I am Rohit and newly diagnosed with this scary disease hepb

Just diagnosed or new to the community
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Hello all respected members and founder @ThomasTu @et5656 @Bansah1 @Suwang88 @john.tavis @learnandshare i am Rohit from India and want to introduce myself. I live with my wife and 4 years old child. I am newly diagnosed with CHB in march 2026. I went to hospital for an operation and before that they performed some tests and declared that i am hbsag positive and the value of hbsag was 4920 S/CO. Then i consulted a gastroenterologist who told me for further testing in which i got results are as follow:

  1. hbsag: 4920 S/CO( reactive)

  2. hbv dna viral load: 825 IU/ml

  3. hbeag: 0.37 S/CO(non reactive)

  4. anti hbe: 0.11 S/CO(reactive)

5)Fibrosacn:

A) Median Stifnees: 4.2kpa

B) CAP: 189 db/m

C) IQR/med: 16%

  1. LFT was normal

  2. whole abdomen ultrasound was normal

These all tests were performed in march 2026.

My wife and child both were hbsag negative in march 2026. My child was fully vaccinated at the time of birth and doctors tested my wife and child for anti hbsag after this event happened. For my child anti hbsag value is 26.31mIU/ml( greater than 10mIU/ml) and my wife had anti hbsag 2.60mIU/ml(lesser than 10 mIU/ml) so we started her vaccination and 2 shots (0, 1month) has been given to her and 1 shot(6 month vaccine shot) is pending only. Instead of discussing on my reports and results, i want to discuss my first and biggest fear.

Question1: is it possible that my child can contract the virus from my saliva. As before my diagnosis, i was used to kiss my child on his cheeks, lips which i dont do now. I was used to touch my lips(while thinking something), teeth(while eating some snacks or food like burgers) and did not wash hand everytime before touching him or anything others which also i do not do now. I am very very scared about my child because on WHO website it is written that hepatitis b viruses are present in Saliva. Because this activity of protection no one can do lifetime. Kindly help and advice?

Question 2: i used to play with my child and used to spent a lot of time with him playing and i never thought of any scratch made by him on my body from where a little blood come out and never thought of any acne which bursted with little blood. So the main question is that can a little blood from acne or scratch from daily activity cause infection to the child of 4 years if he is fully vaccinated and develpoed antibodies greater than 10mIU/ml? Also on the internet(google) i read that yes it is possible, google gave two reasons. First one is, breakthrough infection can occur to a vaccinated child also. Second one is, infection can occur to a vaccinated child if the mutations of virus has been occured(which can evade the antibodiesvaccine) in CHB father. Kindly help and answer?? And if my child is safe from little blood them why it is said to seperate the toothbrush, nailclippers etc.?

Question 3: can nasal fluid( running nose because of some other infection) cause the spread of hepatitis b?

Question 4: what about sweat as i was used to play with my child and sweat will obviously come in contact with any part of body of my child.

I only want my child and wife protected from this virus. I am very scared and in deep depression as i diagnosed 4 months back. I left my job and only do 3 things from last 4 months which are eating, sleeping and reading or researching on google about hbv. Became frustated from the U turn of my life. I lost complete focus, no interest in daily life and all day stress which goes deeper as the time passes.

I have a big list of questions which i will ask later as i seriously want the answer for the above mentioned questions first.

Thanks

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Hi @Rohit,
Welcome to the community. I am sorry to meet you under this circumstance. I am glad that all your test are normal or close to that.
Question 4: There is no scientific evidence that hepatitis B can be transmitted through sweat. I have not heard or seen anyone infected with the virus via this route.

Question 2: While it is true that the virus can be found in the saliva mixed with blood, there is not enough blood to lead to an infection. Further, kissing, hugging, sharing utensils, bathrooms, bedrooms, cooking and eating together, etc. do not lead to transmission. Toothbrush, nail clippers, needles, etc. could cause more bleeding, more blood exposure, and may cause the virus to remain on those surfaces possibly leading to exposures to others.

Question 3: I am not aware of any instance where exposure to nasal fluid has led to an HBV infection. I will encourage good hygiene if someone experiences running nose.

Question 1: If the person is vaccinated and has developed antibodies, no they can’t get infected even when they are exposed to the virus. anti-HBsAb of 23.31 is high and should provide strong protection for your child. Your wife definitely will benefit from a booster since her antibodies seem to have waned.

Please continue to play, hug, eat, have fun with your kid, don’t let this diagnosis prevent you from doing so. Remember, hepatitis B is a bloodborne virus meaning for an infection to occur there must be an infected blood. Many of us struggled with the initial diagnosis and some still struggle, please take it easy. You are not alone and the community is here to support throughout this.

