I was diagnosed With hepb last year and my reports were normal placing me into the “Inactive Carrier” Category where I am not on any meds yet.
Now my reports are as follows
July 2024:
Hbv DNA - 496 IU/ML
HBEAG - negative
HBSAG - 1156 IU/ML
ALT/AST - Normal Range
Nov 2024:
HBV DNA - 395 IU/ml
ALT/AST - normal
March 2025:
HBV DNA - 216 IU/Ml
ALT/AST - normal
Now when i tested the previous week Aug 2025
HBV DNA - 2390 IU/ML
ALT - 45.3 U/L (5-49 Ref range)
AST - 34.0 U/L (5-46 Ref range)
So you see my hbv dna has spiked to like 11x~12x and my alt ast are almost at the edge what can I do in this situation? My Ultrasound almost 2 months back was normal havent had a fibroscan done yet
Around the same time in March i also started having weird pains in my stomach area that kept moving in the right side had a check with the doc told me it can be gastritis. Then I had the ultrasound to check 2 months back everything was normal from my kidneys to my liver
Now i dont know why the sudden spike so I can only think of my meds that I am taking these days for my stomach issues
I am taking:
Fexuclue (Fexuprazan)
Librium (Chlordiazepoxide)
PREPRO IBS (For IBS + Good bacteria)
Vitamin D tablets (Weekly)
What do you think can be the change that caused my hbv dna to spike I am very upset right now and dont know what to do.
Do you think it is being reactivated? or entering the immune active phase?
Should I start antivirals? Should I wait and see if it was medicine induced rebound which i asked an Ai and it said can be very dangerous if antivirals are not started as it can start attacking the liver
Being 23 I am very skeptical of starting meds rn I do want to start them but when I am around 26 or 27 when I am settled properly so ofc I dont want to wait long but i dont feel like I want to start treatment straight away as well.
I am sorry to hear about these changes. It is hard to say why a sudden increase in HBV DNA when it has been stable for a long time. Flare-ups can, of course, lead to an increase in viral load. From my research, Librium can cause liver injury as well. Could that be the cause of this increase? I can’t say. It is also possible that you have something else going on, possibly an infection that is affecting your immune system, hence the increase we are seeing.
If you have access to the medications and can afford them, sure, I will encourage you to start. Waiting is not going to change much. Starting treatment early leads to a better long-term prognosis. It is hard to say exactly why this increase has occurred now. What has your doctor said about this?
Hey @Bansah1 ,
Thanks for the reply, I myself did not take Librium much because I did not want to get addicted to it on a daily basis so i checked what it does and it did not significantly fix my gastro issues in my opinion so i never took it religiously took it like 4-5 times only but i took fexuclue and preproibs everyday.
So I dont think Librium might be the cause at all. I had a chat with my Hepatologist and he said that not to start it for now he even told me he wouldnt start it even if the value hit 10k without significant changes into your ALT/AST (I am questioning him rn lol) otherwise it’ll be a lifelong commitment which might not be needed rn.
But I want to take second opinion from the doctors and science experts here as to what should I do should I wait like the guidelines suggest to see if it goes down or if something starts happening with my ALT/AST or should I start my meds?
I am not a doctor, but a similar thing happened to me in 2022 when my viral load went from 2500 to 167,000, along with slightly elevated liver enzymes. I would recommend calling your doctor and asking to set up an appointment. Your liver enzymes are borderline, so thankfully you’re not in the dangerous zone. My doctor told me to get more lab tests in 2 months to see if the DNA and liver enzymes are still elevated.
By the time I went to see the doctor, my liver enzymes were still high, but viral load had started to go down again. Still, I decided to go on treatment with TDF to avoid a more severe flare-up down the road. My liver health has been good and stable since then. Good luck!
As i said in my above post My HBV Dna spiked from 216 (March 2025) to 2390 IU/ml (Aug 2025) in 6 months as mentioned in my last LFT report my
ALT was 45.3 U/L
AST was 34.0 U/L
Last Fibrsocan - 6.0 KPA (when i got my hbv dna reports of spike Aug 2025)
And now i just did a LFT check as I am monitoring it closely my AST i.e (SGOT) came out to be 80.40 U/L and my ALT stayed around the same 47.80 U/L
Should I consider starting treatment? Am i becoming High risk? Ill be turning 24 this december and I am very worried as I thought i would start my meds in my late 20’s around 28 or so I am very scared and idk what to do.
Thanks so much for this.
Note: I’ve also been having random stomach pains at different locations they keep moving and the pain comes and goes away its not persistent and isnt even that bad ive been having it for more then 6 months now but ive choked it up to be a normal discomfort or gastritis as my doc SAid might be IBS or Gastritis but the pain is there very very mild and sometimes not existent but it’ll come back the pain is also near the ribcage end and start of stomach or sometimes below my heart a the right side only though i feel it might be on the muscles then in the liver or so but i cant be sure.
AST elevations are not an important as ALT in determining the ultimate state of liver inflammation. This being said, a new HBV DNA test and liver enzyme assessment is in order, perhaps before the normal 6 month interval.
I agree with @availlant — best thing to do is re-test HBV DNA. If it makes you feel better, I first started treatment when I was 18, and looking back, I wish I would have started sooner. It gives me more peace of mind, because I’ve never had a flare up while on the medication (I definitely have without it). It has also helped reduce my anxiety about accidentally transmitting HBV to others. We have substantial evidence that shows that low/undetectable viral load = minimal risk of transmission. I’m not sure what country you’re from, but hopefully you’re able to access affordable treatment.
Your pains we can’t diagnose as we aren’t doctors and would need to see you.
I’ve had similar pains caused by constipation.
Not a blockage but able to feel my stools moving through my colon from right to above stomach and down left side. I need to watch my diet and try to keep my stools soft. Fibre, physician husks etc.
as for antivirals, I’ve been on them approximately 6 years. They are part of my daily routine. One tablet before food in the morning every day. It’s a small tablet and I’ve had no side effects on Entercavir. They have been around quite a while, safe.
