So this test was from last year. I will likely get it done again this year based on what my hematologist suggests but unfortunately the earliest appointment I could find with him was in October so I’m feeling a little anxious until then.
This test was taken last year through a general practitioner, and last year my viral load (not shown in screenshot) was 49 iu. This year it rose to about 200-something iu (I forgot the exact number).
However this year I was only tested for my viral load and not for these other factors in the screenshot I’ve attached. I was only tested for these last year. I was going through my old results and found them. Can someone explain to me what my mix of non-reactive and reactive results means? I’m confused as to why there’s so many different Hep B results and what my mix means.
These data indicate you have HBe-negative chronic HBV infection. The meaning of each of these tests is:
HBeAg antibody - reactive means they can detect antibodies against HBeAg in your blood. That means your immune system has responded to it. This is usually is associated with slower disease progression.
HBsAg - reactive means they can detect HBsAg in your blood. That is usually associated with active replication of the virus. Having detectable HBV DNA in your blood also supports the conclusion is that there is ongoing viral replication.
HBcAg antibody total - reactive means you have had active HBV replication at least sometime in your past; it could be either an ongoing infection or one that has been cleared.
HBcAg antibody (IgM) - non-reactive means that your infection occurred at least ~6 months or more ago. This is because IgM is the first antibody to develop, and it is then replaced with a different type of antibody, ususally IgG.
HBeAg - non-reactive means they cannot detect HBeAg in your blood. That is usually associated with having HBeAg antibodies, which is the case for your test results. Together, the HBeAg and antibody data indicate that you had HBeAg in your body in the past but that it is not there now, usually because the antibodies have cleaned it out of your blood but it could be due to mutations to the virus that block production of HBeAg.
HBV viral load (presumably HBV DNA) - 49 IU. This means you have a very, very small trace of HBV DNA in your blood. This DNA is usually within virus particles.
Overall, this pattern is consistent with a very low level chronic HBeAg-negative HBV infection that is pretty well controlled by your immune system. The rate of disease progression in people with this type of infection tends to be slow.
Note that I am not a physician and cannot formally diagnose your condition. My comments are based on the normal patterns seen during a chronic HBV infection. I urge you to call your doctor’s office if you still have questions.
@john.tavis thanks for the input! This is very helpful! Yes I plan to visit with a Hematologist but unfortunately the soonest I could get to one who has a lot of background with Hep B patients is in mid/late October. Hopefully he’s as knowledgeable as you!
This helps to answer my questions and ease my concerns until then. So, just so I’m clear, does my Hepatitis Be Antigen being non-reactive typically indicate a good thing for someone who’s a carrier of Hep B? Or is it being non-reactive pretty insignificant, all things considered?
Sorry about your dilema with these Reactive and non Reactive results.
Some few tips
Your last year results shows that you have cleared HBeAg and supressed viral replication which is normally refered to as inactive Carrier State which is characterized by undetectable or low viral loads (less than 2,000 IU/mL) and comes with improvements in liver inflammation and fibrosis. In this phase, adults will typically have normal ALT levels and minimal inflammation, but it is important that doctors are on alert for evidence of advanced liver disease. This phase may be lifelong, decades, or not long at all.
Currently, the PCR-based assays for HBV DNA detection have the best range of quantification, now being standardised to IU/mL commonly referred to as the viral load which is expressed in international units per milliliter (IU/mL).
Clinical implications of some of these values
<2,000 IU/mL: Often considered inactive carrier status in many guidelines. >2,000 IU/mL with elevated ALT or liver damage: May indicate need for antiviral therapy. >200,000 IU/mL: Often triggers treatment consideration, especially in pregnant individuals to prevent mother-to-child transmission
Your recent lab value of 49IU to 200IU suggests trace amount of virus in the blood which comes with low risk of transmission.
Its important to note
Viral load alone isn’t enough—doctors also consider liver enzyme levels (ALT), fibrosis stage, and other markers.
Even HBV DNA-negative patients (i.e., <20 IU/mL) may show liver damage, especially if aged ≥30 years, so guidelines vary globally.
Reactive anti-HBc-IgM: Indicates a recent or new infection with hepatitis B virus (HBV), typically within the last 6 months.
It usually appears at the onset of symptoms and declines to undetectable levels within 6 to 9 months.
In some cases, a flare-up of chronic hepatitis B can also cause HBc-IgM to be positive, so follow-up testing is important. In your case is Non REACTIVE…
Thanks, I hope this was helpful, i may not explain everything but you could get additional explanation from your hepatologist
@TomA thanks for the input! So to ensure I understood correctly, are you saying that my non-reactive values could potentially flip to reactive one day if my progression gets worse?
This is typically a quite good outcome as it is associated with much lower levels of HBV replication and slow disease progression. Again, this is just the general pattern. Your physician can interpret these values better as s/he will have access to your full medical history.
Correct. Even if your immune system is controlling the infection very well as in your case now , you can still go into active phase where the virus starts to replicate again if your immune system gets weakened due factors
-Immunosuppressive therapy: Treatments that weaken the immune system—like chemotherapy, corticosteroids, or biologics—can allow HBV to resurface.
-Organ or bone marrow transplantation: Immunosuppressive drugs used post-transplant can trigger virus replication .
-Treatment for hepatitis C: Direct-acting antivirals (DAAs) used for HCV can disturb the immune balance and reactivate HBV.
-HIV infection or changes in HIV therapy: Co-infection and therapy shifts may lead to HBV flares.
-Other immuno supressive conditions like cancer and the therapy
-Autoimmune diseases: Conditions like rheumatoid arthritis or lupus, especially when treated with immunosuppressants, increase risk.
-Spontaneous reactivation: Rarely, HBV can reactivate without an obvious trigger, especially in older adults or those with liver cirrhosis
Its important to take care of your general health, exercise regularly, eat healthy, monitor your weight, avoid alcohol etc
Its very important to have 6monthly or yearly checkups with your hepatologists or physicians to monitor the disease progress because chronic HBV is very dynamic disease.
As per now you dont need to worry so much but follow the periodic checkup as planned by your doctor
Thanks @TomA this is helpful! I try to be as healthy as possible. I eat healthy (as much as I can)…lots of dates, honey, greens, etc and exercise regularly as well as avoid alcohol and smoking. I’ll do my part and hope that this is enough! I hope it never reactivates but I’ll be sure to always stay on top of my visits, and ultimately, I always try to remind myself there are worse things in life that others are enduring and I feel blessed compared to many!
Sure! Positivity and goodwill is as good as therapy. Many people with chronic hepatitis B can live long, healthy lives often comparable to those without the condition. The key lies in consistent medical care, lifestyle choices, and early detection of complications.