I hope this is helpful. Keep us posted if you can. Bansah1

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Dear @Rohit

First, I’m sorry to hear of your diagnosis and the stress it has put on your family. I’ll address your questions in order, but first I want to note that your HBV DNA level (that measures the overall amount of HBV in your blood) is quite low at 825 IU/ml. Those numbers can get up to the 10’s of millions in really high level cases. The risk of transmission is roughly proportional to HBV levels, so your low DNA levels mean you have a lower (but not absent) risk of transmission.

Question 1: HBV does not transmit through saliva unless there is fresh blood in it, for example from a cut to your gums or cheek. Detecting HBV DNA in saliva by ultrasensitive PCR tests is not the same as having high enough levels of intact virus in saliva to transmit an infection.

Question 2: An antibody level of >10 mIU/ml efficiently blocks transmission. There are always rare outlier cases where the virus could get past the antibodies, but they are extremely rare. My recommendation is to limit contact with your blood by your child, but not to worry if a small amount of contact occurs. If you are still concerned, you may wish to consider getting an additional vaccine booster shot for your child as 26.3 mIU/ml is sufficient for immunity but that level will slowly decline as your child ages.

Question 3: Nasal fluid cannot spread HBV unless there is blood in it, for example from a nose-bleed. It is the blood that is transmissive, not the mucous secretions.

Question 4: Sweat cannot transmit HBV unless there is blood in it, for example from a cut. It is the blood that is transmissive, not the sweat.

An additional suggestion: The full vaccination series for HBV typically takes 6 months. I recommend you use condoms when being intimate with your wife until she completes the series and has a documented antibody level of over 10 mIU/ml. It is best to be safe as HBV can transmit sexually.

Finally, I am very distressed to hear that your live has been so badly upended. I am not HBV+ myself and cannot speak from first-hand experience, but there are many HBV+ people on this forum who are living happy, productive lives and raising loving families. They can be an outstanding resource for you as you learn to manage your infection and the stress it has put on you and your family.

I wish you the very best.

John.

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@john.tavis @Bansah1 Thank you very much for your support and advice. Need answer on two more points which i asked earlier too.

  1. Can breakthrough infection occur to a person or child who has developed sufficient antibodies? What is breakthrough infection?

  2. if virus mutation occurs in CHB patient can it cause infection to a fully vaccinated person or child who has developed sufficient antibodies? Because no one knows when mutation will happen in a CHB person.

  3. how regularly i should recheck or retest my child for hbsab to determine whether his immunity waned off or not? I am thinking to confirm his immunity status once a year. Should i do this or there is no need to do so every year?

  4. @john.tavis Why is it said and mentioned every where that even after vaccination(and after developed sufficient antibodies) CHB person’s razor, nail-clippers, toothbrush etc should be kept away from the vaccinated person also. I think these personal items may carry a little blood only. But as you advised me that from a contact of little blood there is no worry. kindly describe me in details? Need your more support and time

    Thanks

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Breakthrough infection for hepatitis B occur when someone is vaccinated against hepatitis B virus and still gets infected. Cases such as this a very RARE and has to do with mutations or a suppressed immune system. I don’t think you or your family have any of this based on what you have shared with us. Antibodies wane over time in some people and that could be the case with your wife. But with vaccination, she can develop strong and higher protective antibodies against hepatitis B.

Please, take anything you read from Google with a grain of salt. Not everything on there is accurate or helpful. It’s good to learn about the disease, but please don’t overdo it. We don’t want you stressing yourself over something that might be inaccurate and doesn’t apply to you.

For testing, please consult with a doctor that treats hepatitis B or has knowledge about it. They can develop a care plan for your case and guide you through the rest.
Regarding testing your son, as @johnTavis suggested he can get a booster shot to help increase his antibodies. This might be the best option so you don’t have to test him very much. One’s he gets the booster and there’s evidence of an increase in antibodies, maybe recheck every 5-10 years.

I hope this helps. Bansah1

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@john.tavis @Bansah1 @ThomasTu Thank you so much for support.

In india doctors dont give booster vaccine if someone has antibodies greater than 10mIU/ml. I asked 2-3 doctors to do so but they denied as child has 26.3mIU/ml hbsab.

  1. So now can i consider that i can kiss my child and wife?

  2. And if viral load is high then can saliva play any role in transmitting the infection or not?

afraid of thinking again and again.

