HBV DNA viral load

I am just throwing this question to all the experts out there…has there been any indication of what causes HBV DNA to go up or down? Is there anything we do that can cause the DNA to go up or down…or is it just out of our control and completely just dependent on what the virus itself does?

Hi Joseph, I’m going to let a scientific expert like Thomas Tu answer your specific question. But as a nurse and someone who has “knowingly” lived with hep b for more than 30 years (meaning I wasn’t diagnosed until I was in my 30’s), my understanding that the viral DNA can go up and down, almost randomly. I know that drinking alcohol, stress, etc. can affect one’s liver enzymes (ALT). Studies have shown that people who have a drink or two before the day being tested can result in elevated ALT blood test results! I don’t think that these things would affect the DNA. But you’re asking a good question and many of us will be very interested in the answer! Always, Joan

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Hi @joseph,

Good question! Hep B DNA is interesting: it’s quite easy to measure, but tricky to figure out what is affecting it at any given time. Obviously HBV DNA goes down if you’re on treatment - that’s the whole point. But it can also go down if:

  • The virus changes into something that can replicate to a lower extent
  • Your immune system starts killing Hep B infected cells or targeting the virus itself.
  • Something affects your immune system
  • Something affects your liver

These last two can be affected by things we do (stress, diet, alcohol, other drugs, etc). It gets complicated when you involve the immune system: on one hand, we know that inflammation from the immune system can lower the virus, but also inflammation is one of the primary drivers of liver fibrosis and cancer. It’s not a simple good-guy bad-guy scenario.

So, that’s why we can’t just look at HBV DNA levels to assess how you’re doing, but we need a whole panel of tests.

Hope this helps,


Thanks Thomas for making science understandable! I really appreciate how you can explain things simply and in a way that’s understandable. Always, Joan

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Interesting stuff…thanks for the input :slight_smile:

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Hello. I dont know how to start a new post so im posting here if that isnt a problem
First of all thank u very very much for this forum and all the explanations
I am a medical doctor and my husband is HepB positive. Diagnosed oct 2020 after trying to donate blood. Fibroscan Normal ( F 0) normal ALT Hbsag 22800 ui/ml. Hbv dna <50 iu/ml
March 2021 we were asked to do only HbsAg which resulted 15200 iu/ml and normal ALT also
Spetember 2021 results: normal ALT and AST , HbsAg 23120 iu/ml, HbvDna 213 iu/ml. Waiting for the fibroscan now.
My husband’s hepatologist says he is still in the “inactive phase” or better in the monitoring phase given his lab results. But i have 2 questions

  1. Why this discordance between HbsAg and HbvDna values
  2. This rise in hbv dna eventhought still in the very low ranges, will it be permanently rising? Or can it go down on its own even in this phase
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Dear @Nipatoho,

Welcome to the community and thanks for sharing your experiences. From your description, your husband is in a relatively safe state and it sounds like he is getting appropriate monitoring.

To answer your questions:

  1. There are slightly different forms of the virus in the liver. There are replication-competent forms (that can produce new virus and contribute to HBV DNA levels) and replication-deficient forms (which can’t produce new virus). Both forms can express HBsAg, but only the first can produce HBV DNA.
    Initially in an infection, most of the virus in the liver is replication-competent. During the immune response against the infection, your immune system focuses its energy on clearing replication-competent forms. So in effect the body select for the replication-deficient forms and they become more common. This leads to the discordance between the two values.

  2. A permanent rise in HBV DNA is what you are monitoring for. It’s quite common for people in this phase to have fluctuating HBV DNA levels, so I wouldn’t worry too much about it until you see that it is increasing as a trend. If they do continue rising, antiviral therapy may be recommended.

Hope this helps,


Thank you very much. IT is more clear.
Between the Whys and Hows there is so much informations. Just wanted to reassure if this is the right way to manage it.


Hi Thomas,
Thanks so much for this information! I’ve researched Hep B for years and I never heard of these different forms of the virus. I’m curious as to how these different forms relate to the eAntigen. I understand it to be an amplifier increasing replication of the HBV but does that mean a person would have more replication-competent forms of the virus?
I am asking because I am still eAntigen positive despite being in my late 50’s. I acquired HBV at birth so I have had very high viral loads (in the billions) most of my life. However, my ALT was mostly WNL so I was not on treatment until last year when they began to double the ULN (36 U/L) of my lab to 75 U/L. Hence I was started on antivirals in June’2020. Initially I began on ETV but developed a severe skin rash so switched to Viread and eventually Vemlidy. My rash persisted so my specialist agreed to let me take the medication every other day as I found it was reduced when I did not take the medication. However in Dec’2020 I was diagnosed with chronic urticaria and prescribed antihistamines which reduced the rash and so I began taking Vemlidy daily. My viral load did decrease while on medication but has not become undetectable probably because I was not taking the medication daily initially. However my most recent blood test taken this month did not show any change in my viral load from my results 3 months ago. (191/192) As well, my ALT have not gone down to normal and have hovered around 37-43 U/L which I know is not high but I was hoping to go below 36.
My hepatologist has not contacted me but I wonder if I should be concerned. I can’t think of any other options though in my treatment plan.
Thank you!

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Dear @wml,

Great to hear that your skin issues were diagnosed and treated successfully.

Regarding your viral load, it can take a while (months-years) to go down to undetectable, so I wouldn’t worry about it not going down. It may be more of an issue if it goes up dramatically while you’re on treatment.

With the ALTs, they may also take time, but your hepatologist should take into account possibilities of other issues causing raised levels (e.g. fatty liver disease).

To me, the lab results don’t appear to require urgent change in treatment and I wouldn’t worry too much about it, but you should bring it up at the next appointment with your hepatologist.

Hope this helps,

Hi Thomas,

Thanks so much for the response! I appreciate your insights and reassurance. I understand that it can take some time for the viral load to become undetectable and for the ALT to normalize but I have also read that the longer it takes to reduce these numbers, the more likely a person will face possible liver problems such as HCC. Nevertheless, I agree that the only course of action is to continue on my daily medication and monitor my situation.

Yes, considering my age, fatty liver disease is certainly a possibility. However, I have maintained a normal or below normal weight all my life as well as exercise daily and eat a healthy diet, with some exceptions ;). I’ve been trying to reduce any further damage to my liver!

Thank you again.


No problem, @wml.

Yes, fatty liver disease is a really complicated thing, and our research group works on it quite a bit. What we and others have shown is that “lean” fatty liver disease is quite common and that there are so many factors that come into play (not only food and exercise, but also other metabolic changes, underlying genetics, environmental stressors, etc.).

I’m not an expert in the field, but it’s important not to only think fatty liver disease only happens to people who are fat, but can start affecting almost anyone. My understanding is that peripheral fat (arms, butt, thighs, hips, etc.) is not that detrimental to health, but visceral fat (covering our internal organs like the heart and liver) plays a much larger role.

Hope this puts everything into some context.