Just diagnosed, confused, depressed, and looking for answers

Just diagnosed or new to the community
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Hello and welcome, thank you for creating this community, it truly has helped me understand the scale of hep b,

about myself im a 33 year old male from the MENA region, i did bloodwork’s last week with the usual std checks and noticed i haven’t checked for Hep b since last april, and as you might expect it came back positive, here are my results:

ALT 32 U/L
AST 24 U/L
ALP 84 U/L
Total serum Bilirubin 1.3 mg/dl
Direct Bilirubin 0.186 mg/dl
Indirect Bilirubin 1.11 mg/dl
HBsAg 15.41 COI ( >1 = Positive)

the last check up i did for hep b was in april last year and it came back negative, so #1 i have no idea when i contacted it, because i only had two sexual partners during that period and both tested back as negative and are vaccinated, #2 i’d like to believe i am in the acute phase and im part of the 90%-95% of individuals who reach a ‘functional’ cure.

i have told my close family and friends and people who i interact with, for some reason everyone is vaccinated except myself, and i received the usual stigmatizing response as anyone but i will deal with that later.

i went to my doctor to do more tests and i did an ultra sound for the liver, which came back to be have mild enlargement CC measured at 16.9 cm , normal outline & texture, normal Parenchymal echogenicity , hepato-renal index at 0.99, no fatty liver changes, no focal lesion, portal vein is of normal diameter

and did a pcr test to measure viral load for Hep b&c incase for cross infection (my std panel showed negative, HIV, and HCV), the pcr result should come back next week

i browsed the forum and got plenty of answers (thank you all) but would still want to learn more, assuming (hoping) im in the acute phase:

#1 is the 90%-95% ‘functional cure’ thing real? because my doctor said there was no such thing as acute/chronic hep b, all hep b is chronic and you have to medicate it for the rest of your life, because from what i read after the 6 month markup (which i still don’t know the exposure date) i was hoping i would get rid of the virus and only do 3 months check ups to see if i need an intervention

#2 in terms of lifestyle changes, i already don’t drink much and cut that out completely, reducing my smoking and with the current plan i should cut out cigarettes in a week, my diet is now whole grains, chicken and fish all cooked without oil in a pressure cooker, green juices, turmeric, ginger, my main concern is with working out, my doctor advised that i cut out the gym completely aside from cardio, i have some muscles and i don’t mind cutting back a bit but not entirely, is it true i can’t workout any longer

#3 i take supplements in terms of multivitamins, b complex, d3-k2, magnesium, pro biotics, omega 3-6-9, milk thistle, and now the doctor advised i take another ‘forte’ milk thistle supplement, i cut out protein powder and creatine, is that ok or are protein powder and creatine not harmful for the liver?

#4 as i said i do not know the exposure date and im not sure if im the first or final stages of the hopefully ‘acute’ phase, i haven’t experienced major side effects aside from fatigue, but i already have a cold so i hope it’s that, but i want to do anything possible to avoid or prevent jaundice, as i can’t cope with the stigma of it, are there any ways to help with that?

#5 i am currently taking ozempic, 0.5 every two weeks, i know it doesn’t work on the liver, but i just want to be safe, my concern for cutting it out, is that im afraid i will have blood sugar spikes that will affect recovery, is that reasonable?

#6 in terms of antivirals, i know they do not work on the acute phase (again i don’t know if im in this phase) but is it possible to take just to help even a little bit?

#7 in terms of future tests, i see people posted to do tests every 3 months, and at the same time seeing fluctuations in liver functions happen over the course of a week, is it reasonable to keep doing the tests every week or two weeks?

i’ve also posted this as reply in another discussion because i wasn’t able to write a thread

thank you for going through this thread, this community truly is a godsend : )

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Dear @Daylen ,

See replies to your questions below.

