Hi @availlant thank you so much for your feedback, greatly appreciated !
Hi, thanks for accepting me here. I found out I am positive for hep b as I’m planning for IVF. I did in-depth test and went to gastrologist and the result is attached below.
my question will be, do you think I need to start antivirals before getting pregnant based on my HBV number or not? my gastro said nothing to worry about its a low number and I need second opinion here. I feel like my doctor doesnt have lots of knowledge about hep b and its hard to find docs around me who did. I did liver biopsy as he told me and the liver is normal. thanks!
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Dear @wmonik,
Welcome to the forum and thanks for the great question. The WHO has summarised some data on this as following (from page 13 of this report here: https://apps.who.int/iris/bitstream/handle/10665/333391/9789240002708-eng.pdf): “When timely birth dose and HBIG were used, there was no breakthrough infection reported when the maternal HBV DNA viral load was below 5.3 log10 IU/mL” (this is equivalent to 200,000 IU/mL). Basically, as long as you get your newborn vaccinated within hours of birth and provide HBIG, then the likelihood of transmission is very very low.
Hope this helps,
Thomas
Hello,
Brief history and results. During an annual exam in June 2022, I added HBV to my tests and had a positive HBsAg. This was followed up with an exam about a week later with a Primary care doctor. Here are the results:
HB core AB: positive
HBsAg: positive
HBsAb: negative
HBeAg: negative
HBeAB: positive
HBV DNA: 40 IU/mL
The primary care doctor then referred me to a gastroenterologist. Tests were done 16 days later, after the first labs, and the following were the results:
HB core AB: positive
HBsAg: positive
HBsAb: negative
HBeAg: negative
HBeAB: positive
HBV DNA: 83 IU/mL (performed using Real-Time Polymerase Chain Reaction)
Liver scan was done and no problems were observed.
ALPHA FETOPROTEIN, TUMOR MARKER : 4.2 ng/mL
AST: 27 IU/L
ALT: 38 IU/L
Bilirubin total: 0.9 mg/dL
Alkaline Phosphatase: 82 mg/dL
On Feb 8, 2023, another lab test was done.
HBsAb: negative
Hepatitis Delta Antigen b: not flagged (negative)
HBeAg: negative
HBeAb: positive
HBV DNA: 27 IU/mL (RT-PCR, standard range used is <= 9 IU/mL)
AST: 30 IU/L
ALT: 49 IU/L
Bilirubin total: 1.11 mg/dL (Flagged high with a reference standard range of 0.10 - 1.10 mg/dL)
Bilirubin direct: 0.40 mg/dL (Flagged high with a reference standard range of <=0.35 mg/dL)
Alkaline Phosphatase: 106 IU/L.
I have never received any treatment.
Could you comment on the results?
Also, I came across this paper titled Hepatitis B surface antigen clearance in inactive hepatitis B surface antigen carriers treated with peginterferon alfa-2a. Sorry, I could not link it here. How extensively has peginterferon alfa-2a been used to help patients achieve HBsAg clearance? Could it provide long term clearance? Thank you.
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Hi @ one,
Welcome to the forum!
In your Feb 8 2023 results, what was your HBsAg result?
Hi one
I may not offer you any medical perspective at this point in time as am also trying to stabilize in the group. However, I sincerely welcome you hoping you will get the support you need.
Kinoti
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Hi Availlant,
I think HBsAg was assumed to be positive because of the previous results.
Thank you for the welcome Kinoti
Hi @one ,
So, assuming your Feb 8 HBsAg result was positive (not sure why they tested HBsAb then), the following would apply:
You have inactive HBV infection (formally defined as HBV DNA < 2000 IU/mL with normal liver function). Your bili results from Feb 8 are essentially normal. This inactive HBV infection appears durable.
This means that your body has reached a successful “stalemate” with the virus - your immune system has enough control to prevent infection at a problematic level but not enough to completely control it (this is functional cure). With HBV DNA results this low, there is little benefit from taking standard NUC therapy. Patients with inactive HBV have a very good long term prognosis and do not develop liver disease in the absence of treatment. However the lingering HBsAg with inactive HBV infection makes such individuals more prone to reactivation if they become immunosuppressed.
pegIFN can work to achieve functional cure but this only works in ~30% of individuals when HBsAg is very low (< 500 IU/mL). With HBsAg > 1000 IU/mL, functional cure is much harder to achieve.
A quantitative HBsAg test might be informative.
Best regards,
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Hi everyone! This community is great and it’s the best resource I was able to find. Thank you for all this 
I have been diagnosed positive 10 years ago, and it resulted that my mom and my grandma are also positive (my sister and dad are negative).
I have been monitoring myself yearly and the results always look more or less like this.
