I’m very confused

Hello everyone, I live in Nigeria. I’ll like to connect with a community here in Nigeria.

I have just been diagnosed of HeP B. My ALT is 42U/L and my viral load came out as 3005 IU/mL.

I don’t know how long I have had it but the doctor said I should wait for 6 months before I test again. He said it’s still acute without putting me through further test.

After reading a lot of resource online and on here, I’m scared and I think a viral load that high means I should start treatment immediately. Please I’ll appreciate every insight I can get as regards this. I can’t talk to any other person asides this. Living in Nigeria with this condition will make you stigmatized.

Hi Intime009,
Welcome to the platform. I think before one is treated there are multiple parameters (tests results) considered beyond just ALT and viral load. Your ALT is low but viral load is high. I will advise that you take it easy and not stress yourself out. It feels scary and fearful, but please don’t beat yourself out. Your doctor may order more tests after 6 months to determine where things stand and go from there. Our experts will weigh in and offer
their insights soon. Best, bansah1

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Dear @Intime009,

First, welcome to the Community, and I’m sorry to hear you received this diagnosis.

I’m an HBV researcher and can shed a bit of light on your questions.

This is a modest HBV titer, not a very high one. Scientist tend to count “genome copies per ml” rather than IU, with 1 IU= 6 genome copies. That gives a reading of 1.8^5 genome copies, which is far, far lower than HBV can reach. Your ALT levels are not high (the exact definition of “high” varies by community), but at worst this is a very mild elevation. That means you are not experiencing a large amount of liver damage now, which is good.

HBV infections can be either acute or chronic. An acute infection is right after you get the virus, and as an adult, you have a ~90% chance of getting rid of the virus by yourself if this is truly an acute infection. However, without additional tests, it is impossible to say if it is acute or chronic. A chronic infection is when the virus just stays in your body indefinitely, and that is the more serious form of an HBV infection because chronic infection can cause serious damage to a person’s liver. Your doctor is waiting 6 months to test you again because the definition of a chronic infection is an HBV infection that does not go away in 6 months. This delay in possibly receiving treatment is normal. HBV disease (called Hepatitis B) progresses very slowly, typically taking many decades to cause big health problems. Therefore, waiting to see if you get rid of the virus naturally is the right thing to do now given that you are otherwise healthy.

As to the stigma—this is terrible. This is just an infection by a virus, and viral infections happen all the time in everyone. You have a medical issue that is not your fault, any more than getting a head cold or breaking your leg in a fall would be. It is wrong for people to stigmatize you. Fortunately, you have found a welcoming community with whom you can share your concerns and seek information. Welcome, and we wish you the very best!



Thank you so much for your reply.

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

What other tests can I get done to determine if this infection is Acute or Chronic? Like I said, I don’t know how long I have had it, I just got a diagnosis last week. I will like to do a test so be sure so I know where I stand. If I have to wait it out or start treatment. As of now, I don’t have any symptoms whatsoever. I’ll look forward to your reply. Thank you for being a part of this community and for shedding more light for people like us.

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Unfortunately, there is no definitive test to distinguish acute from chronic infection. The standard way to do it is to test again after 6 months. Please try not worry too much about this delay (I know that is easier to say than do!)—it is standard clinical practice and we are here to support you in the mean time.



@john.tavis Thank you for your kind words. I’ll keep in touch. Thanks again.

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Don’t mention, Intime009.

@john.tavis Hi John, here is the result of my LFT that came out today. I don’t know how to interprets this. It says my protein is high and Alkaline phosphate is low. Please can you help me interpret what my whole result means? Thank you so much.

@john.tavis Here is also a copy of the one I did 11 days ago. There seems to be a lot of changes when I compare it to the most recent one.

Dear @Intime009,

I am a research scientist, not a physician, so I cannot give medical advice. Overall, these appear to be nearly normal results. However, detailed interpretation needs a physician.


Okay. Thank you so much. If there’s a physician or nurse that you can help tag to this result in the community please do. Thank you for all you do for the community

Hello @john.tavis @ThomasTu @PuallyHBV @Bansah1, How’re you doing today?

I’m 32 years old. No family history liver disease or cancer.

Here is a follow up on my case and the results. I did a fibroscan today and it came out as 4.9Kpa
Also my;

HBV viral load is 6700IU/ml
HBsAg quantitative is 29,600 iu/ml
HbeAg is negative
LFT is normal and perfect
2 ultrasounds I did 2 days ago came out normal too.

Do I fall within treatment on antivirals or I should keep monitoring?

My first diagnosis was exactly one month ago.

Hi @Intime009 ,
When it comes to treatment it is at the discretion of your provider and what they think based on your results. They consult with the guidelines and your results to make that decision. I have the believe that any patient that want to be treated should be given that opportunity. But that is not what the guidelines suggest. At least there is a movement led by providers to update or refine the guidelines. Each provider is going to take have a different approach. I will urge you to talk to your provider about this if you have not done so already. Best, Bansah1.

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Hello, @availlant @ThomasTu @john.tavis Can you please say something on this. I want to know what to do next. Thank you so much.

Dear @Intime009,

I sympathize with your unease and uncertainty, but I am a scientist, not a physician. I am not qualified or legally permitted to give medical advice. I strongly suggest you have a good conversation with your care provider. S/he will will be able to give you the guidance you seek.

I wish you the very best.



Hi @Intime009 ,

See this post here for some discussion:

According to official guidelines in NA and EU, you would not be treated as you do not have evidence of liver disease. According to the newer Chinese guidelines, you would be treated.

As John has said, you should have this dialogue with your physician. You always have the right to seek multiple medical opinions if you need to in order be more comfortable with your treatment program.

Best regards,