Recently diagnosed, anxious and seeking advice/ reassurance

What do my lab results mean?
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Hi all,

I have been recently diagnosed and I have a few questions and mainly looking for some reassurance and advice - this may be a long post.

This whole experience has been so difficult for me and I have been unable to talk to anyone about this just yet, I understand how morally wrong this may be but I feel like I will be riddled with judgement and I am very scared that my family and boyfriend who I’ve only been with for 3 months will leave me.

In June my bloods were taken and my diagnosis was e antigen negative- chronic hep b and my viral load was 11,500

I got tested again in August and my viral load increased to 18,400 - both times my Dr said my liver biochemistry is normal.

I got put on antivirals in August and now my viral load is <10 IU/ml and my liver biochemistry is still normal as mentioned by my Dr, I just want to know if this is a good thing? and did my viral load drop this quickly because my levels were not very high to begin with, I know this seems like common sense but again, I am seeking all the reassurance I can get.

My second question is, what is the difference between someone who is e antigen negative and e antigen positive? And does everyone who is e antigen positive eventually go into the negative stage?
Does me being e antigen negative put me in a worst off position?

All information ive seen online is that people who’s viral load is over 20,000 is put on medication and because I was lower than that, I am confused and anxious as to why I was given meds.

I found out about this because I donated blood, in the letter they wrote me, it stated the following:

“Tests have shown that you have developed antibodies to part of the virus, called ‘e’ antibodies or anti-HBe. These antibodies are not able to overcome the infection and eliminate the virus from your body, but they make you less infectious to other people, and at less risk of developing health problems yourself.”

^^ Is anti-hbe the same as e antigen negative? And how come my doctor has not mentioned anything about antibodies, is that a good thing or in my case does it not make a difference?

My final question is, (I asked the same question to someone from a helpline here in the uk and looking for other options) is it true that t your viral loads have to be in the hundreds of thousands - millions in order to transmit this virus sexually?

I may have other questions along the line but any information will be appreciated.

Thank you!

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HB e Antigen is present when there is viral replication and HB e antibody is produced by your body in response to the presence of the HB e Antigen. Hopefully your family and boyfriend are loving and understanding and gets checked and immunized for HepB to avoid complications of HepB infection. You should follow your doctor’s instructions and take the antiviral so that you keep the virus from replicating and causing harm to your liver

Hep B Antigen Antibody

Hepatitis B virus (HBV) has several antigens and antibodies that play crucial roles in diagnosing and monitoring infection. Here’s a breakdown of the key components:

Antigens:

  1. Hepatitis B surface antigen (HBsAg): Appears first in acute infection, detectable 1-9 weeks after exposure. It’s a marker of active HBV replication and indicates current infection.
  2. Hepatitis B core antigen (HBcAg): Not directly measurable in blood due to its association with the viral core particle. However, antibodies against HBcAg (anti-HBc) are produced during infection and remain detectable indefinitely, serving as a marker of past HBV infection.
  3. Hepatitis B e-antigen (HBeAg): Typically present during acute infection, associated with high HBV DNA levels and increased infectiousness.

Antibodies:

  1. Hepatitis B surface antibody (anti-HBs): Produced in response to HBsAg, becomes detectable 1-3 months after infection. Its presence indicates recovery from acute infection and confers immunity against future HBV infection.
  2. IgM anti-HBc: A marker of acute HBV infection, detectable at the time symptoms appear and declining to sub-detectable levels within 6-9 months.
  3. IgG anti-HBc: Remains detectable indefinitely, serving as a marker of past HBV infection.

Interpretation of Test Results:

  • HBsAg positive: Indicates current HBV infection.
  • HBsAg negative: May indicate:
    • Recovery from acute infection (anti-HBs present).
    • Chronic HBV infection (HBV DNA and/or HBeAg present).
    • Immune status unknown (requires further testing).
  • Anti-HBs positive: Indicates recovery from acute HBV infection and immunity against future infection.
  • Anti-HBc IgM positive: Indicates acute HBV infection.
  • Anti-HBc IgG positive: Indicates past HBV infection.

It’s essential to note that a comprehensive understanding of hepatitis B test results requires consideration of all three tests (HBsAg, anti-HBs, and anti-HBc) and their combinations. If you have concerns about your test results, consult with your healthcare provider for a thorough explanation and guidance.

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Hi @TomPsu

Thank you for getting back to me!

If my doctor has written that my diagnosis is E Antigen Negative- Chronic HepB then do I still need to know the full results for HBsAg, anti-HBs, and anti-HBc?

Is that something that gets tested separately or is this information automatically known when they tested and it shows you have chronic hepb anyway?

Thanks!