HBV E antigen negative
3.6 log HBV viraemia
HBV quantitative surface antigen 8800 international units
HCV, HIV, delta negative
Normal liver ultrasound Liver stiffness 5.9kPa
My questions are:
- what are the chances these results change over time? I don’t see any variation over all these years.
- what are the things that could impact the results?
- is there any chance I could ever clear the virus with treatment or naturally?
For context, I am 34 years old, I live a healthy life, exercise and overall haven’t had any health issues. I wonder how this is or will impact my life. So far it’s more the stress of feeling I’ve got a chronic illness when I am not really impacted by it (apart from having to do lab tests).
Hi Loli, welcome to the forum!
Can you sent your ALT test result?
Best regards,
Hi Loli
The stress of having a chronic illness is common to many who find themselves in that state. There is nothing you can do about it, but I think the worries get less as one gets used to the illness
In UK they don’t provide a detailed view of ALT. Rather they state they are at “normal levels”.
Hi @loli,
You most likely acquired your HBV infection from your mother.
Although your liver function is normal and you say your viremia has been stable for several years, your HBV DNA titers are high enough that you are at increasing risk from developing liver disease and (far less likely) liver cancer the longer your infection goes on uncontrolled. Unfortunately, it is unlikely that your infection will self resolve (especially if you contracted it by maternal transfer).
You should discuss with your doctor starting therapy to suppress your viral infection.
Best regards,
Thank you availlant. I am open to therapy if it would help me from getting liver disease early on.
I wonder, why doctors have not offered this in UK? Are regulations different in each country?
What are the levels that usually suggest one should start therapy?
Hi
I have posted here couple of months ago but let me start again . This is regarding my father , he is 67 years old lives in India.
He has been recently diagnosed with chronic hep b.
Here are his results
HbsAg : 6.63
Bilirubin total : 1.74
Alp:158
Alt/sgpt:187
Hbeag:0.67
Viral load >50,000
Hbv viral copies:>4,10,000
Was told mot to start any antiviral medication.
He was started on medication to get his alt levels to normal range which came back normal after few months
They repeated his labs again and these are his recent results
Due to his fluctuating alt levels they prescribed fib scan ( this is after 6 months he was diagnosed with hep b)
Cap :336(db/m)
E(kpa) : 27.2
Iqr: 3.9
Iqr/med : 14%
The doctor asked him to start antiviral mediation and repeat labs every 3 months
He is visiting us (USA) with just visitor insurance not sure how much of lab work can we do . How does his labs look. What can be the course of action . How to monitor his health . As he visiting us , I want to keep and my family safe .
Does his fib score looks bad . What supplements or additional measures can we take to improve his health .
Thank you
Sri
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HBV DNA viral load is <32 IU/ml --Undetectable
hbsag is 25,000 IU/ml
Anti nuclear antibody is negative
LKM1,Liver kidney Microsome Antibody is negative
Solubel liver antigen is negative
Ceruloplasmin is 18.8 mg/dl
IgG Total is 1015 mg/dl
Vitamin b12 is 170 pg/ml
ALT is 130 U/L
AST is 55 U/L
ALP is 137 U/L
serum bilirubin total is 0.97 mg/dl
serum globulin is 2.48 gm/dl
I came to know about my hep b status in oct 2022, since then I am on TAF. My HBV dna has gone down to undetectable(it was 412 IU/ML in oct 22) but HBSAG still exist , came down from 37k to 25k. Also my ALT/AST level are always around the range i mentioned throughout last 5 months. I feel discomfort in right top quadrant , some pain around this area and especially after eating food.
I fail to understand why my ALT/AST are constantly high when dna has gone to almost zero ?
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Hi @data_guy788, welcome to the forum.
It is normal for HBsAg to only be mildly affected by NUC therapy (ETV / TDF / TAF) as the bulk of HBsAg production is disconnected by viral replication and is replenished in the blood by the production of non-infectious subviral particles.
Abdominal pain is a recognized side effect of TAF. Despite this, your upper right quadrant pain and persistent elevated ALT/AST on TAF should not be ignored. You should report these symptoms to your doctor and discussing liver imaging tests (ultrasound or CT) to investigate further. You might also discuss with your doctor switching to TDF or ETV.
Hope this helps.
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Dear Sri,
It is best if your father keeps taking the medication, this is probably most important as it will prevent any ongoing disease progression.
A fibroscan score of 27.2kpa is quite high and would represent advanced liver fibrosis/cirrhosis.
I don’t think any foods in particular have been shown to improve liver cirrhosis, but it is best to follow his doctor’s instructions.
Hi @data_guy788,
I agree with points that @availlant has made. If your ALT/AST remain high, it is worth investigating if there is something else that may be causing it (e.g. fatty liver disease).
Hope this helps,
Thomas