  1. one more scenario comes in my mind like if me and my family going somewhere in a car and get a little accident and injuries, then what are the chances for other persons who dont have hepb can catch it? And what should be done first at that time?

These are last philosophical questions. Kindly reply.

After that i will provide you some shocking results or data of viral load fluctuations in last 4 months in my body as in last 4 months i tested 4 times for hbv dna.

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Casual contacts including kissing do not lead to an infection. So, yes you can. A higher viral load doesn’t change this. Hepatitis B doesn’t spread casually. It’s not like a cold or flu. When in doubt about something please use caution.

It’s important that your wife finishes her entire vaccine series so she can develop strong and higher antibodies and protection. Your son already has strong antibodies to protect him. Please try not think about the worst case scenario. Hepatitis B is preventable with a vaccine that’s safe and effective.

It’s normal to experience viral load fluctuations. We all experience it from time to time. 820 is considered a very low viral load. Anything above 2000 is considered abnormal or high risk, plus a high AST/ALT and abnormal ultrasound then there should be a concern.

I won’t test monthly. Try every 3-6 months. I will strongly encourage you to seek care so you can get help with your condition. Best, Bansah1

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@Bansah1 @john.tavis Thank you so much for your support.

I got your point that we need to take it easy as it is a long journey with it. Also as per my understanding we need to focus on the precautions majorly for unvaccinated persons not for vaccinated persons( who has developed sufficient antibodies).

Now i want to ask about present and upcoming treatment and functional cure.

In present treatment except NA therapy, should i go for interferon as i have read it can help in achieving hbsag loss or lowering the hbsag level in body. What is the success rate?

Also one more question regarding upcoming treatment bepirovirsen. As they declared that 20% patient (who had hbsag <1000 IU/ml) achieved functional cure and around 50% experienced drop in hbsag level. But in the patient who achieved functional cure after 6 months hbsag rebound. So my question is can they take bepirovirsen treatment every year so that their hbsag will remain not detected always?? Is it possible to take bepirovirsen every year to keep hbsag low or not detected??

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Dear @Rohit

@Bansah1’s advice is very good–I agree fully with him.

To answer your question about razors, etc. That recommendation is for an abundance of caution–it is better to do something simple like that than have an unpleasant surprise if the person you are sharing the items with becomes immunosupressed (for example, from an organ transplant or a measles infection).

Please don’t over-think scenarios out of loving worry for your family. It is best to remember the fundamentals about HBV and manage situations where risk is present

HBV transmission probability is roughly proportional to viral levels (i.e., it is not a Yes-No thing, but a probability). People with very low viral levels have a lower chance of transmitting than people with moderate or high levels, but the risk of transmission is present even with low viral viral levels.

HBV is transmitted vertically (infected mother to baby), through direct blood contact, and sexually. It is not transmitted by casual contact like playing with your child, giving them a kiss, or sharing a spoon while eating ice cream. Tears, saliva, and sweat are not infectious if they do not contain blood.

A vaccine titer of over 10 mIU blocks infection extremely efficiently. Vaccine titers can slowly drop over many years, so people who live with someone who is HBV+ should have their anti-HBs (ie, HBs antibody) levels tested every few years.

HBV levels can vary with time, both going up and down, and the range of numbers can be from very low (<100) to extremely high (>10^8), so don’t worry about small fluctuations in viral levels at your routine monitoring visits–only long-term trends and big changes (~5-10 fold) are things to worry about.

Always discuss your concerns with your medical care team. They are there to help you!

I hope this information helps you adjust to your new situation, and I wish you and your family the very best.

John.

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@john.tavis Thank you so much for your support.

I got your point that we need to take it easy as it is a long journey with it. Also as per my understanding we need to focus on the precautions majorly for unvaccinated persons not for vaccinated persons( who has developed sufficient antibodies).

Now i want to ask about present and upcoming treatment and functional cure.

In present treatment except NA therapy, should i go for interferon as i have read it can help in achieving hbsag loss or lowering the hbsag level in body. What is the success rate?

Also one more question regarding upcoming treatment bepirovirsen. As they declared that 20% patient (who had hbsag <1000 IU/ml) achieved functional cure and around 50% experienced drop in hbsag level. But in the patient who achieved functional cure after 6 months hbsag rebound. So my question is can they take bepirovirsen treatment every year so that their hbsag will remain not detected always?? Is it possible to take bepirovirsen every year to keep hbsag low or not detected??

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I am a scientist, not a physician, and I cannot give specific treatment recommendations. Please speak with your medical care team to develop a plan that works for you.

