I do not have that information yet but I will ask my gastro. Thanks, @ThomasTu
Hello @ThomasTu @john.tavis @availlant Here are my test result, can you please interpret. Am I acute or Chronic, I’m alright, I just want to know if I should start treatment immediately. Thank you so much.
1 Like
Dear @Intime009,
I am not a physician and am not legally allowed to make medical recommendations. I can give my personal impression of these data.
These test results say you have an active HBV infection–you have HBV DNA and HBsAg in your serum. The liver function test is nearly normal–I know nothing about the slight elevation in total protein, but my guess is that it is not very important given the other numbers are in the normal range. I cannot say whether you have a chronic HBV infection without HBV DNA tests >=6 months apart. I would be surprised if you were a candidate for treatment given that your liver profile was not overtly abnormal.
I cannot comment further, but perhaps a physician could.
John.
2 Likes
Thank you @john.tavis
I’m just a little worried because of the high value of the HBsAg Quant. It said over 29,000. Is this an important parameter over the HBV DNA?
3 Likes
Dear @Intime009,
Quantitative HBsAg is more to judge how close your body is to clearing the virus infection, but has little to do with the actual disease. As far as I know, HBV DNA is usually the value that is more important in determining clinical treatment.
Thomas
1 Like
As per ChatGPT, it can only reactivate during immunosuppression therapy, chemotherapy, co-infection, or organ transplantation. Is it possible to reactivate on its own?
1 Like
@ThomasTu thank you for your response. Will you consider my HBsAg quant of 29,500 very high in this case? I posted my results too
Hi @many723,
That IS a very high viral load but at least your ALT and AST aren’t high. I know that just finding out about having HBV causes the emotional rollercoaster you are experiencing. Good job on deciding to be informed and searching for resources and finding hepbcommunity. Welcome to the community!
Here is a good place to start to learn more about this disease and what you can potentially expect. It will help you have a good starting knowledge to ask informed questions from your doctors and of course on here too, to our experts and also the community as a whole.
https://www.hepb.org/what-is-hepatitis-b/faqs/
-Paul
1 Like
Hello Dr Thomas,
So can it be assumed that if HBV DNA reach undetectable levels and continues to stay so, patient is in safe zone regardless of quantitative HBSag being high (10-20k) ?
Also, i read somewhere that Quantitative Hbsag is non infectious. So if HBV DNA is undetectable the risk of transmission is minimal inspite of having high quantitative HBSag ?
I am little confused about relevance of quantitative HBSag besides telling whether person is infected or not ? Has that no got anything to do with liver disease progression in long time.
Regards,
@ThomasTu @john.tavis @PuallyHBV Please can you provide answer to this questions. A lot of us are unclear about what’s quantitative HBsAg is how relevant it is to recovering including why value is considered very high. Thank you so much
1 Like
Hi @Intime009,
I am not an expert or a professional in health or science and I too get confused with all the terms and meanings. The Hep B Foundation has the definition of HBsAg as:
Hepatitis B Surface Antigen (HBsAg): The surface protein of the hepatitis B virus that is used as a marker to detect infection. If this blood test is positive, then the hepatitis B virus is present.
This definition is only for qualitative and not quantitative. I think qualitative being negative or positive. I remembered seeing at least one post about HBsAg quantitative. Here are some links to discussions about it. Maybe it can help you until one of the experts can respond and elaborate more.
https://www.hepbcommunity.org/t/deciding-when-to-start-treatment/119/83?u=puallyhbv
https://www.hepbcommunity.org/t/what-is-amount-of-hbsag-loss-per-year-on-taf/1117
https://www.hepbcommunity.org/t/hbsag-count-interpretation/2417/3
Now I am a bit confused as I thought HBsAg qualitative was positive or negative. So now I am at a loss.
https://www.hepbcommunity.org/t/rebound-of-hbsag/2636/10
So this is why we have experts. Hopefully one of them can explain it in a way even I can understand. I wish I could at least get Viral load, HBV DNA and HBsAg quantitative straight. I’d like to add to your question and ask if HBsAg quantitative is a necessary test or good to have done. It seems from what I have been reading in those above links is that it doesn’t change much and it depends what country you reside in and that the U.S. doesn’t even do that test.