#1 is the 90%-95% ‘functional cure’ thing real? because my doctor said there was no such thing as acute/chronic hep b, all hep b is chronic and you have to medicate it for the rest of your life, because from what i read after the 6 month markup (which i still don’t know the exposure date) i was hoping i would get rid of the virus and only do 3 months check ups to see if i need an intervention

80% of people who are initially infected with HBV (acute HBV) self resolve their infection without therapy (they achieve functional cure on their own). We do a test called HBV core antigen IgM antibody to see when someone has acute infection. Generally when infection becomes chronic after 6 months, this specific form of antibody disappears. Of the 300 million or so who have developed chronic infection over the years, antiviral medication is required to suppress viral replication and prevent the progression of liver liver disease.

#2 in terms of lifestyle changes, i already don’t drink much and cut that out completely, reducing my smoking and with the current plan i should cut out cigarettes in a week, my diet is now whole grains, chicken and fish all cooked without oil in a pressure cooker, green juices, turmeric, ginger, my main concern is with working out, my doctor advised that i cut out the gym completely aside from cardio, i have some muscles and i don’t mind cutting back a bit but not entirely, is it true i can’t workout any longer

Everything you are doing here is fine and you can still workout.

#3 i take supplements in terms of multivitamins, b complex, d3-k2, magnesium, pro biotics, omega 3-6-9, milk thistle, and now the doctor advised i take another ‘forte’ milk thistle supplement, i cut out protein powder and creatine, is that ok or are protein powder and creatine not harmful for the liver?

Too much protein in you diet can be harder on your liver but if is reasonable (this seems to be the case here) there is no real issue as long as you done forget to include carbohydrates in your diet. Milk thistle (and its main active component, silymarin) do have any definitively proved activity against HBV infection. Its much better to take one of the approved antivirals in this case.

#4 as i said i do not know the exposure date and im not sure if im the first or final stages of the hopefully ‘acute’ phase, i haven’t experienced major side effects aside from fatigue, but i already have a cold so i hope it’s that, but i want to do anything possible to avoid or prevent jaundice, as i can’t cope with the stigma of it, are there any ways to help with that?

You need to have your viral load (HBV DNA assessed) to determine how active your viral infection is (this cannot be determined from any (HBsAg test). From there your doctor can better decide if you need to start therapy. This is the best way to prevent the development of liver disease.

#5 i am currently taking ozempic, 0.5 every two weeks, i know it doesn’t work on the liver, but i just want to be safe, my concern for cutting it out, is that im afraid i will have blood sugar spikes that will affect recovery, is that reasonable?

You should not stop taking any existing medications without consulting your doctor first. There is current no known issue with taking this kind of medication for people with HBV (or how are also taking antiviral therapy for HBV).

#6 in terms of antivirals, i know they do not work on the acute phase (again i don’t know if im in this phase) but is it possible to take just to help even a little bit?

Approved antivirals are indeed effective during the acute phase as they control viral replication. In cases where acute infection causes liver function uses, these antivirals are used to control / r verse these symptoms.

#7 in terms of future tests, i see people posted to do tests every 3 months, and at the same time seeing fluctuations in liver functions happen over the course of a week, is it reasonable to keep doing the tests every week or two weeks?

You should have your HBV DNA and liver function tests done every 6 months.

@availlant

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very much appreciated, thank you : )

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update:

since the pcr dna took a while to develop i went out and tested for antibodies and antigens and it at the same time received my pcr dna result and it came back as this:

HBsAg Negative
HBsAb Negative
HBeAg Negative
HBeAb Negative
HBcAb Negative

Hepatitis C RNA Negative
Hepatits B DNA Negative

which was extremely confusing, so i went and tested the antigens and antibodies at a different lab, and i got back all negative expect HBcAb and HbeAb were postive

my doctor concluded that the initial tests were false positives or i might have gotten the first test in the very last stage of an acute infection, but for him as long as the pcr test was negative then its all clear,

i asked since the test shows it has a sensitivity of 200 IU/ml, if that means the viral load could be less than 200 and it wasn’t detected, and he said thats more or less a margin of error but since it came back negative then it’s all cleared

i due to do another antibody, antigen, pcr test in 3 months to make sure nothing has changed, but i am extremely grateful and thankful of these results

will update the post once i get i do the tests again

thank you

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Dear @Daylen,

The second result at least makes sense (and your doctor’s interpretation). Based on these latest results you have HBV functional cure and are indeed in the clear. What part of the world do you live in?

