EXPLAINER: Lab results and their interpretation

Dear 174, I am incredibly sad to hear about the loss of your husband to HCC. How devastating to you and the entire family. But as Thomas wrote, your blood test results indicate that you are protected from hepatitis B and have developed protective antibodies against any future exposure to this virus. Fortunately for you, even though you were exposed (probably by your husband?) to the hepatitis B virus, you had a strong healthy immune response that was able to fight off an infection. Please stay in touch with us, especially if you have any other questions. And if you have children, hopefully they were vaccinated at birth. Thanks for posting and we all wish you the strength and comfort to endure your grief. Always, Joan

Hi,
I had my first hepatitis B surface antigen test in Feb. 2019; the value was 832 iu/mL. I repeated the test a year later (Aug. '20); the value: 870 iu/mL. Both are marked red (high).
My most recent (Apr. '21) AFP-L3% and total AFP test is 1.5, and the virus DNA is not detected (which has been the case since 2018 when I started treatment on TAF).

What is your interpretation of the results? What is my risk for HCC?

Thanks,
TM

Dear @Private,

Welcome to the forum and thanks for sharing your result. It’s very difficult for anyone to form an accurate picture of your liver from one low res image - there is generally a ultrasonist’s report giving an interpretation of ALL the pictures of your liver taken together. That is the thing that will really tell you what is happening.

Moreover, I am just a scientist, so I am not qualified to give interpretations of ultrasounds. I would contact your liver specialist and have a good in-person conversation about what the results might mean.

I hope this helps,
Thomas

Dear @teh-minbrown,

Thanks for sharing your results.

Regarding HCC risk:

  • HBsAg: There isn’t a good strong link between HBsAg levels and HCC occurrence. Some have shown patients below 1000 IU/mL are at lower risk (see here).
  • AFP appears to be normal, which is a good sign
  • Low HBV DNA levels seem to help lower HCC risk, as does taking antiviral.

All in all, it seems to be good news for you. Ongoing monitoring will help you make sure you stay there!

Hope this helps,
Thomas

Thanks Joan and Thomas. God bless

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Thanks so much for the same day response.

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Good dear, colleagues!
I’m Alex from Russia.
Could you help me a little bit with an explanation of my results…
It looks really weird and probably I’ll retest it.
The story begins from my 6 years, it was the time when I got my first shot of the HEP B vaccine and as long as I know I got a full course of the vaccine. At this moment I’m 25 yo.
17 of March 2021, I had a risky sexual exposure, I had a protected by condom vaginal contact, and unprotected insertable oral sex ( Felatio). After the exposure, I used a local antiseptic within 2 hours and took a shower…
After that, I’ve started to test with enough time after potential exposure…All of them were negative. A few days ago I was surprised to see that I still have immunization for HEP B but already 20 years have passed and my titer higher than 1000 mIU / ml … Is it possible?
All test were made by the Abbott ARCHITECT system

MY results of tests:

17 of april 2021 ( 31 days after potential exposure)

Anti-HCV total - Negative
HBsAg (quality test) - Negative

25 of april 2021 (39 days after potential exposure)

HBsAg (quality test) - Negative
Bilirubin in urine - Negative
HBV DNA test with sensetivity 20 IU/ ml - Negative

06 of may 2021 (50 days after potential exposure)

Anti-HCV total - Negative
Anti HB core total - Negative
Anti HBS (quantity) - > 1000.0 mIU / ml

Should I worry and retest again?

Best regards to everyone and be healthy!

Dear Alex, thanks for joining the forum and sharing your situation. The good news is that your hep b vaccine resulted in a very high antibody level, which means you are completely protected! Any level that is above above 10 mIU/mL is considered to provide protection against a hep b infection. Typically, levels in the 100s or 1000s of mIUs/mL are achieved following a 3-dose vaccine series. So you have achieved an ideal immune response to the vaccine. I hope this is helpful. Others may chime in with additional information. Thanks again for your excellent question! Always, Joan

Hi @AlexBrut,

Yes, I agree with what @Joan_Block has said. An additional possibility is that if you were exposed, your immune system responds very strongly against the virus when you’re protected and can produce even more antibodies. Basically it may be a sign that both the vaccination and your immune system is working as intended.

