I’m 37 male. I have chronic inactive Hep B. In 2024 I regularly started monitoring my viral load at the urge of my wife (initially diagnosed in 2007, I strongly believe I contracted it after a surgery in my home country as shortly after is when I tested positive when I tried to donate blood whereas before I would never have issues with donating - Hepatitis B is very prevalent in my home country and the clinic I got my surgery at unfortunately wasn’t the best, but I digress)
Anyways back in 2024, my viral load was very low at only 49 IU/mL. Last year it increased to 294 IU/mL, and unfortunately this year it’s increased even more…my latest reading says 593. I’m quite worried about this steady YoY increase. My PCP said it was slightly elevated so I’m worried bc he used that term “elevated”. I did see a Hepatologist last year and he did a scan but nothing stood out.
My ALT and AST were both within range on my chart, which I guess was good news.
I’m very worried about the increase in my viral load however. What can cause this? It was so low just 2 years ago and now it’s almost 600. If it keep up this YoY increase I’ll be at 2000 before I know it
I will say, I underwent a lot of stress over the course of these past 2.5 year…my brother passed away unexpectedly, I had to work through taking care of everything he left behind (his businesses, ensuring his kids’ money was protected for once they reached adulthood, etc), then two months later my other brother passed away, I also lost my job last fall and had to relocate states, I also have my own business that I’ve been struggling with as well, my sister got divorced and I had to help her navigate a lot including an ongoing issue, etc so just a lot has and is happening and I believe I once read stress can affect it but I’m unsure if that is true
Anyways, feeling hopeless and worried about my next results. Would love to hear insight, if this is normal, etc
Also, if it helps to provide insight, this is my 2024 result for the non-reactive/reactive for Hepatitis B
Hi @Anon2023, I’m so sorry to hear about all of the stress in your life with losing your brothers, and losing your job. Yes, it is possible that stress can affect your body in many ways. If starting treatment would give you more peace of mind, then I would recommend it. However, the difference between 49 and 593 is actually not as significant as you might think, so I won’t insist that you must start treatment immediately. Please take care of yourself
Hi @et5656 thank you for your kind words and input. I feel I would not want to take medicine since I am still under 2,000. However, I am just very concerned since every year ever since I started testing my viral load (2024) it has gone up by roughly 200 each year. Do you know if this is normal to see an increase like this? I’m worried the yearly increase will continue @ScienceExperts I would appreciate any input as well
Viral Load Trends below:
2024: 49 IU/mL
2025: 294 IU/mL
2026: 593 IU/mL
At this rate, I’m worried next time I test it will be 1,000. Then the upwards trend will continue until I eventually reach 2000 I will admit, I did not test my viral load before 2024 (only had gotten a liver scan before 2024) so I don’t know what my load used to be and how the trends used to look. But since 2024, it’s not looking good that it keeps increasing.
I also wonder if this is happening since I’m also getting older. Is it normal for our viral loads to increase with age?
Hi and thank you for sharing. Sorry about your circumstances - yes, stress is a big one for health. I am in the UK and my viral load has been jumping around quite a bit - for example 6 months ago it was around 8,000, last week’s test 4,000. My Dr isn’t very concerned and wasn’t even going to start me on any meds as I have no other indications of progressive liver damage and normal liver enzimes. She told me that there is not much difference between those numbers and not to be concerned. I guess lower thousands is still low when it comes to treatment options. So I hope this could help a little bit.
Personally I never had treatment and I lived with it now for over 30 years. I went from millions to almost zero at one point and then a steady up climb and it fluctuates. I have been struggling with major fatigue for years and I suspect it is related to Hep B - the body/immune system has to work hard to keep this virus under control, that takes energy. I have been living a very heathy and holistic lifestyle for the last 10-15 years - no alcohol, healthy organic food, yoga, meditation and other ways to manage stress. That helps. I am having a dilemma of my own about starting treatment but I just turned 50, so thinking that maybe it is worth considering. Though my Dr feels that I don’t need it, even with the viral load much higher than yours. I hope this helps
Hi @Roxyoxy thanks for sharing your story That’s good to know, I always thought meds needed to be started once you hit a viral load of 2,000. I’m glad it went down from 8,000 to 4,000 - that’s quite decrease in just 6 months! Hopefully your trend continues downwards.
