Hi @availlant based on my original post, I was told I have very low HBV DNA results too which was refreshing. My ALT, bilirubin, and albumin all have normal levels and did not flag as being out of range (they are 33 U/L, 0.8 mg/dl, and 4.8 g/dL respectively). Although I’m unsure what INR stands for…and could not find it on my results.
But, my white blood cell count, MPV, and Absolute Neutrophils are all out of range. Is this worrisome in relation to my status as a Hep B carrier?
Hi @Anon2023 ,
INR stands for international normalized ratio. It is a test which measures indicated how long it takes your blood to clot. Many factors involved in the clotting process are produced by the liver which is why this measurement can indicate liver dysfunction.
Changes in which blood cell count (and neutophils - which are a subset of white blood cells) can occur with chronic HBV infection). Your platelet and mean platelet volume (MPV) are essentially normal. These are not particularly worrisome in your case but they should be followed in your next blood test.
Thank you @availlant Interesting to know that, I got a liver scan back in Aug of 23 and my liver was showing completely normal. I’ll definitely follow-up. But in short, nothing to worry about concerning my WBC, MPV, and Absolute Neutrophils, correct?
Dear @Anon2023 ,
I would not worry about your hemaotology results. However, these should be followed-up at your next visit along with HBV DNA and liver function.
@availlant will do, thank you for the insight! It seems my liver results were good, from my understanding:
I also had a liver scan back in August and my liver looked normal.
Given all that, and my viral load from my initial post, is it safe to say I’m doing OK for someone whose a Hep B carrier? My dr. said nothing to worry about, but I’m a worrier and always just want to make sure. And he’s also a primary physicican, not a specialist, so insight from a specialist like yourself would be nice
Hello @Anon2023
I’m not a medical expert but have lived experience of HBV of 40 years +
To lessen your anxiety whilst waiting for @availlant to reply, your results look very good.
They are all within the normal limits.
I have the same concerns as you. I am being looked after by a general practitioner, not a liver specialist. So I understand your worries.
If you want more information or knowledge we have lots on this forum.
Or any questions, don’t hesitate to ask. 
Greetings to you sir… Just found out I got diagnosed with HepB I had to do get a test done fast…please can you interprete this result for me? Is it a serious concern?Thanks in advance.
Dear @Isreal,
This is the same diagnostic test (for the presence of infectious virus in the blood) with the results presented in three different units of HBV DNA (IU/mL, copies /mL and log IU/mL).
Your shows that you have active HBV infection does not tell us if it was recently acquired (with a better chance of self resolution) or chronic (where the infection will likely persist for many years).
We cannot know if your chronic HBV infection is actually chronic hepatitis without having some additional tests of your liver inflammation. Do you have these test results (a liver ultrasound and or an ALT test)?
There are excellent medications available to suppress your infection so that you can live a long, productive and happy life. Is is unfortunate that you have HBV infection but you should not be worried.
However, with this test result, your doctor should have scheduled the additional tests I mentioned above to see if you should start medication.
Dear @availlant and @ThomasTu first of all, I want to thank you guys for you efforts and answering to all questions, I appreciate it! Now, let me share my story, and will be very grateful for your advices!
Male 38 years old, currently living in Germany. A year ago, from a random blood test, it was found that I have chronic hepatitis B. I have no idea how or when I got infected.
Hbsag positive and HBeAg-negative. Since then I have been struggling with depression, I have two children and I constantly think about them. After I found out about the diagnosis, every 3 months I do blood tests, enzymes, ultrasound and viral load.
These are all my results:
June 2023: Alt and AST normal, below 20. Viral load 240 IU /ml
September 2023: Alt and AST normal, below 20, Virus load 2200 IU/ml.
December 2023: Alt and AST normal below 20, Virus load 3300 IU/ml.
March 2024: Alt slightly increased to 29 and AST 15, Virus load 1800 IU/ml, AFP 3.2. Hbsag quantitative 2029, Albumin 49
June 2024: Alt 25 and Ast 19, Virus load 1100 IU/ml.
August 2024: ALT 19 and AST 15, Virus load 1900,afp 3,2, Album 48, Ultrasound normal, only slight steatosis.
September 2024: alt and ast under 20, Virus Load 3700
The first ultrasound examination(June 2023) revealed a fatty liver. Since then, actually since I found out about hepatitis, I don’t drink alcohol, I try to eat healthy, and I do sports. At the last ultrasound, the steatosis had decreased significantly.
I keep reading about the new world recommendations and guidelines on who should be treated for chronic hepatitis b and I am very confused. Some say that with a viral load above 2000 IU/ml and high enzymes, it should be treated. For me, there are results that exceed the limit of 2000 (especially last one) , but my enzymes are always normal.
I would really appreciate it if you could take a few minutes and give me some advice and opinion. What do you think about my status, am I an active or inactive carrier. Do you think with these results I should push for therapy? If not, what are the risks? My doctor advised me to keep monitoring (even in every 6 months) and not starting treatment. That last result make me little nervous, are those fluctuations normal and the loads are high? I would really appreciate it if you could give me your opinion and advice!
