I recently completed a blood test. The reason for it was I recently acquired hbsab (26 u/ml), so I was curious about my hbsag level. My initial reaction was shock. To see that hbsab was no longer detectable. But also my AST and ALT levels had shot up
I need help from the experts to explain my results. If there is anything I should do with regards to my AST and ALT levels.
I also have some questions.
As I understand it, hbsab forms part of the immune response. Is it true that hbsab levels can fluctuate and even become undetectable. But memory b cells still be present.
Is it true that t cells are targeting the surface of the hepatocytes. Which is causing the inflammation, therefore the increase in ALT/AST levels. Which may explain the sensation around my liver?.
Is better to experience increase in ALT/AST levels if hbv DNA level remains at a low or undetectable level.
I don’t drink alcohol or take drugs. I try to eat healthy and continue to exercise. The only real change I can think of is that it has taken some time to adjust to the hot and humid weather.I definitely do a lot more walking. As I understand it muscle breakdown can influence AST and ALT levels. If yes, how much of an influence.
Abit of background information. I participated in the clinical trial involving vir3434 and interferon over a 12 month period. I completed my last dose mid 2025. By 2025 Dec, my hbsag rebounded to about approx 10.71 u/ml and hbeag to 0.71 u/ml. I never quite reached the levels of undetectable. Test in May 2026 confirmed I acquired hbsab, however qualitative testing confirmed I was still positive for hbsag and hbeag.
Sounds like hepb virus mutation and hepbAB is not present therefore increase in ALT/AST. My situation was similar in which I briefly acquired hepbAB during a flare up with very high AST/ALT and DNA load levels. I was put on ENT and within 2-3 months and levels stabilized back to normal and undetectable but no longer hepbAB detected with HBsAG positive HBeAG negative to this day. According to my heptalogist, the chance of obtaining hepbAB is slim but possible and with functional cures in the works many of us may achieve that.
I am also interesting in hearing from any expert on this topic.
Thank you for your response. When you say mutation, that’s integration within the liver cells?. In your case I can understand the rationale for starting on ENT(I assume entecivir) to get the viral load and AST/AlT down. It’s great to hear that things have stabilise and I sympathise that hbsab haven’t reappeared. I do have questions, did you acquire hbsab before receiving any form of treatment. If you did that’s amazing!. Did you know what your hbsag level was and what it is now.
I should have mentioned that I am continuing to take tenofovir and my viral load is undetectable. If I am already taking medication, what other option to consider. Or is interferon continuing to stimulate a immune response. So I am wondering is there a difference between high AST/ALT and undetectable viral load vs high AST/ALT and detectable viral load.
At a guess combination therapy will be a pathway to functional cure which will be huge positive. But it’s such a tricky illness to tackle.
Hi, I am not a medical expert but I know a few things about HBV. There are two unusual findings in your lab test results. First, any HBV reactivation that might be causing increased ALT and AST spikes usually coincides with the increased HBV-DNA titer, but in your case it is undetectable so there is no viral replication. Is it possible something else is going on, maybe another viral infection? There are other viral infections that can produce liver enzyme elevations. Also, the finding that Hbe antigen and anti-Hbe antibody together is also confusing as this antibody titer should knock down the antigen. Anyway, good luck and I hope this is quickly resolved in a positive way. Best, Ace
That’s an interesting point you made, regarding what else is causing the liver enzymes elevation. In terms of physical symptoms, the sensation continues to be around the side and rear of the liver(perhaps abit more intense than normal). If there is something new that is causing the elevation I am wondering if I would feel it around the front of the liver as well. Which I haven’t experienced since the early stage of the trial study. Than again, if there is something new there maybe no physical symptom as such. But that’s a definitely an interesting point, so I have to jog my memory for anything unusual prior to the test.
Good observation regarding hbeag/hbeab. I don’t know what is happening.
Thank you for your response and I appreciate your kind words.
Hi @MikeT sorry to hear about your current situation. I agree with @Ace that the presence of both HBeAg and HBeAb is strange. Were you previously e-antigen negative, or have you always been positive in the past? I’m also wondering if you’re on any type of antiviral medication (tenofovir or entecavir) since your trial ended?
Another thing that seems unusual about your results is that your AST is higher than your ALT. Whenever I had flares in the past, it was the opposite. My understanding is that AST also lives in your heart, kidneys, brain, and skeletal muscles, whereas ALT is found primarily inside liver cells. So whatever is causing your levels to become elevated may not exclusively be a liver problem.