Do you not take meds because your AST/ALT numbers are still good and no signs of cirhossis during scans?
I worry about my wife if my viral load increases. She is fully vaccinated and has the proper titers but I do wonder if, as my viral load increases, she could potentially be at risk even though she is vaccinated. I’m not sure though.
I’m also glad to hear about your lifestyle. I live the same - no alcohol, no smoking, regular exercise, largely follow a Mediterranean diet, organic foods, minimally processed foods, etc. I always hope that this hopefully helps to keep my Hep B under control.
Hi @Anon2023,
I am sorry to hear about your situation and the losses you have experienced. Definitely, stress can impact our immune system. However, I agree with @et5656 on this. Given that your liver imaging, ALT, and AST are all normal, I will not be extremely concerned about these small increases. Your surface antigen remaining under 1000 is still good. I will encourage you to continue monitoring this in addition to all the other liver tests.
I also hope that you can adapt a little better to all your losses. It is never easy or something you get over, but with time, we adapt a little better to the situation.
Continue to monitor and keep us updated. Best, Bansah1
Hi @Anon2023,
If your wife is vaccinated and has strong antibodies, she will be protected even if your viral load increases to a million. Stronger antibodies mean almost zero risk of transmission in the majority of people. This is something she can monitor to ensure her antibodies don’t wane over time, thereby putting her at risk of exposure. Currently, the risk is low for her. Bansah1
Yes @Anon2023, healthy lifestyle absolutely does help in my opinion!
So basically my Dr says that for treatment to be justified it needs to to have 2 out of 3 criteria - viral load over 2000 + either notable liver damage or high AST/ALT numbers. In my case i only have the viral load which fluctuates frequently but is never as high as to cause her concern. She seems to think that there is not much difference between 2000 and 8000 - these numbers are in the same category and the actual practical difference between the numbers is too marginal to take notice unless there are other markers, as above. But she still agreed to prescribe TDF because I asked her to. Having said this, it might be different here in the UK as we have free health service. For example, I asked if she could prescribe TAF instead of TDF as it is newer and has fewer side effects and she said she can’t due to cost - TAF is more expensive and they don’t usually prescribe it for HBV treatment for this reason. In the UK they only prescribe TAF to HIV patients.
Hi @Bansah1 thank you for your kind words & your input This makes me feel better. I will admit, prior to 2024 I never really tested my viral load, so I supposed I don’t know my history with it and am unaware with how fluctuations work and what it was in the past, for all I know it could have been high in the past and now it’s lower than it was before. I’m just bummed bc it has increased every year since I first started to test It’s disheartening to see. & thank you for the input about my wife’s protection. Is anyone else here in a similar situation where you are Hep B positive but your spouse is negative? I’m unsure if she should check for protection every couple of years or if she should feel safe without always testing. She got vaccinated and got her titers checked in 2024. She was born in the USA after the vaccine started commonly being given to babies so she actually got the Hepatitis B vaccine at birth but it appears she lost immunity over the years bc when she tested for titers in 2024 at age 28, she did not have antibodies which is why she got revaccinated that year.
@Roxyoxy thank you for the input! Well I’m glad to hear you only meet one of the 3 criteria! Hopefully it stays that way! I will say, it’s very reassuring to hear that you have lived with Hep B for over 30 years with no treatment, it gives me hope as I often worry that one day I will need treatment or that my viral load or AST/ALT numbers will be too high, or that I will develop cirhossis. I’ve lived with Hep B for almost 20 years now, so here’s to hoping by the time I make it to 30 years I can say the same as you!
Maybe every 3-5 years if that makes it less stressful for you both.
Fluctuations are common. The good thing is that your liver imaging, AST, and ALT remains normal so, I doubt the increase is causing any issues. Yes, as we age things like immune control reduces as well. If you can continue to monitor this.
