I have a few questions about being an inactive Hep B carrier:

General Discussion
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(reposting here in the General Discussion forum as I mistakenly initially posted in the Introduction/Orientation forum but deleted it to repost here instead)

Hi all- current inactive Hep B carrier and I had a few questions:

  1. I saw some talk about Hep B Carriers and and link to infertility for men. Anyone have any specific and reliable stats surrounding this? Any other men here who are carriers themselves who have easily had children, or was it a struggle?
  2. If you’re an inactive carrier and have a low / undectable viral load, does this equate to less of a chance for liver cancer/disease/etc.?
  3. If you’re an inactive carrier and have a low / undectable viral load, does this equate to less of a chance of your Hep B becoming active?
  4. My current status for my Hep B readings is below. Is there a chance that either of the “Reactive” results could become non-reactive (not in terms of future advancements in Hep B cures but simply where we stand today, is it possible that either of those reactives may one day become non-reactive? How about the opposite, is it possible that my non-reactive may one day become reactive?).
    ->Hepatitis B Core AG IgM: non-reactive
    ->Hepatitis B Surface Antigen II: Reactive
    ->Hepatitis B Core Total: Reactive

Edit: Also, I was told I’m an inactive carrier. But if by my results it seems I’m an Active carrier and not an inactive like I believed I was, please do let me know

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Dear @Anon2023,

This has been addressed this in other threads: Having children and Hepatitis B - #69 by ThomasTu

Yes! People with low inflammation and low/undetectable viral loads have lower chances of progression to liver cancer and liver disease.

Hep B Surface antigen can turn from reactive to non-reactive in a small number of patients (~1% per year).

Activity is based on inflammation. If your ALT levels are persistently normal, then it is accurate that you are classed as an “inactive carrier”

Cheers,
Thomas

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This has been addressed this in other threads: Having children and Hepatitis B - #69 by ThomasTu

Thanks! I had read through some of that thread and forgot that I bookmarked it to continue - it’s a long one but a good one, looks like a lot of people were sharing success stories. From what I can tell it’s just a slightly higher risk of infertility - which is nice. Do we know if lower/undectable viral loads correlate to less of a chance of infertility, or is there not enough research on that?

Yes! People with low inflammation and low/undetectable viral loads have lower chances of progression to liver cancer and liver disease.

Very refreshing to hear! Sounds like my chances of liver cancer or disease from my status as a Hep B carrier are just as likely as my chance of getting any other cancer or disease due to consuming a modern day American diet? (kidding, I try to be as healthy as possible not just for my status as a Heb B carrier, but for myself in general). According to the Hep B foundation, individuals chronically infected with hepatitis B have a 25% to 40% lifetime risk of developing liver cancer, which sounds a little scary. Do we have stats for those w/ lower to undectable viral loads?

Hep B Surface antigen can turn from reactive to non-reactive in a small number of patients (~1% per year).

It’s small - but the chance is there, so I’ll be optimistic :sweat_smile:

Activity is based on inflammation. If your ALT levels are persistently normal, then it is accurate that you are classed as an “inactive carrier”

OK I’m a little concerned now. But maybe I should not be too concerned until I get advice from a professional / get to chat with my doc…I just looked at my most recent lab results from back in August of this yr and it looks like I have a weird ALT level… Is this the value you are referring to? It’s 22.0 but says normal reference is either 752 or 7.52, can’t tell lol. Nonetheless, that seems off…

image

Now, I will say, in that same month, I got an abdonimanl ultrasound just to ensure all was well and my comments on the result are below. Essentially, seems my liver was normal

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Also, I have another ALT level from some bloodwork back in 2016 in which my value was 23, so just about the same as my 2023 value, although this normal range seems more refreshing to see vs the range they have on my 2023 results. Maybe I shouldn’t panic…this was done at 2 different labs and clinics so maybe their way of quantifying normal ranges is different…

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Hi @Anon2023,

I don’t think much is known about how Hep B causes this lower fertility levels, so I can’t comment on this.

Previous studies have estimated HCC rates to be ~once per 1000 person-years in people with <300 IU/mL (https://jamanetwork.com/journals/jama/fullarticle/202137). So every year, people with <300 IU/mL would have 0.1% chance of liver cancer, which is very low.

The normal reference is supposed to be “7 to 52”. Your reading of 22 is within the normal range and does not indicate any current liver injury.

Hope this helps,
Thomas

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Gotcha - and on the topic of liver disease / cancer, I was reading some stuff online and came across this source (Hepatitis B - Disease Prevention and Control, San Francisco Department of Public Health) which stated the following:

“In chronic hepatitis B infection, the liver becomes inflamed and scarred over a period of years. However, the speed at which inflammation and scarring take place varies between people. Some develop severe liver scarring (cirrhosis) within 20 years. In others, liver disease progresses slowly and does not become a major problem during their lifetime”

So is this stating all individuals with Hep B, whether active or inactive carriers, will eventually start to undergo liver inflammation and scarring throughout life? I noted the last part says that for some it’s more slow and may not be a major issue for them during their life, but it still seems to indicate that it will be the case for everyone who has a chronic infection. Am I understanding that right? Should I expect that overtime, whether slowly or rapidly, inflammation/scarring is the ultimate outcome for my liver?

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I think everyone is different. There are people who are older with inactive HBeAg-negative infections that have no obvious liver damage. Liver damage is not inevitable with Hepatitis B.

Hope this helps,
Thomas

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Noted! But in general, if I understood correctly even inactive carriers are at risk of liver damage? Or is it just those with active Hep B who are at risk of liver damage?

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Yes, people with normal ALTs can still have liver damage progression. Liver inflammation can happen between blood tests or at such a low level that it can’t be detected. However, progression is slower than if there is raised ALTs. Therefore, it is important to maintain monitoring to pick any damage up (e.g., by fibroscan or raised ALTs compared to your past tests).

Hope this helps,
Thomas

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Happy belated new year.
Once again thank you so much for the good work you are doing here.
I have a Viral load of less than 1,000 iu/ml. Im hep b e antigen negative.
I have normal alt.
My surface antigen is 6,000.00
I’m currently on Tenofovir.

What are my chances of clearing hepatitis b if I add peginterferon?

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Hi @kenyan,

Happy new year to you too. My understanding is that low HBsAg levels (at least below 1000IU/mL) are likely to clear HBsAg.

Thomas

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