Recently diagnosed Hep B (planning pregnancy)

[Maja]

Hi everyone, nice to meet you!

My name is Maja, I’m 35 years old and from Poland. I was diagnosed with chronic Hepatitis B last month while trying to conceive with my husband. My gynecologist suggested I get tested, and that’s how I found out.

HBV Results
- HBV DNA (PCR, quantitative): 126 IU/mL - very low viral load
- HBsAg: reactive
- Anti-HBe: reactive
- HBeAg: non-reactive
- Anti-HBc total: reactive
- Anti-HBc IgM: not detected
- Anti-HBs: < 2.00 mIU/mL - non-protective
- Anti-HCV: negative
- Anti-HDV (Delta): negative

My doctor said this profile suggests the infection is in a low-replication or inactive phase.

Ultrasound Findings (10.09.2025)
- Liver: normal size (10.0 cm in MCL), normal echogenicity overall, slightly heterogeneous, not enlarged
- Stable hyperechogenic focal lesion: 10 mm
- Portal vein: 11 mm
- Gallbladder: thin-walled, no stones or sludge
- Bile ducts: not dilated
- Pancreas, spleen, kidneys: normal, no focal lesions
- No free fluid in the abdomen
- Uterus: anteverted, heterogeneous

Background
I first discovered this small liver lesion 8 years ago during a routine check-up. Since then, I’ve had ultrasound and blood tests every year, and everything was always normal. Only this recent scan mentioned that the liver texture is now slightly non-uniform.

I was vaccinated against Hepatitis B as a teenager (three doses at age 13–14). I believe the infection must have happened much earlier, probably when I was a baby around 3 months old during a hospital stay for pneumonia.

About Me
I’m slim and active - 52 kg at 165 cm (BMI ≈ 19.1).
I eat a healthy diet, don’t have fatty liver, and my ALT/AST are normal.

In Poland, drinking alcohol is very normalized, and I used to think drinking at parties or on weekends was harmless. Recently, while trying to have a baby, I completely stopped drinking alcohol.

Elastography Results
I’ve had two different elastography exams, and the results are confusing:

- First test (private clinic): 7.29 kPa (better result) but IQR/median = 49%, depth 4–6 cm - hepatologist said it was unreliable

- Second test (hospital center next to hepatology clinic): 9.84 kPa (F3 fibrosis), IQR/median = 21%, depth 3.5 cm - said to be more accurate

I was told the higher result probably reflects long-term scarring from an old infection, likely from childhood, and that it will probably never regress. However, since my viral load is low and ALT/AST are normal, no treatment is needed right now - just regular monitoring.

Questions
- Which measurement depth is more reliable for a very slim person (3.5 cm vs 4–6 cm)?
- How should I interpret these two different readings?
- Is there a chance for fibrosis regression, especially if the scarring took place many years ago?
- Has anyone here lived with F3 fibrosis for a long time and seen improvement through a healthy lifestyle?

Thank you so much for reading.

I’m feeling anxious but also hopeful to hear from others who’ve been through something similar, especially those who’ve managed to stay stable or even improve their liver health while living with chronic Hep B and planning pregnancy.

Maja

[Bansah1]

Hi @Maja,
Welcome to the community. I agree with your assessment of when you may have been exposed. I am also glad to hear that you have cut out drinking. It will be helpful for your liver.
Yes, fibrosis can sometimes be reversed with a healthy diet and avoiding anything that causes damage or injury to the liver.

You can still have a baby; let your husband get tested and vaccinated if he has not already done so. Staying in care is strongly recommended. The numbers can vary depending on where one gets the test done.

Keep us posted. Best, Bansah1

[et5656]

Hi Maja,

I agree that it’s likely you were infected prior to receiving the vaccine. I’m also very glad to hear that you stopped drinking. I would recommend keeping this up even when you’re not pregnant/trying to get pregnant. Honestly, I think avoiding alcohol is the best single thing you could do for your liver. I agree that it’s possible that your fibrosis could improve if you continue to avoid alcohol. Make sure that you are being followed by a healthcare provider who is experienced in treating hepatitis B. The prophylaxis that exists today is extremely effective at preventing mother to child transmission of hepatitis B, so you can still have a baby. The most important thing is to make sure that the baby receives the first dose of hepatitis B vaccine within 12 hours of birth (the sooner the better), and make sure that they complete the series, ideally by 6 months old.

I am not a healthcare provider, so unfortunately I don’t know how to interpret the Fibroscan results. Perhaps someone else can help here?

[ThomasTu]

Dear @Maja,

Thanks for sharing your story with us. Requesting one of our @HealthExperts with experience in elastography to comment on your SWE results.

Regarding some of your other questions, F3 fibrosis can be reversed over time. This will involve limiting any other drivers of liver damage (as you mentioned, limiting alcohol is a big one).

