Hi - so I’m a lifelong carrier from birth 29 years old now.
My HBeAg became negative about 10 years ago. Until recently my viral load was low usually under 1000iu/mL. This month my bloodwork showed it’s 29,500iu/mL.
From researching paranoidly online I saw that the HBeAg negative + viral load rising means I might have a mutant virus or something which is bad. I also read some stuff that said HBeAg negative might have a worse outcome and prognosis… I’m not on treatment yet but my doctor wants me to start soon now.
This doesn’t necessarily mean there’s a mutant virus, and even if you did, it doesn’t necessarily mean that it leads to worse outcome. First line antivirals will slow viral replication (regardless of mutations) and help reduce any disease progression.
HBeAg-negative is linked to diseases because it is mostly associated with later phases of disease and past inflammation, it’s a way of categorising patients, rather than something specific about being HBeAg-negative.
Do not worry about “mutants”………what is relevant if you are still in the “inactive carrier state” (HBeAg negative chronic infection phase) or if you are moving to the HBeAg neg chronic hepatitis phase. If this is the case, antiviral therapy is recommended………
If your hbvdna is greater than 2,000 IU/ml and ALT > Upper Normal Limit, then you may be in the Immune Escape Phase and treatment is needed. Antiviral drugs such as Entecavir and Tenofovir are very effective for this phase too. In the old days, this phase was usually called Immune Escape Phase, nowadays, it is called HBeAg negative chronic Hepatitis.
Thank you @ThomasTu for your reply and information. I’m very glad I found this community you’ve built and the information you provide here to all of us
I would not say yours are approaching the “dangerous” level. I am not a doctor. I don’t believe there is any magic about the number 2,000. Viral loads can vary, it can go up then goes down, and vice versa. I would perhaps step up the monitoring of ALT and hbvdna, even a Fibroscan, and consult the doctor more often. As Prof Lampertico said, the important issue is whether you are moving to the HBeAg negative chronic (Immune Escape) phase. I believe an experienced HBV specialist will take many other factors into consideration, not just relying on one set of test results. All the best.
Hi @Opa,
I agree with @Stephenw. A 1660 IU/Ml viral load with an ALT below the upper limit is considered good. You worry when either both viral loads remain high over some time or one test. @Stephenw is also correct in saying that these numbers can fluctuate occasionally. With these results, you are not clocking to any dangerous levels. Keep doing whatever you are doing and remain under care. Best, Bansah1