Feel free to test your antibody levels again, but from the lab results you show here, I don’t think there is any real reason to worry.

Cheers,
Thomas

Good day, Dear @ThomasTu !
Thank you a lot for your explanation and thoughts!
Yep, I’ve read that some people could produce even more antibodies if they are facing the virus, just it’s quite a rare case.
Anyway, thank you a lot for your answer!

By the way, when I’d been involved in reading articles about hep B cause I was thinking that I’m 100% infected, I faced the article that the Russian main virus laboratory has almost finished the cure for chronic hep B.
If you have time, you can read this article. Just google it and first link will provide you on site: rscf ( RUSSIAN SCIENCE FOUNDATION )

Project title: Elimination of cccDNA of hepatitis B virus in chronic infection by nucleolytic activity of CRISPR/Cas9 system, epigenetic remodeling and modulation of double strand breaks repair pathways

I thank you a lot and wish you all the best! I hope the cure will be developed in this decade!

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Hi @AlexBrut,

Thanks for the heads-upon this work. I’m familiar with some approaches using CRISPR to target Hepatitis B (I myself have done a bit of research into it). Most of the trouble comes from targeting cccDNA: this form of the virus seems to be quite resistant to cutting by the CRISPR system. There are also troubles with how to get the CRISPR system to ALL the infected cells in the liver and make sure it cuts ALL the cccDNA. I would be interested in seeing what comes of this, hopefully something helpful for the affected community!

Cheers,
Thomas

REPOST

Dear Thomas and Other Hep B Survivors,

Context: Past results since March 2021:

  1. HBsAg Screen: Confirmed “positive abnormal” from the blood bank results.
  2. Hep B Core Ab, Igm: Negative
  3. Hep B Surf Ab Quant: <3.1. (Low).
  4. Hep B Core Ab, Tot: Positive Abnormal (reference range: negative)

I have not yet been advised to take medications. I see my gastroenterologist in June as a precautionary measure and for “peace of mind” (recent colonoscopy was fine) and I visit my primary next week. My primary noted that my past 2 years of blood work have been normal, including liver enzymes and tests for cancers and diabetes because I WAS obese 3 years ago.

Now I have new results, updates, and some questions.

New test results: HBV DNA RealTime Abbott

Hep B Quantitation: 320 IU/mL
HBV log10: 2.505 log10 IU/mL

  1. Are these numbers a positive sign? hopeful? concerning? dangerous?
  2. Do these numbers help me to understand how long I have had the virus (e.g., 3 months, 1 year, 10 years, 25 years, since birth)? I am 52 and was diagnosed March 2021 by a blood bank donation.
  3. Do these numbers help me to understand if I can transmit the virus?
  4. Do these numbers provide any hope of one day being in that miraculous group where the infection can “spontaneously clear itself from the body” (FAQs about Hep B by Immunization Action Coalition, St. Paul, MN).

As a side note, for the past 2 years prior to diagnosis, I have been eating more healthy, exercising regularly, losing weight, and doing more mindful breathing exercises. I’ve never been a smoker nor do I consume “hard” alcohol and I might have a glass of sweet wine once every few months. But…

I have a history of high blood pressure (as do family) and I take medication for cholesterol and potassium. My grandfather died of prostate cancer and grandmother died, I believe, from liver cancer. I am not sure of all the illnesses my parents had before they died.

As always, thank you for patience, listening, and sharing.

Dear @hopefulone ,

Sorry to have missed responding to this.

Regarding your questions:

  1. These numbers basically put you in the HBeAg-negative “suppression” phase, your immune system is controlling the infection to a large degree (low HBV DNA levels). People in this phase with similar results are less likely to progress in terms of liver disease compared to people with high viral loads, so I think these are generally good results for you.