My understanding is you can have both HBsAG and HBsAB during when your body’s immunity is fighting the virus. HbsAB was present prior to any treatment but my guess is because I was immunized for HepB and presence of the antibody was because of that. All tests that were done through my insurance was qualitative rather than quantative.
ALT is mainly indicator of liver enzymes AST can be indicator of issues with your other major organs like kidney, heart, etc.
Regards to your question about other treatments to simulate an immune response, perhaps your doctor could answer that.
Hello. It does not look at all to be from your liver the issues. Ask about repeating AST/ALT and checking CK, kidney function, electrolytes, and a full liver panel, including bilirubin, ALP and PT/INR. CK can help clarify whether muscle injury is contributing to the high AST. Make sure the bilirubin units are included, as they matter for interpreting the result.
I ended up going to see a doctor at a different hospital. I showed him my previous test results and provided him context regarding history etc. He ordered new tests for my ALT and AST levels.
So based on the new results, my AST is 33.8 U/l and ALT 41.5 U/L. ALT just above the range, but both look a whole lot better. The doctor mentioned that there was possibly contamination or a mix up of results. Which is funny in some ways because I actually asked the previous hospital was there a mix of results and could they double check. The doctor mentioned he had doubts. Wanted new tests to confirm.
I have disregarded all information from the previous results. I will put the pursuit for hbsag level confirmation to the side for now.
My may test confirmed hbeag positive. I have disregarded the previous results so assume I am still positive. I continue to take tenofovir. I acknowledge this keeps my viral load at a undetectable level.
It’s good to know my ALT and AST are at a lower level. I was starting to worry maybe I had chemical or heavy metal contamination. Apologies for the false alarm:)
I agree that you can have hbsab along side with hbsag. I think you are spot with your comments regarding ALT and AST. Fingers crossed you can acquire hbsab again!
You were right about the need to get the ALT/AST test redone. He did the test for bilirubin. The test showed 8 umol/L which is higher when compared to May results of 5. But still within range. I suppose if the retest still showed elevated levels he probably order the tests you described
Thanks for the continual updates on your situation - definitely a bit of a rollercoaster ride.
The antiviral immune response even in the best of times is a very complicated system (one of the reasons I remain a lowly virologist - a little bit easier just understanding a single virus with 4 genes rather than 100s of different types of immune cells ), but in response to these new therapeutic approaches it gets mind-blowingly difficult to understand. We’re still learning a lot about what might be happening with all of the interactions happening in all of these different organ systems. So I hope you can appreciate that we can’t give you a direct answer about what might actually be happening as it’s in new territory. Complicating matters is that vir3434 is an anti-HBs antibody in itself that lasts for quite a while in the system (due to key modifications of the antibody). This may be able to cross-react with the blood tests.
In any case, it looks like this has been resolved with subsequent tests and you have a bit more of a clearer idea.
Thank you for your reply. You are a highly qualified and knowledgeable guy. We are lucky to receive your input!
Thanks for providing context regarding the complexity of the illness. I suppose the simple answer is that there is no easy answer(even there was I’ll probably struggle to understand it). The best thing I can do is to continue monitoring with regular blood tests and ultrasound.
I have told myself to disregard the results. But I cannot help but think that the hbsag level and viral load seems to suggest it is correct. There is an reluctant acceptance of what the results will be with the next blood test.
Anyway I have to remind myself to be happy and think of the good that has happened!
HbseAg and HbsAg are different antigens, and also antibodies are different (HbsAb and HbeAb). Some chronic HBV patients are HbeAg+ (like you) and some are HbeAg- (like me) and have developed anti-HbeAb antibody but not HbsAb. In your case, since you are positive for both HbeAg and HbeAb, maybe you are in the process of converting to HbeAg-? Good luck, Ace
When I was at the doctors office I actually remembered your previous comment so it prompted me to ask the question. He pretty much said what you said in that it may be the case of converting hbeag-.
Given the inaccuracy of the prior ALT/AST results and the absence of hbsab. I kind of parked the hbeag/hbeab results to the side and not to have too much expectation. Perhaps a way to mentally prepare, so set the bar low so to speak.
But I do appreciate your comments, because in this case it prompted me to ask the question at the doctors office.
), but in response to these new therapeutic approaches it gets mind-blowingly difficult to understand. We’re still learning a lot about what might be happening with all of the interactions happening in all of these different organ systems. So I hope you can appreciate that we can’t give you a direct answer about what might actually be happening as it’s in new territory. Complicating matters is that vir3434 is an anti-HBs antibody in itself that lasts for quite a while in the system (due to key modifications of the antibody). This may be able to cross-react with the blood tests.