Hope this helps,

Thomas

[chul_chan]

Hi @ Maja.

Welcome to hepbcommunity forum. Thank you for sharing your HBV profiles and elastography test.

As your HBV profile, your status are in HBeAg -ve inactive (immune control) carrier state at this time.

However, your ultrasound findings show slightly heterogeneous that I think it’s likely course echogenicity which may be from many causes eg. fatty liver, fibrosis etc . Your portal vein is normal in size ( <13 mm ) The focal lesion may be from benign tumor eg. hemangioma which can be detected in healthy people and the follow up should be done.

According to your questions , the measurement depth for accuracy of elastrography in slim person is not the problem between 3.5cm and 4-6 cm . There are some factors that can affect the accuracy of elastrography results. The first one, we look at the median IQR which should less than 30% for the reliable results.Other factors eg. ALT elevation > 120 or hepatic congestion can increase LSM results and probe size M used in low normal BMI may increase LSM in contrast with high normal BMI. If you don’t NPO before procedure at least 3 hours, the LSM results may show increases due to high blood flow to the liver after food ingestion.

The second test shows 9.84 k Pa suggests advanced fibrosis (F3) which is clinically significant.

In your case , I think that you should assess APRI and FIB-4 scores via online calculator and compare with your LSM results. If these values are concordance such as APRI > 0.5 or FIB-4 > 1.5 , so the second test result is reliable. Another option (if available) to increase reliability of test is to use splenic stiffness measurement (SSM) with the new generation of guided VCTE (Fibroscan) can assess the portal vein pressure and compare with the reference values. If the SSM increases more than healthy subjects, so it may indicate mild portal hypertension in your case.

Due to human liver plasticity, fibrosis can regress spontaneously from clinical significant fibrosis to mild fibrosis or normal liver parenchyma if we eradicate causes of it eg. stop drinking and smoking and have healthy lifestyle. You should consult with your doctor about management plan for monitoring and follow up. I hope this may help you.

chul_chan

Chulapong Chanta. MD . Pediatrics.

[Maja]

Thank you so much @Bansah1, @et5656, @ThomasTu, and @chul_chan for your kind replies and for taking the time to explain everything so clearly. I really appreciate all your guidance and support — it’s been incredibly helpful and reassuring for me.

@chul_chan – thank you for your detailed medical explanation. I just wanted to clarify a few points about my preparation and results:

My second elastography (the one that showed 9.84 kPa) was performed at 9 a.m. in a hospital hepatology center.

I was very well prepared — I had a light dinner at 6 p.m. the evening before, last drank water around 11 p.m., and did not eat or drink anything before the test.

So I believe the result should be accurate.

My laboratory results are from September and elastography was done in October (approx. 1 month interval):

• ALT: 31 U/L

• AST: 28 U/L

• Platelets: 232 × 10⁹/L

• Age: 35 years

• Fatty liver score: S0 (no steatosis)

Based on these, my calculated scores are:

• APRI = 0.30

• FIB-4 = 0.76

Both are well below the thresholds that suggest advanced fibrosis (APRI > 0.5, FIB-4 > 1.5).

Could you please help me interpret how these low APRI and FIB-4 scores fit with my elastography result of F3 (9.84 kPa)?

Once again, thank you all for your valuable insights — I’m very grateful for this community and the expertise you share.

Warm regards,
Maja

[chul_chan]

Hi @ Maja

Thank you for further details and information about your laboratory results. Your platelets count is good( > 200 x 10 3/microL ) which indicates that your liver fibrotic staging maybe less likely to be advanced fibrosis (F3) .In your case , we may consider in 2 parts of diagnostic tests. The first one is liquid non invasive tests (APRI & FIB-4) and the second one is solid non invasive test ( Elastography) .Your APRI and FIB-4 scores are much less than cut off points for significant fibrosis (F2). As WHO guidelines 2024 for HBV management, if we use APRI cut off points at 0.5 for significant fibrosis (F2) , the sensitivity was 72% and for transient elastography(TE) with cut off 6.0-8.0 kPa then the sensitivity for F2 was 75% . Additionally, study from Marcellin et al Hepatology 2005 for TE in chronic hepatitis B with cut off 7.0 kPa showed the sensitivity at 66% and specificity at 83% and positive predictive value at 84%. In general studies, FIB-4 < 1.5 can rule out or exclude advanced fibrosis (F3-F4) with the sensitivity at 74% and negative predictive value at 95%.

