EXPLAINER: Lab results and their interpretation

Dear Suresh,

Its good that your ALT is dropping. However, we do know that in clinical studies of people receiving TDF/TAF in combination with pegIFN in people with HBV/HDV co-infection that ALT flares can occur during therapy so this may happen in the future. It is IMPORTANT to note that your doctor should also be testing for other markers of liver function (these are called bilirubin, albumin and INR) and in the cases of these ALT flares, the liver function was actually normal, indicating that the ALT flare was a sign of the immune system clearing infected cells from the liver (which is a good thing).

Regarding your HBV RNA and fibroscan data, can you confirm the following:

  1. Your liver stiffness measurements (fiboscan) were all performed using a fibroscan machine?
  2. You HDV RNA viral load test results are reported in the same units (e.g. IU/mL or copies / mL).
  3. Do you have a recent test result of your HBsAg level?

Best regards,


Thanks for detailed reply. My doctor is checking weekly:
bilirubin, albumin, etc.

I had flare of GGT since I started pegINF. The bilirubin and albumin are stable. ALT and AST were very high before starting pegINF and it started to drop.

For HDV RNA viral load, the unit of 13,000 was iu/ml but there was no unit mentioned for 288,000.

I don’t have the result of HBsAg but i will try to ask.



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Dear Suresh,

The regularly normal bilirubin and albumin should provide you with comfort that your liver is ok (despite the GGT flare). I suspect the HDV RNA test results are in different units and thus not directly comparable.

thanks for fast and quick reply.
what your thoughts on Bulevirtide

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Dear Suresh,

Bulvertide is a recently approved medicine in Europe for the treatment of HDV infection (previously known as myrcludex B). You take this medicine via a daily subcutaneous injection in addition to therapy like ETV, TDF or TAF for your HBV infection. A doctor may also add pegylated interferon into the treatment regimen to increase your chance that contorl of HDV infection can be achieved after removal of therapy.

Bulvertide works by blocking the entry of HBV and HDV virions occurring via a specific receptor on the surface of liver cells. Although this medicine has very little effect on HBV infection, it is well tolerated and works very well in most patients to eliminate HDV viremia from the blood and importantly to normalize ALT in these patients. This medicine is an important advance in the treatment of HBV / HDV co-infection.

Unfortunately, evolving clinical data indicate that like ETV, TDF and TAF for HBV, bulvertide will also be a life long treatment. Also, there are a small fraction of patients who either do not respond to bulvertide or who experience viral rebound on bulvertide. We do not yet have good clinical data demonstrating the reason for this.

Hi Thomas
I wanted to ask you some question , u told me before at my viral is very low is 1450 ul/ml
and my viral dna is about 148 ul/ml positive
There is risk of transmission in this level?
Im al so hbv e negative
Hvb E anti body positive
My regards ibrahim

Thanks availlant.

life long treatment for HBV or the HDV ?

I have been given price for Bulevirtide as 70,000 USD per year.

Dear @ibrahim_barry

There is some risk of transmission because your virus DNA is detectable, but it is very low.


Hi Suresh,

Bulvertide is being used for the treatment of HDV infection. Limited clinical data have shown that withdrawal of bulvertide is accompanied by rebound of HDV RNA. Currently there is no data demonstrating the establishment of HDV RNA suppression with finite therapy of bulvertide.