Bepi is not yet approved for use (but I think it will be approved relatively soon), so we cannot speculate on what the approval conditions will be, and they are likely to vary at least a little bit from country to country.

John.

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@john.tavis Sir, i know that you are a scientist and have more and more knowledge and experience in hbv field, that’s why i am asking to you about bepirovirsen process as in some patients hbsag came back with low levels after 24 weeks of bepirovirsen treatment. I am curious to know and a general question that is it possible that after 48 weeks bepirovirsen therapy can be given again or it is a one time therapy in life??

What do think and suggest?

Thanks

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Hi @Rohit,
I agree 100% with @john.tavis. There is still a lot we don’t know about Bepi, so it is impossible to predict or give advice on a medicine that is still not approved and in circulation yet.

Please, treatment decisions should be done in collaboration with your doctor. Avoid buying medications for your usage without receiving any advice from a medical provider. I strongly encourage you to seek a medical help and guidance regarding your case. It will serve you well, rather than following Dr. Google an the internet.
Best, Bansah1

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Thank you very much @Bansah1 . Dr. Google is a good one, hahaha.

Now i want to ask you personal health questions.

Before diagnosis of CHB in march 2026, i was alcoholic and smoker too. I used to consume heavy alcohol like 3-4 large beers(660 ml each with 8% alcohol) or 5-6 pax(60 ml each) of whiskey 4 days in a week from last 17-18 years and also around 7-8 cigarettes per day from last 18 years. But i am also surprised and by god’s grace my Fibroscan is as normal as non alcoholic and non smoker.

@Bansah1 @ThomasTu

Kindly help to analyse the fibroscan whether i am correct or not?

Fibroscan values:

image
image1170Ă—747 159 KB

After diagnosis, in the last 4 months i drank no alcohol because i was scared very much but yes 3-4 cigarettes per day i am smoking. Now i am very frustated with daily life. So what amount of alcohol can consume in a week?

Q1: I have read that consuming alcohol increases the viral replication directly, is it true??

Q2: 3-4 beers( 330 ml each with 5% alcohol) is safe or less harmful in a week?? And what about cigarettes as i smoke 3-4 cigarettes each day? Will this be ok for a long run or need to make it lesser??

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Hi Rohit,

4.2kPa is the normal range of liver stiffness and is consistent with minimal fibrosis. This is great news!

To answer your other questions, the less alcohol and cigarettes you consume, the better. There isn’t a “safe” level, it is all a sliding scale. I myself have essentially cut out all alcohol out of my diet, and I do note that I feel better.

Cheers,

Thomas

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Thank you so much for kind advice.

One important question is does alcohol consumption increases the viral replication in body? Does alcohol have direct impact on viral replication?

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@Bansah1 @et5656 @ThomasTu @john.tavis Does alcohol consumption increases the viral replication in body? Does alcohol have direct impact on viral replication?

Also does alcohol consumption in moderate amount have the direct negative impact on working of NA therapy?

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In my layman’s view, alcohol affects the liver, by causing inflammation and severe damage (increasing scarring). Because the liver also plays a role in our immune system, yes over time it can. A weak immune system could lead to an increase in viral load. Alcohol might not directly affect the antiviral, but it will affect the liver by increasing inflammation. This could possibly lead to severe liver damage and the antivirals may not be effective in those conditions. Our immune system and antivirals helps keep hepatitis B virus in check and a weakened immune system could not continue to provide such protection.

The lesson is that no amount of alcohol is good for the body over time. It might be fine right now and not affect your viral load or antiviral, but over time it can cause severe liver damage and issues.

This my take as a fellow patient, not as an expert. Bansah1

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Hi @Rohit

I know of no data saying that alcohol consumption interferes with NA therapy or enhances HBV replication.

However, as @Bansah1 remarked, alcohol is a hepatotoxin (ie, something that can be toxic to the liver). As such, it should be used in moderation even by people without other liver diseases, but people with any liver disease or infection (HBV, HCV, HAV, autoimmune hepatitis, etc.) should avoid alcohol or use it very sparingly if they cannot fully abstain. The underlying liver disease/infection will be damaging the liver, so adding another source of liver damage such as alcohol can be harmful even if the amount of alcohol consumed would be tolerated by a person without liver disease/infection. In short, it is better to be safe than sorry.

John.

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@john.tavis @ThomasTu @Bansah1 hello all, hope you all are doing good there.

My question is if someone has hbsag<1000 IU/ml and dna viral load is not detectable by pcr can he/she still transmit infection to others by blood?