In summary, there are no absolutely 100% accuracy of diagnostic non invasive tests and we should combine these with other clinical data to evaluate and make decisions in clinical practice.Your test results when considering with evidence based data which include APRI, FIB-4 and TE , I think we can most likely rule out clinical significant fibrosis (F2) or advanced fibrosis (F3) with the high negative predictive value (NPV) of APRI ( < 0.5 ) & FIB-4 ( < 1.5 ) scores and the results of your TE with F3 may be from false positive of the test which occurred about 16-17% when considering specificity (83%) and positive predictive value (84%) of this diagnostic test. I hope this may help you to clarify and understand how to interpret your laboratory tests.

chul_chan

Chulapong Chanta. MD. Pediatrics.

[Maja]

@chul_chan
Thank you so much, doctor — your explanation is very reassuring and really helps me understand how to interpret the relationship between APRI, FIB-4, and elastography.

I wanted to ask a few more things, if I may. Would MRI elastography give a more accurate or reliable picture of the actual fibrosis stage? I’m asking because I’m planning pregnancy soon and would like to be sure about my liver condition before that.

Also, with my current HBV DNA level of only 126 IU/ml, does this mean that there is no ongoing liver damage, or could fibrosis still slowly progress over time? Depending on the real fibrosis stage (for example, if it’s truly F2 or F3), how likely is it that it could progress to the next METAVIR level? My hepatologist mentioned there’s no need for antiviral treatment right now, but I want to understand my long-term risk better.

And one more question — are the following supplements safe and suitable for someone with chronic hepatitis B who is planning pregnancy?

Ovosicare Fertility (Caronositol® Fertility complex):
• D-chiro-inositol 300 mg
• Myo-inositol 1100 mg
• Pomegranate extract PomanoX P30 50 mg
• Niacin 18 mg
• Vitamin E 15 mg
• Zinc 5.3 mg
• Vitamin B6 2 mg
• Riboflavin 1.6 mg
• Thiamine 1.4 mg
• Folic acid (5-MTHF-glucosamine) 400 µg
• Iodine 100 µg
• Selenium 45 µg
• Vitamin B12 15 µg
• Vitamin D 5 µg (200 IU)

Fibraxine:
• Soluble dietary fibre (arabinogalactan from larch bark) 5–10 g
• Lactoferrin 50–100 mg

Would these ingredients be safe for my liver and okay to use while preparing for pregnancy?

Thank you again for taking the time to explain everything so clearly — your advice has really helped me calm down and focus on maintaining a healthy lifestyle.

Warm regards,
Maja

[chul_chan]

Hi @ Maja

About MR elastography, I have no experience with it. However, Meta-analysis study (Xiao et al. Plos One 2017) showed that MR elastography is more accurate than Fibroscan in liver fibrosis staging for chronic hepatitis B patients.

Highly HBV DNA level > 2,000 IU/ml which mean active viral replication is the most significant factor affecting the ongoing process of fibrosis in the liver due to the host immune response to virus lead to inflammatory and healing processes.Your HBV DNA level at 126 IU/ml that mean your cccDNA transcriptional activity is inactive and under your immune control and least likely to induce ongoing liver damage.The process of fibrotic changes in METAVIR stage of the liver may take a few years or many years depending on etiology or other factors eg alcohol ingestion, unhealthy lifestyle and is unpredictable. You should follow up and monitoring for your CHB status and liver health with your doctor. About the supplements for CHB patients, there may be other health experts in this forum that can help you in this issues. I hope this may help you.

chul_chan

Chulapong Chanta MD. Pediatrics

[Maja]

Hi @chul_chan,
Thank you very much for your detailed and reassuring explanation. It’s great to hear that my low viral load means the virus is under immune control and unlikely to cause ongoing damage.

I will definitely continue regular follow-up and healthy habits. I’m also considering MR elastography for confirmation — it’s helpful to know it’s generally more accurate than FibroScan.

I would also like to kindly tag some @HealthExperts for their opinion on the supplements I mentioned earlier — whether they are safe for someone with inactive hepatitis B and F2/F3 (9.84 kpa in elastography SWE2D) fibrosis:

Ovosicare Fertility (2 capsules):
• Caronositol® Fertility (D-chiro-inositol 300 mg + Myo-inositol 1100 mg)
• PomanoX® P30 (Pomegranate extract – 50 mg, including punicalagins and punicalins 15 mg)
• Niacin 18 mg
• Vitamin E 15 mg
• Zinc 5.3 mg
• Vitamin B6 2 mg
• Riboflavin 1.6 mg
• Thiamine 1.4 mg
• Folic acid (5-MTHF-glucosamine) 400 µg
• Iodine 100 µg
• Selenium 45 µg
• Vitamin B12 15 µg
• Vitamin D 5 µg (200 IU)

Fibraxine (1–2 sachets):
• Arabinogalactan (from larch bark)
• Maltodextrin
• Lactoferrin (50–100 mg)
• Anti-caking agent: silicon dioxide
• Sweetener: acesulfame K

Are these ingredients considered safe for someone with chronic hepatitis B?
Thank you again for your time and for clarifying all of this.

Best regards,
Maja