You are welcome. We are all in this together. Helping others doesn’t take their struggles away, but I hope it helps give them a break if even for a couple of minutes or days, that’s good. Sharing as they say is caring. Best, Bansah1
@Anon2023 I totally understand your worries. But I think they can also add to unnecessary stress.
I think you are doing very well and your levels are really low. To be completely honest, I hardly ever think about my condition. And I only began considering treatment because of the fatigue issue which I feel is preventing me from living my life more fully. It’s interesting because I only realised this when I saw the dr the other day and asked about what’s available. Part of me thinks - why not wait a bit longer for the cure - I would like to get rid of it of course. But on the other hand, I also do not want to introduce a foreign substance into my body’s ecosystem. I feel that it has managed quite well over the years. Though giving my immunity a boost might not be a bad idea. I still haven’t decided.
I guess the argument might also be that as we age the immunity slows down, but… If you maintain good health, manage stress, have a healthy lifestyle and diet, the rate of your biological ageing will decrease or at least remain at an optimum. I would focus on that and also the fact that you really are at a very low risk and have been for the past 20 years - that’s really, really great!
Overall, I would not stress about it but celebrate the fact that your body is managing so well. Just continue monitoring and stop worrying I know people who lived with hep b all their lives but died of something completely unrelated or stress related. So manage that first and everything else will fall into place
I wish all the best and perfect health to you and your partner!
Hi, its very unfortuanate your going through all these but remember your health is paramont to any other responsibilities. I will suggest you meet hepatologist and discuss medical concerns futher. In the mean time, pls find time to eat well, hydrate more and rest more..
Thank you! Is it the norm to get it checked every 3-5 years, or is this more of a suggestion for folks who are worried?
OK noted! See, I unfortunately never tracked my viral load before 2024, so I have no idea what my numbers or fluctuations were before 2024.So for all I could know, my viral laod could have been much much higher than it is now, I just never knew. I guess it’s true when they say what you don’t know won’t kill you LOL. I was just concered because ever since I DID start tracking it, it’s been an upwards trend.
And thank you! Wishing you all the best My wife and I found this community back in 2024, and it’s always nice to connect with others in the same boat!
HI @Roxyoxy agreed, I will try to stop thinking about it, I was just so worried given it’s been an upwards trend since 2024, but I will just wait and see what my next reading says.
And I agree, it seems your body is handling it quite well so if you can hold off on treatment, why not? Sometimes, we can give our bodies energy boosts in another ways with different supplements or foods. But of course, you and your doctor will always know what’s best for you and your body.
And thank you for the insight! I unfortunately had worse examples of individuals living with Hep B growing up, I knew a couple of people who passed away from it when I was younger, so it scares me. And bc of that, when I first found out I had it, I thought my life was over. It was the worst week of my life lol, but thankfully my sister was in medical school at the time and she calmed me down and made me feel better. I also remind myself we were living in a very poor (but very beautiful) country, so over there they just did not have the same resources I now have in the USA. It was very sad. And to your point, I have since learned about so many people who have had it for decades and decades and live long, healthy and prosperous life and end up dying as a result of something completely unrelated! Just for me personally, I unfortunately had bad experiences with knowing and learning about the virus growing up.
It’s not the norm. Once people check and they have higher antibodies, they move on. For most people that antibody protection can last a lifetime. However, in a small set of people we see their protection levels wane over time. But, I suggested that timeline if it helps with your situation. Some people check once every 10 years. It’s not a standard, but what makes people feel comfortable and in control of their health. Best, Bansah1.
Sorry to hear about the passing of your brothers and the struggles you had.
From hundreds of millions to few numbers and vice versa, this is how the viral load fluctuate, do not worry at all as your ALT/AST and your liver condition is normal.
I am 6000 VL and I consider myself in a good level, even this number sometimes goes up and down due to the mood and morales!
It’s all about immunity to fight back the virus, if there’s stress or the lack of healthy food, the virus will take chance to replicate.
Now adopt new healthy life style with zeroanxiety, and remember you’re very far from high levels, rather you’re among the best situation of the patients who had ‘inactive’ chronic HBV.