Hope this helps you for now,
-Paul
Thank you @PuallyHBV. Please @ThomasTu @john.tavis can you provide more insight? Thank you so much.
Dear @Intime009,
I would clarify Thomas’ comments earlier.
Circulating viral markers in chronic HBV infection have two important facets:
-
Viral replication: required for the transmission of infection to new liver cells and reinfection of previously infected cells. This is measured by HBV DNA.
-
HBsAg: a measure of non-infectious, subviral particles produced separately from virus and not impacted by approved therapies except for pegIFN. HBsAg turns off immune control of HBV and plays an important role in the persistence of HBV infection.
In terms of approved agents lik ETV and TD / TAF, HBV DNA is indeed the most important marker as it indicates effectiveness of currently approved therapies in controlling viral replication. When your HBV DNA becomes very low or undetectable, this lets your physician know that your treatment is effectively controlling the replication of the virus, which we know in turn restores normal liver infection and stops the progression of liver disease. However, we also know that unless HBsAg also becomes undetectable, this therapy cannot be stopped because immune control of your HBV infection is not present.
Qualitative HBsAg can tell us only two things: HBsAg is present (positive) or at such low levels (negative) that immune control is restored.
Quantitative HBsAg can tell us if there are changes in HBsAg levels in the blood during treatment. This is important as the lower the HBsAg becomes the more likely HBsAg loss will occur. Also, the amount of HBsAg present will dictate how well you may respond to other therapies like pegIFN. The average HBsAg load in chronic HBV infection is ~10,000 IU/mL. At this level, the response to pegIFN is poor. When HBsAg is < 1,000 IU/mL (in about 5% of patients), the response to pegIFN is greatly improved, with up to 30% of patients achieving functional cure (HBsAg loss).
Best regards,
5 Likes
This is in reply to @rjktgj’s post #879.
2 Likes
Thanks for providing this additional context, @availlant. Much appreciated and agree with these points.
Thomas
1 Like
Hi all!
I am 46 and was diagnosed with Hep B two years ago.
I have constant easy pain just under my rib on the right side since two years, which started one month after starting Tenofovir.
Ct scan showed liver dimensions in the upper limits of the norm.
Should I be worried that also AST is higher than ALT?
HBsAg 803.8 IU/Ml
HBV-DNA Negativ
HBeAg 0.01
Fibroscan 5.13 k/pa
AST 22.2 U/L
ALT 15.4 U/L
Total Bilirubin 1.2 mg/dL
Direct Bilirubin 0.239 mg/dL
Indirect Bilirubin 0.57 mg/dL
Platelets 195
Creatinemia 0.73
Azotemia 22.10
@availlant Thank you so much for providing insights to this. I have one more question. What’s the average HBsAg levels for Acute HBV? You mentioned that of chronic HBV to be 10,000 iu/ml. What is it for Acute HBV?
Hi @Intime009,
The problem with acute HBV infection is that most people pass through this phase without realizing something is wrong and then find out many years later that they have chronic HBV.
People with HBeAg+ HBV infection are generally considered to be earlier in the natural history of HBV infection (although this is not a hard and fast rule) in these patients HBsAg can be greater than 125,000 IU/mL (this is the limit of the quantitative assay in an undiluted blood sample).
So it is possible that HBsAg levels can be this high during acute infection but there really is no good data on this.
Best regards,
1 Like
@availlant Thank you for your insights.
1 Like
Hi @availlant is there any data for reference or understanding about the timeline of HBeAg turning negative of chronic adult horizontal transmission. My infection is probably 3 half years old. Still HBeAg positive as of may 23. The result value was 5.261 on (11/5/24) last year it was 724.831 (29/7/22) i am on meds.
Thanks.