With such low level HBV DNA, liver disease usually absent. However, HBV DNA integration still occurs and so the risk of developing HCC is still elevated.
This is the major philosophical difference between North American (AASLD) and European (EASL) guidelines, which advise to withhold treatment in the absence of liver disease and the newer Chinese guidelines which advise to treat any person who is HBV DNA positive.
Rates of death from HBV are not declining suggesting that the NA and EU guidelines are only partially effective in the long term management of chronic HBV and not addressing the issue of death from HCC. There is also no safety data which suggests a benefit to withholding NUC therapy in a patient with no liver disease and low HBV DNA.
This fundamental issue is what divides doctors on whether to start treatment in these kinds of patients.
Hi
Thank you, founders of this community, for letting me in.I am a new member here but a hbv patient off medication for 10 years. I first got it in 2013 and I couldn’t clear the virus in 6 months. My doctor put me on lamivudine. After 4 months on this medication, l lost my hbsag and developed anti-hbs.
Now it’s been almost a decade. My test results are as follows:
Hbsag- Not detected Heb core antibody (total)- detectedHeb core antibody (igm)- not detectedHeb surface antibody- <10 IU/L
Alt- 140 u/lAST- 87 u/l
Few years after my hbv, I was diagnosed with diabetes. I saw a persistent elevation of my LFT after that.
My personal opinion is maybe the loss of anti-hbs is triggering ALT elevation coupled with the effect of diabetes.
Should I go for a viral load test? How can I lower my ALT?
I would appreciate if some experts could shed light on my test results.
Thanks in advance.
Hi @Lovely,
Welcome to the platform. Your ALT/AST is high. The standard range varies by laboratory, for ALT 7-55 U/L and AST 8-48 U/L. As you can see your numbers of 140 and 87 are over the standard range. I will agree with you, but talk to your provider about this. Start from there and then if that result(s) is normal then you can probe other sources for this issue with your provider. Best, Bansah1.
You have no evidence of an ongoing HBV infection in this qualitative screen (HBsAg = not detected), but you do have serological evidence of a past infection (HBcAg antibody = detected; the IgM just says that the HBcAg antibody was not initially stimulated within the last month or 2). The ALT/AST values seem a bit high, but the upper limit of normal can vary from place to place and assay to assay, so you’ll need your doctor’s help to diagnose that. Loss of anti-HBs could contribute to a rise in ALT/AST if HBV were reinfecting your liver, but the lack of HBsAg in your blood makes that quite unlikely. I have no idea how this may be related to your Diabietes, but I am an HBV scientist rather than a physician.
Overall, I encourage you to speak with your doctor. S/he will be able to interpret these results in context of your full medical history and give you the guidance you seek.
Welcome to the forum and hope you find this forum useful!
Yes, agree that your ALTs are relatively high. Given that you have been recently diagnosed with diabetes, it may be worthwhile to consider Steatotic Liver Disease (formerly known as fatty liver disease). Have a talk to your doctor about this and they should be able to do some tests to determine if this is the case.
Could one of our lovely @ScienceExperts please help me in interpreting my results?
I had to rush on my lunch break to grab them and I didn’t want to pressure my Korean doctor to explain them quickly for me.
Previous results: all I know is I have a chronic infection but my liver function test on December showed no inflammation and normal results. My doctor did not do a full HBV DNA PCR at the time.
Also, please excuse my crusty nail, I’ve been holding out on getting them done until just before I go on vacation next week
Both your HBV DNA and HBsAg being undetectable is a good sign that your immune system is clearing the HBV infected cells from your liver successfully. It is recommended that you maintain monitoring to make sure that these remain low.
This is not a standard profile (as it does not match any of the patterns beneath the results). It may be worth repeating these tests to make sure none are false-positives or false-negatives.
@ThomasTu thank you for your response. I’m sorry, I’m trying to wrap my head around this. Does this mean that I’m on my way to being “functionally” cured?
Yes, this is a reasonable interpretation of the results. You would need to make sure that this is not a temporary reduction and it is long-lasting, so you’d need a follow up test. But it is promising news, congratulations!