@availlant

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Dear @Daylen,

Great to hear! I am sure that this is a relief for you.

If indeed the initial tests were false positives, then it may be worthwhile considering getting a vaccination against Hep B to ensure that your anti-HBs antibody titres are at protective levels. That way if you are potentially exposed in the future, at least you will know that you have the peace of mind that you are much less likely to get a chronic HBV infection.

Hope this helps,
Thomas

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as I mentioined im in the MENA region.

Im still unsure what ‘functional cure’ means, does it mean my system fought it off and the virus no longer exists, or i have but its currently dormant and inactive, if so doesn’t it mean it can reactivate again?

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Thank you,

the doctor advised that i need to redo the tests (antibodies, antigens, and DNA) two months from now, and as i said he thinks its either false positives or my system fought it off, to get a final answer

in terms of vaccinations, i don’t have my infancy vaccincation info - and don’t know where to get that info to begin with- but another doctor said that with the hep b vaccination was mandatory by the time i was born so i must have gotten it, that was also a reason why he was skeptical in his diagonsis as he assumed i was vaccinated.

the 2nd doctor i went to suggested i wait untill the three months mark (two months) from now to do the vaccination as it may interfer with the test results, im not sure how and why, and even if it does affect the results it will only be a good thing. either way im waiting for the next round of tests to get a vaccination or a booster dose, as my doctor said that both works.

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on a personal note:

im still not 100% certain of what my current status is, the 2nd round of testing was a relief but still not conclusive as the false postiive/ false negative could happen in both test cases (as it shows human error is a major factor with medical testing, also a doctors opinion has a major effect on the psyche, so if you’r doctor made things look abysmall simply consult another, as the first doctor i went to was really into stigmatizing to the point of almost insults)

what is giving me relief about this, is that hep b managable and if positive i have detected it early, so with the right treatment and changes in lifestyle (which i have started doing just because they’re healthier in general), as well as there is a hep b program in my country where mediciations, treatments and some other things are subsidized, im feeling hopefull. i have felt the frustration and the punching in the dark that almost everyone in this forum went through, and i really hope and wish and pray for good health, peace of mind, and proper management for anyone who’s going through this : )

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Hi @Daylen,

Yes, if the doctors still aren’t sure which of the tests are false positives, it may make sense to delay. The vaccine is made up of virus protein, specifically HBsAg (the same marker we use to determine if someone has an infection). So if you are vaccinated, you may be able to detect HBsAg from the vaccine.

Hope this helps,
Thomas

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Thank you for your kind words.

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Update:

as my doctor and almost everyone else advised, i need to do an HBV panel + PCR after 3 months from the original tests, just did a PCR DNA Hep B tests as well as the antigens and antibodies and got the results, will add previous test results for those who didn’t read the initial post,for context i did a quarterly bloodwork on april 10th and received a positive HBsAG result, which led to the below results:

Date HBsAG hbsab hbeag hbeab hbcab PCR DNA Lab
10 April positive Lab a
15 April negative negative negative negative negative Lab b
15 April negative negative negative positive positive Lab c
15 April Negative Lab b
15 June negative negative negative negative negative Lab b
15 June Negative Lab b

i have yet to visit the doctor as they’re booked until the beginning of next month, so i will chat gpt for now, from what i can tell the intiial positive HBsAG was a false positive, i don’t think i will ever know if true nature of why the original HBsAG came back as positive or why the HBcAB positive in one of the tests, if it was an acute infection or if i were vaccinated when i was an infant and the test panel confused one thing for another, i assume the next step would be a Hep b vaccine but i need to check with my doctor once again.

its a major sigh of a relief, will keep you updated once i have my doctor appointment, wishing safety and ease of mind for all within this forum

thank you

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Dear @Daylen,

Glad to hear that these ended up being negative results.

As you mention, the negative anti-HBs suggests that you may still be susceptible to future exposures, so the general recommendation is to be vaccinated - which could help with peace of mind too.

Hope this helps,
Thomas

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