Dear @ka85 ,
There is no shame in your diagnosis; many people found out they have chronic HBV this way. There is no way of knowing how you got it. It is even possible that you may have gotten it from your mother at birth. This should be investigated if possible, especially if you also have siblings. Your spouse and children should evaluated for HBV infection and vaccinated for HBV as soon as possible if this has not already happened.
You have chronic HBV infection which is borderline inactive. Persons with inactive HBV are not at risk for developing liver disease and also have a lower risk for liver cancer than persons with active chronic HBV infection. Your HBV DNA titer is quite low for someone not taking NUC therapy.
Your doctor is following current EU guidelines which indicate withholding treatment until some form of liver disease becomes manifested. Your minor ALT elevation could be related to your fatty liver.
The debate in the field regarding when to start treatment for patients comes from the ability of the virus to lay down copies of itself in the chromosomes of your liver cells over time. This increases the risk of liver cancer over the lifetime of your infection. However, the rate of this process will by much slower for someone with such a low level of viral replication such as yourself. Nevertheless, the risk for liver cancer down the road is still increased. There are those in our community who advocate for the treatment of HBV function as soon as it is diagnosed as we know that NUC therapy is more effective in preventing liver cancer the earlier it is started. This is a discussion I encourage you to have with your physician.
Hi @availlant, I really want to thank you for your time answering my questions!
Yes, from the moment of my diagnosis, we did immediately vaccination for my wife, my kids are vaccinated at birth, so actually I think they are safe.
You said that my infection is borderline inactive, do you think that those result sometimes above 2000 can reactivate the virus? Because I have reading that inactive carriers are with viral load below 2000. Do you think that these fluctuating from 200 to 3700 are normal for a inactive carriers? I know is really silly to ask you, but with these levels, what is my percentage for a liver complications, per year, or for 10 years, idk…
Yes, I already saw that a lot of people recommended starting treatment after diagnosis even with low DNA, but in this case with low levels, will the benefit of treatment be tangible? I am not against the therapy, even I told my doctor that I can start immediately if he say so, but at these levels, isn’t better to wait a bit, because I might need the treatment more in the future. But in the same time I don’t want to put myself in the risk. Probably again stupid question, but if you were in my shoes, given the results, what would your decision be?
I really have so many questions, sometimes I am so confused. Really sorry for my long post!
Thanks!
Dear @ka85,
If your wife and children were vaccinated than they have already been screened. So yes all is good on this part.
Yes it is normal for HBV DNA levels to wobble which is why you are “on theedge” of inactive chronic HBV.
The reason to treat now instead of later (even when you don’t have liver disease or liver inflammation) is to minimize as much as possible the integration of HBV genomes into your chromosomes (which is still occurring to a small degree with your low level viral replication). This ultimately has the best effect on lowering the risk of HCC in the long term.
The efficacy of the treatment in controlling your viral replication will be the same whether you start it now or later.
Thanks once again for your answer @availlant!
On my next appointment, I will probably ask and push a little my doctor for treatment, and will see what he is going to tell me. I guess, it will be difficult to get a answer about what kind of risk I have in long term if I stay with these levels.
Also, I use to running almost every day for about a 1,5-2 km., but I also had read, that people with chronic hep b need to be careful with exercises. Do you think is a good idea to reduce my exercises, or to stopped them?
And last question, is there any promising trials, and how actually is the progress finding the cure? I had read about the TherVacB here in Germany that sounds promising. But I don’t know if will be available for a people not on a therapy…
Greetings from Germany and one more time thanks for your time!
Dear @ka85,
There is no issue with exercise for people with even mild liver disease so I see no issue with continuing your running. If anything, this helps with your immune function.
To date the only agent to give high rates of durable functional cure are NAPs. These are currently in use on a compassionate basis for persons with advanced liver disease and HDV co-infection where they are working very well. We even have a patient in Germany who has responded very well to treatment.
Unfortunately, there have been several attempts at therapeutic vaccination, even in combination with siRNA as the TherVacB group are proposing. These have all failed. Preliminary clinical trial data with TherVacB are not encouraging but we will see how things progress with combination studies.
Thanks @availlant
I thought that the TherVacB still had no information from the first clinical trial, but apparently, unfortunately, this is not the case.
Last question, most likely my doctor will want us to continue with the monitoring, but for several years my kidney function has decreased slightly, and I read that some drugs have a negative effect on the kidneys and bones. Which therapy is appropriate in this case, if it comes to therapy?
Thanks!
Dear @ka85 ,
Yes preliminary data from TherVacB was presented at the HepDart meeting in 2023.
If you are already experiencing a decline in kidney function then TAF (tenofovir alafenamide) should be the drug considered.
Thanks Andrew, much appreciated!
If you don’t mind, after my next appointment which is in December, I would like to reach you again, if I need some advise! Greetings!
