EXPLAINER: Lab results and their interpretation

Thank you ….
I was told I will start medication

Vemlidy Tenofovir Alafinamide 25mg Daily

But I was trying to make research before I take any meds …

Hi @Ben2020,

This should be a decision you make with your health care provider and the treatment plan should be tailored to you. We can only mention what the general guidelines are in the field, but nothing for your specific set of needs.

Regarding background on medication, you might find some helpful information in the other threads: Deciding when to start treatment; Possible side-effects from long-term antiviral therapy.

Hope this helps,


I am new to this forum. I have been diagnosed with chronic Hep B about almost a year ago. I recently started Antecavir since Feb 2021. Prior to treatment my viral load was over 100 million and alt was fluctuating between 53-48. Since I started Entecavir, my viral load has decreased from 100 million to 2900 as of June 2021 but my alt remain at 48. I am e positive. What does this mean? Should I be concern? I am seeing a liver specialist, Nurse Practitioner through Kaiser. Will my alt decrease over time? I am worried because I have two relative that have pass away from hep b complications due to liver cancer and failure.

Any advice would help. Thank you so much.

Dear @Sunshine1 ,

Thanks for sharing your story and welcome to the forum.

I think you are doing the right thing in getting monitored and remaining under treatment, which looks like it’s working. It is common for antiviral treatments to take months to years to reduce your virus loads down to undetectable. As virus load decreases, ALTs will usually come down too.

It is also possible that you have other liver complications, such as fatty liver disease. If you haven’t had one, an ultrasound or fibroscan may help to see the condition of your liver.

Hope this helps,

Thank you @ThomasTu for your response. I had fibroscan in Dec. 2020 and it showed I have slight fatty liver. My BMI is 25. I have been getting an ultra sound every 6 months and per ultra sound everything looks normal. My liver specialist stated that I needed to loose about 20 lbs or so to see if that will help drop my alt. She thinks my alt is high due to my lack of exercise and diet. I started an exercise regime of 30-45 minutes running on thread mi daily and am changing my diet to a more healthy diet. I’m hoping that will help with my alt. I am 5.4 ft and weight 148 lbs. base on my last routine check up in 2020, I don’t have any other condition besides the hep b.

Is there anything else I can do to help lower my alt?


I think what you’ve done are good things to implement. These will have slow, but sure improvements as long as you keep sticking at it. Just think about how many years you have spent with your previous diet and exercise, you shouldn’t expect overnight improvements as you change, but it’s OK.

Chronic liver disease usually progresses over years to decades, which gives you time to change course. It is like steering a great big ship, slow changes even if there is energy and momentum behind them.

Hope this helps,

Thank you. Yes, it does help.

You might also find this other thread useful: Lifestyle changes, nutrition, and supplements for hep b

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Many thanks @ThomasTu and @Joan_Block for your time and efforts. My doctor said my Fibroscan result is fine but I’m a bit worried. You will all recall my husband was diagnosed with HBV late last year, then he progressed quickly to HCC and lost the battle in February. It’s scary for me and I don’t want to die.
Kindly help in interpreting the fibroscan to enable me know if I’m impacted by the HBV exposure or not. My last HBV 3 panel results are stated below too for a complete interpretation. Thank you.

HB cAb positive
Core Value 4.52 s/co
HB Core IgM Negative
Core M Value 0.08 s/co
HB Surface Antigen Negative
HB Sab Immune
HB Surface Ab value 29.57 mIU/mL

Dear @174,

Thanks for your questions. Your blood results show that you are completely protected against Hepatitis B and do not have an infection (although you have been exposed before, you have cleared it). Your fibroscan results show that your liver is completely normal and that there is no sign of liver damage or fatty liver. This is a very good sign and you have almost no risk of liver disease due to hepatitis B. Indeed you doctor is correct and the result is fine.

Hope this helps to settle your mind,

Hi Thomas,
My doctors have been tracking my HBV Surface antigen since 2019. My last lab (July, 8, 2021) shows that I have no immunity to hepatitis B virus and that my hepatitis B Surface antigen has climbed to 1214 IU/ml. (In 2019 it was 832 IU/ml; 870 IU/ml in 2020.) I have been on Vemlidy since 2019, and the virus DNA is undetectable.
My G.I. doctor suggests getting a liver biopsy and adding a drug to decrease the the surface antigen. He was in a rush, so I didn’t have the time to think, much less to ask questions. So I am turning to you as your explanations are clear, generous, and much appreciated.

My questions:

Why is the surface antigen number increasing despite Vemlidy? Is it because it targets the virus’s DNA only? Is the surface antigen a different entity? What does an increasing S antigen portend?

Since it is circulating in my blood, does it mean I can infect others who are not vaccinated against HBV? I was probably born with hepatitis B, it’s hard for me to imagine that I am still infectious after all these years. Or does one go in and out of the infectious phase depending on the numbers?

Is it possible for liver cancer to develop incognito despite the fact that the liver function panel, the liver ultrasound, and Fibroscan all have been within the normal reference range and one does all the right things (eats healthy, exercises, consumes no alcohol, does not smoke …) for years?

Do you know or have any information about jnj 73763989, which suppresses the s antigen? This experimental drug was mentioned on the forum recently.

Finally, people who have had covid develop antibody for it, why then I don’t have antibody for HBV since I have already been infected by the disease?

