatment, we need to either do very long or very large studies to show any benefit and sort out the signal from the statistical noise. These are currently impractical to carry out, but we may see some change if other issues are taken into account (e.g. anxiety of onward transmission).

Cheers,
Thomas

Thank you for your reply @PLampertico , I didn’t check HBsAg quantity but I guess I should do that. I really appreciate your reply, but which test would I do in favour of false positive?

Hi @Smart55, I think you would just get the HBsAg test again to check if it is consistently reactive. If it is not consistent, then it is likely just a false positive and you should interpret it as non-reactive.

Thomas