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Hi @Mia1,
Usually a 3 test are ordered which are HBsAg, HBsAb (anti-HBs), and HBcAb (anti-HBc). If these tests are missing then your doctor might have to order them. This information is not automatic and these tests are separate so they must be included in the order. Best, Bansah1

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Hi!

Thank you, I have emailed to request these.

Sorry if this is a silly question, I’m still a little confused, these results will show if you are chronic or in an acute stage & if you’ve managed to clear the virus etc etc as I already know I have chronic hep b, what else would these test be able to tell me?

Thank you.

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Yes at first it can be very confusing with these siew of tests . Now you are armed with some knowledge so now you can ask your doctor questions after you receive the results and see how to proceed with your treatment. Many live healthy lives with HepB so live a healthy life and take care of yourself and mindful of people close to you. Your doctor may do others tests such HIV, HepA,D,C,E and others since there is a chance of co-infectuons but of course you can request other tests too which you can discuss with your doctor.

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The doctor considers all the test results to make that inference. There’s no single test to tell if someone is chronic or acute, rather they rely on results from multiple tests to inform their decisions one way or the other. Thanks

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Hey!

Thank you, so I am already on medication & I take Tenofovir, I’ve been taking it for about 4 months now and my viral loads have gone down from 18,500 to <10. I’ve never had any issues with my liver and all results have come back normal for that.

Because I’ve had quite a few test done already, I know im in the all clear for all of the above.

In my original post, I was mainly looking for reassurance as to how the meds are working in my case for someone who is e antigen negative chronic hep b.

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Welcome @Mia1

I bet you have a ton of questions! Fire away.

This is a great community and I’m glad you found us.

Your results have come down because of the medication. They we’re going up. The higher they are the more damage to your liver could be happening.

The thing with HBV is there are no symptoms of liver damage happening. That’s why we need constant monitoring. Usually 2 blood tests and ultrasounds a year.
So, it a good thing the doctor has done putting you on medication.

I’m not sure of correct numbers but know anything in the thousands isn’t good.

I have lived experience of forty years with HBV. Been on treatment about five. Live mostly healthy diet, no fatty foods or fried. Red meat doesn’t seem to agree with me.
Exercise.

Others will help you out too. @ThomasTu

I’m sorry you are having to go through this. We understand how you don’t want to share your results. I know I’m very careful who I tell. It seems to raise questions I can’t answer.

Thanks for sharing your story.
Caraline Australia

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Hi @Mia1,

Sorry that you’re going through all of this (completely understandable) confusion and anxiety about lab tests. To answer your questions:

  1. The quick reduction in viral load is absolutely expected and is a great sign that the antivirals are working. It’s a good thing and, as you say, is related to the fact that they were relatively low to start with.
  2. People who are HBeAg-positive generally have a higher viral load compared to people who are HBeAg-negative. This test is a sort of hold-over and was done before we had PCR tests to actually show the viral load. People who are HBeAg-negative are usually positive for anti-HBe antibody - essentially people in this case have had some active antiviral immune response against the virus (but not so much that the virus has been eliminated). As the immune response is the thing that drives inflammation, people in the state are more likely to have more liver disease - but if you have checked that this is not the case and your viral load is low, then the risk of ongoing liver disease progression is also low and it is a relatively stable phase.
  3. People with higher viral loads are more likely to transmit it. We don’t have very good numbers on the levels required to transmit it sexually, as these sorts of clinical trials are hard to do (as clinicians are ethically obliged to offer HBV vaccination in cases where one person is HBV-positive and the other is HBV-negative). The only numbers that are well established is that there has been no reported case of mother-to-child transmission for newborns newly vaccinated in mothers with a viral load less than 100000 - this is a situation where there is a lot of body fluid exchange and where the recipient is vulnerable to infection. This is not exactly the same situation, but should give you context about the necessary amount of exchange to cause an infection.

Hope this helps a bit,
Thomas

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Hi all!

Thank you @Caraline thank you for getting back to me, I have been lurking here for a few months and this community and the stories shared are the only thing getting me through.

How do you know that certain foods don’t agree with you? Do you have familiar symptoms you experience when you do eat red meat?

Thank you @ThomasTu for the explanations, your insights have been reassuring!

May I ask more about progressive liver disease?

My viral load has been 11k and then 18k 2 months later then I was put on meds, as mentioned my liver biochemistry has come back normal on those occasions when tested, you said that “if I’ve checked this then ongoing liver progression is low” do you mean my viral load and liver biochemistry? What other checks are necessary for people in my case or would I be someone who’s falls into liver problems if my viral load and liver test were high to begin with?

Thank you!

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Hi Mia,

Liver disease progression is usually measured by a non-invasive fibroscan test, which is a way to find out if there is scar tissue accumulation in your liver.

Hope this helps,
Thomas