Increasing HbsAb and better ultrasound along with increasing Glucose

I am 45 and diagnosed with HBV 10 years ago, probably having it since birth. I have been on Entecavir for the last 10 years.

  1. The HBV viral load has been TND since I started the treatment.

  2. HbsAb was also insignificant but this time its increasing,

    01/2013 <1.0
    10/2013 <1.0
    1/2014 <1.0
    7/2014 <3.1
    1/2015 <3.1
    7/2015 <3.1
    1/2016 <3.1
    12/2020 0.7
    5/2021 0.8
    4/2022 4.3

  3. Ultrasound was always - “The liver shows coarse echotexture and diffuse increased echogenicity”, this time its - “Echotexture is normal. Surface is smooth”

I noticed more than 5% weight loss without any lifestyle changes and was always feeling hungry, hence blood work and Glucose came very high - 350, so was diagnosed with diabetes.

I am guessing that diabetes caused my body to burn all the fat in my liver and hence it shows a smooth surface on ultrasound. At the same time HbsAb increased to 4.3, not sure what is causing what. Even though HbsAab is still not at where it should be, should I feel happy about the fact that it’s increasing? or am I reading too much into it?

Any thoughts?

My doctor immediately started me on metformin which hopefully should keep diabetes in control…

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Dear @hepb_user,

Thanks for your question and it’s great to hear that both your viral load is undetectable, your HBsAb is coming up, and your liver texture is normal. This is great and looks like you’ve cleared the chronic infection without detectable liver damage, it is definitely something to feel happy about.

Regarding the diabetes, that’s not usually how things go. Diabetes is generally associated with fatty liver disease. The coarse ultrasound is usually a marker of liver fibrosis, not liver fat. You should talk to a doctor specialising in diabetes to provide you with advice on it.

Hope this helps,

Edit: As described by other clinicians on these forums, echotexture by ultrasound isn’t a very accurate measure for liver fibrosis. It may be better to get a fibroscan to confirm the level of liver fibrosis.

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I’m not very well versed in understanding the lab result.
If he has been a chronic hbv patient for 10 years, his result of HbsAb increased to 4.3, does this mean he is cured? surface antibody?
He did not take metformin before HBsAb? Is it after? I’m little confused as I have not seen anyone being cured from chronic hbv… although there are cases, isn’t this extremely rare?
Am I not understanding this right?
Please correct me and thank you so much!

Dear @catcher.007,

The loss of HBsAg is known as functional cure. This can occur in people with Hep B at a rare rate (~1% of people per year), but does happen.

Hope this helps,

But - what is your HBsAg (antigen) level? Before my treatment, my HBsAg levels were very high, above 25000 (and was probably much higher, but it was beyond the lab limit) - yet, my HBsAb were not zero (though below lab threshold, so treated as if I didn’t have any).

Hi Thomas,
You once posted an article about metformin.

There is an interesting study showing that metformin decreases HBsAg, HBeAg and HBV DNA levels in a petri dish: 1.
a clinical trial that is ongoing in China: Metformin as Add-on to the Standard Therapy in Patients With Chronic Hepatitis B - Full Text View - 2.

I just asked my liver specialist if I can take metformin. I don’t have diabetes. He told me no.
There are people out there who take a small dose of metformin without diabetic condition for health reason.
Do you have any opinion on relationship between metformin and HBV? Do you think it’s safe to take a small dose like 250 to 500mg/day for people without diabetes?

What about NMN (Nicotinamide Mononucleotide), an NAD (Nicotinamide Adenine Dinucleotide (NAD+))booster?
I think resveratrol is probably not good for hbv…

Any comments? Thank you so much!

Dear @catcher.007,

I think it’s very difficult to advise you about the safety of taking a drug that you’re not indicated for and that is still very experimental for use in your condition. I think it is best to take your liver specialist’s advice on this as they have examined you and have your medical history to hand.


ok, thank you for your comment.

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Just as a follow-up to this study, there has just been this research out showing that in people, there is no lowering of HBsAg achieved by metformin: Randomised controlled trial: effect of metformin add-on therapy on functional cure in entecavir-treated patients with chronic hepatitis B - ScienceDirect


Hmmm, I guess petri dish study and people study are different.
Good to know. Thank you very much!

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