It’s quite a lot to ask. I still haven’t developed the ability of "being in uncertainties, mysteries, doubts, without any irritable reaching after fact and reason.” I appreciate your answers, any answers greatly.


Doctor, can you explain to me what HBeAb and what is the difference between this and the HBeAg?

Dear @Corina,

This is a bit complicated, but in general:

If you are positive for HBeAg, you are negative for anti-HBe (also known as HBeAb). This usually means your virus levels are high because your body’s immune system isn’t attacking the virus.

If you are positive for anti-HBe/HBeAb, you are negative for HBeAg. This means you body has started to fight the virus, and virus levels are usually lower.

Hope this helps,

Actually I’m HBeAg negative and HBeAb positive… what this means?

Oops, I made a typo above and have now corrected it.

Your lab results mean that your immune system has started to target the virus and you probably have a lower virus level. These tests (in combination with other results) are used by your doctor to figure out whether you should be treated with antivirals or not.


Hi TM, very interesting question you raise about your high HB surface antigen level. I’m surprised your doctor ordered it (was it Dr. Bob Gish?). The quantitative hep B surface antigen blood test that you’re referencing is not routinely ordered here in the U.S. When I asked my hepatologist to order it, his tech support spent quite a bit of time hunting down the Quest lab code number! My value was in the hundreds of thousands, so yours at 1,214 sounds pretty good. What little I know of the quantitative HBsAg test is that it can be used to help determine whether a person could stop their antiviral therapy. The lower the qHBsAg, the better the chance that the viral DNA would remain undetectable off-treatment. Sadly, my value was sky high, so I’m not able to even consider going off-treatment. There may be others on this forum who can either correct or explain my understanding of this test!

In terms of one’s degree of “infectiousness” to others, my understanding is that the hep B e-antigen status determines that. If one’s HBeAg is negative either spontaneously or after treatment (concomitant with a positive HBeAb - antibody to the e-antigen), then a person is considered non-infectious to others.

For more information about JNJ 73763989 (also referred to as JNJ 3989), the Hepatitis B Foundation Drug Watch maintains a list of all drugs in the pipeline for HBV. Currently this compound is in Phase II clinical trials, but I haven’t personally read any updates on its progress. Maybe Dr. John Tavis and/or Dr. Thomas Tu know more about this drug and how it works??

Finally, if someone has been infected and recovered from Covid-19 (or has been vaccinated), then they will develop protective antibodies. This is true also for adults who have been infected and RECOVERED from hep b. Unfortunately, for many of us on this hepbcommunity.org forum, we have been infected and unable to fight off the virus; hence, we have chronic infections. Therefore, we won’t develop protective antibodies like those who have recovered or received the hep b vaccine. Having a chronic hep b infection means by default we have not “recovered” from the initial exposure to the virus.

OK, this is way too long, but I wanted to try to address some of your questions, which are excellent. I certainly hope others will jump in and answer whatever I missed or correct and clarify whatever I wrote!! Thanks TM for sharing your concerns. Always, Joan

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Dear @Tehminbrown,

Sorry to have missed this earlier. To answer your questions:

  1. The increase you see isn’t very much and could be due to difference in the lab, testing or technician doing the work. It could be that it fluctuates from day to day. People range from 0 up to 100000 IU/mL, so this small difference doesn’t mean much unless it’s part of a larger trend. But as you say, vemlidy only targets the virus DNA levels in the blood. The virus can still be in the liver making surface antigen, so the surface antigen level is a measure of how much virus is still there in your liver. Now, this is complicated by the fact that there are some “defective” forms of the virus that can make surface antigen but never produce more virus (science right now is trying to work out to what extent this is happening).
  2. No, you cannot infect someone with surface antigen. HBV DNA is the most accurate measure of how infectious you are. If your HBV DNA levels are undetectable, it is incredibly unlikely that you can pass it on to anyone else.
  3. It is possible (but much more unlikely) that you develop liver cancer with normal results. This is why it’s important to stay under monitoring, so that if it does happen, we can catch it early and treat it more effectively.
  4. I’m not up to date on the latest information about this agent. Probably @john.tavis knows more.
  5. You generally develop antibodies to a virus after you clear it. As you still haven’t cleared HBV, you will not have antibodies against it yet.

Hope these help.


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@ThomasTu Thank you for the reassuring explanation. It is well appreciated. God bless!

Yes, Dr. Gish orders the HBsAg test once a year, which started in 2019. In 2020, I had some trouble getting the result and had to get another jab of the needle. You’re right about the difficulty of hunting down the Quest lab code number–that’s exactly what happened. From the past results, I can tell that Vemlidy does not suppress the surface antigen. And how would it affect the rest of the body since it is circulating in the blood?
Last time, we talked about the effect of Vemlidy on the cholesterol level. I thought mine would trend up as it did in the last lab draw. But I was proven wrong. So Vemlidy does not necessarily increase the cholesterol level incrementally. But it does increase my liver fat and liver size. So we get the side effect we get…There is no such thing as a risk-free treatment.
Thank you for your lovely email. Now I understand a little better about my disease. And if understanding brings about compassion, then I could learn to be afraid of it less.


Hi Thomas,
Thanks so much for the explanation. While It puts the number of HBV S antigen in perspective, it also raises another question: it is circulating in the blood, and the body has no immunity, how would it affect other organs?