  2. Since your “Hep B Core Ab, Igm” is “Negative”, this means you were not exposed in the last few months and so your infection has been going on for longer than this. There is no way to tell if this is 6 months, 1 year, 3 years or your entire life.

  3. Your virus levels are quite low, which means the risk of you passing on the virus to others is also quite low (but not zero, so you should still be cautious about cleaning up any bodily fluids and sharing toothbrushes, razors, etc.).

  4. Your results suggest that you are more likely than most people with hepatitis B to clear the infection spontaneously. However, this rate is still very low (1-2% per year).

It sounds like you’re doing all the right things, @hopefulone! I hope this information helps.

Cheers,
Thomas

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Dear Thomas (and Joan and John),

You, Joan, and John Travis are incredible people! You give people so much hope and clarity with your candor and gift for making the complicated easy to understand.

Thank you immensely for this information. As you might imagine, I do feel a bit better based on your feedback. Now off to see my primary and the gastro. I will keep the community informed.

PS: Please forgive me if I am not putting posts in the right threads. :grinning:

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Hi Thomas, Joan, et al,

I do labs to monitor my blood and liver functions at least twice a year. This year I have done the blood test four times since Jan. And I noticed a troubling trend. In the past my white blood cell counts fluctuated between 3.5 and 3.6 thousand/Ul – it has always been low and seems to run in the family. (I am Chinese.) But since December 2020, it went from 3.0 to 2.4 (in April, '21), to 3.2 (also in April) to 2.1 (June). The June count is the lowest that I know of. There is also a downward trend of the absolute neutrophils in just two months, from 2294 cells/uL (April) to 1189 (June) whereas It had been normal the years before. My absolute lymphocytes has always been low: 1094 cells/uL(July '20), 729 (Dec. '20), 627 (April '21), 647 (June '21). My primary care physician attributes the downward trend of the absolute neutrophils to Vemlidy, which I have been taking since 2019, and suggests that I do a bone marrow biopsy to determine the cause.
I’ve notified my hepatologist of the latest CBC. Meanwhile, I would like to get your take on the blood work.
By the way, I had my first jab of the Pfizer vaccine in late May, before the June lab. I know this sounds like a post hoc fallacy, but do you think the low counts have anything to do with it? Or with HBV?

Thanks so much for your support!

Hi @Tehminbrown,

I do know that reduction in neutrophils (also known as neutropenia) is a known side-effect of tenofovir/vemlidy. It may be that it can be reversed if you get switch to entecavir instead.

@MarkDouglas, what do you think?

Cheers,
Thomas

Hi Tehmin, I don’t really know much about your medical situation so have no useful advice to provide. But I would say that you may want to see a hematologist before agreeing to a bone marrow biopsy. Those are very invasive and hurt!! Having worked in pediatric oncology as a new nurse, I’ve seen them done. You really want to make sure that is necessary. Keep us posted. Always, Joan

Hi Thomas,

Could you please send links that explain the association between Vemlidy and neutropenia?

Thanks again.

Hi @teh-minbrown,

There is a description of some trial results in the product information for VIREAD, showing 1-2% of people on VIREAD having some low neutrophil counts (page 33), though 1% of placebo patients also had this: https://www.tga.gov.au/sites/default/files/auspar-tenofovir-disoproxil-fumarate-131014-pi.pdf

This data from Gilead shows a comparison between HIV patients treated with TAF vs. TDF (plus a whole lot of other HIV drugs), with no difference in neutropenia: https://na.eventscloud.com/file_uploads/a76cf3cc09a9e688a328d8a6d3b4ca58_MarkBloch2.pdf

This is weak data, given it’s in a different disease and there are very low numbers of people with neutropenia (this is a very rare side-effect), but seems to suggest that TDF and TAF (i.e. Viread and Vemlidy) have similar (low) rates of neutropenia.

Take with a grain of salt: this is only a complete guess about what might be happening. There may be other causes for these lab results that you should discuss with your health care provider. I’m not sure if the COVID vaccine might have anything to do with it or HBV.

Thomas