Hormones and hepb


I’m in the UK. I’m 43, had hepb since childhood.
At age 20 I was on Lamivudine but I don’t know any of my results from that time. I was on Lamivudine for 1.5-2 years then stopped because I was struggling to obtain the medication.

For the last 15+ years I was told my viral level was under 2000 apart from in 2010 when it was 4000.

In 2022
Fibroscan was 4.4
viral load result was 140.
surface antigen positive, e antigen negative, e antibody positive.
ALT 16

April 2024
No fibroscan yet
Viral load 3500
Awaiting copy of my blood results but was told ALT was normal

This was the first time in 20+ years that medication has been mentioned again because my viral load went from 140 to 3500. I’m concerned by having this jump up in viral load after all this time. In the UK there’s no routine testing for AFP or genetic variant which I’ve seen mentioned on this forum.

I’m going through perimenopause and my SHBG (sex hormone binding globulin) levels are high. Doctors don’t know why but have mentioned liver disease as a possible cause. I don’t know if my HRT regime is impacting on my hepatitis B and my hepatologist doesn’t know either. I take an oestrogen patch and utrogestan (progesterone) tablet. My viral load was 140 just before I started hrt and this is the first time it has been tested since I’ve been on it and it is 3500. I don’t know if the hrt/my hormones are related to the hepb result or if this is a coincidence. It seems odd that my first result over 2000 in 15 years has been once I was on HRT. I don’t know.

This is the first time I’ve ever been worried about hepb affecting my health. I’m a single parent and afraid to get ill and whether I’d be able to work.

I’m looking for any hope, ideas and info.

  • Could a jump from 140 to 3500 ever be ok or is this panic stations now?
  • Could HRT/hormones be affecting my hepB levels or could my hepB levels be impacting on my hormones including SHBG.
  • Does anyone have experience of having had Lamivudine and then years later required medication again? I think it was a clinical trial when I was on it.

Thank you


Hi @josocks,

Great questions, and I must admit that this is a topic where I’m a little out of my depths. However, on reviewing the literature, it appears that HRT is generally associated with better outcomes (e.g., reduction in liver cancer risk: Hormone replacement therapy is associated with reduced hepatocellular carcinoma risk and improved survival in postmenopausal women with hepatitis B: A nationwide long-term population-based cohort study - PMC). Indeed, women are in generally less likely than men to get liver cancer and disease progression, and some of this effect has been attributed to sex hormones.

The rise in HBV levels is not cause for panic stations, as the virus itself doesn’t cause the liver injury, but the body’s immune response to it. The next steps will be to see if the viral load increase is just a blip, or if it continues to go up. If your immune system is unable to control it and the viral load does keep going up, antivirals would be prescribed to help bring them down and prevent any ongoing liver inflammation.

If you have been treated with Lamivudine in the past, then the recommended antiviral (should you need it) is tenofovir. This has been shown to be highly effective at lowering viral load.

Hope this all helps,

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@ThomasTu Thank you and thank you for everything you have done to bring this forum together.

As I’m going through menopause early, and I already have a low bone density scan, tenofovir raised alarm bells for me as I noted a past research paper that linked it to reduction in bone density and I’m already at increased risk of osteoporosis: Tenofovir and Bone Health - PMC. Hopefully my viral levels decrease and my fibroscan is normal but if I did need drugs, there don’t appear to be many options. I saw a relative take interferon injections years and years ago, with awful side effects and I vowed never to try it. But now Lamivudine might be off the table for me, I don’t know if entecavir is the only other option. It’s mad really to think I’ve spent 43 years with this, wishing for a cure x

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Regarding the virus level, I recall a past consultant telling me that liver injury can occur when the virus level goes up and down as the body is attacking to control it. So could levels below 2000 potentially still cause issues? One result I had 30 then 1200 then 140 now 3500. Could the up and down at low levels still cause a problem? Do people’s viral loads stay roughly similar between tests or is variation expected? Would someone on medication that’s working, in the long-term have viral levels that are stable?

Hi @josocks According to your concern about switching from TDF to entecavir due to side effects. In my opinion, you may have HBV mutation after prolonged use of lamivudine due to viral selective pressure and Entecavir may have cross-resistance with Lamivudine. The best option is to switch from TDF to TAF which is high barrier of resistance drug ,no evidence of resistance after prolonged use and least side effects . I hope this may help your decision making and hope that functional cure of HBV may be discovered in the near future.

Thank you. I was on Lamivudine <3yrs about 20yrs ago. I’ve not been on anything else. My concern about TNF is bone density. I’d not heard of TAF but just read it might not affect bones. Thank you for this info - super helpful!

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