Starting treatment with lower numbers

What are the benefits of starting antiviral treatmnet in lower number … hbv dna ( 890 iu/ml ) and hbsag 2800 iu/ ml…
Was detect on march 2024 with these numbers
Fibroscan was 5.8kpa
Hbeag - negative
Hbeab - positive

My dr immediately started the treatment…after these results…!!
Is their a chance of loosing hbsag with such low numbers ???

@ThomasTu
@availlant
@Bansah1

While there is no guarantee, it’s possible. I can’t predict, but the lower the viral load and surface antigen quantitative the more likely it seems to be the case. But, there’s no guarantee here. Keep taking your medicine and we will see how things play out in a few years time. Best, Bansah1.

Dear @Guru777,

What was your HBeAg status when you started treatment?

@availlant

Hbsag was 2800iu/ml when it started treatment in march 2024
Now last month in sep it was 1580 iu/ml

Hbeag was negative
And hbeab was positive…

Dear @Guru777,

The HBsAg levels are still relatively high, so the chances of HBsAg loss are low on current antivirals. That is not to say that the antivirals are not useful: they will lower the risk of liver disease progression and liver cancer over time.

Hope this helps,
Thomas

Especially given your HBe status, I agree with Thomas…

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Why mybhbsag level fluctuating after every 3 month of routine checkup but my hbv dna says target not detected…
Was diagnosis with hep b in feb 2024, immediately my dr started the treatment …
I am on taf 25mg…
Its been 8 months i am on regular monitoring of mybhbsag and hbv dna and fibroscan and lft…
All lft are normal hbd dna also says target not detected…Fibroscan sore was 5.6 kpa on 26 november 2024,

But my hbsag is fluctuating

Feb it was 2800iu/ml

May it was 2000 iu/ml

July it was 2200 iu/ ml

Sep it was 1500 iu/ml

Now on 29th nov it was again 2800iu/ml

It was down almost 50% in sep but now its back to 2800iu/ml

Can u please expalin whats hppning???

@ThomasTu @Bansah1 @availlant

Dear @Guru777,

These kinds of fluctuations in HBsAg over time are normal. While these changes are real, from a clinical standpoint they are so small as to be essentially the same. There is nothing (positive or negative) happening. In your case, clinically significant declines in HBsAg would be levels << 100 IU/mL.

@availlant

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Does thing change harm liver … will it cause scarring in liver or damage liver …!!
Do i have chances of loosing hbsag or going below < 100iu/ml… …??

Dear @Guru777,

The persistence of HBsAg during your TDF therapy means that non-infectious sub-viral particles are still being produced. This is very common during therapy with all NUCs. While these SVP are being produced, immune control of HBV infection cannot be recovered. This is while TDF therapy is typically life long.

We know that the persistence of these SVP do not lead to liver inflammation or scarring.

Please be relaxed about this.

@availlant

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If liver is helathy and hbsag is increasing what foes that means… is this a cuse of concern??
Can hbsag increase even after antiviral therapy…??

Dear @Guru777,

As I mentioned the changes in your HBsAg should be considered as minor (and normal fluctuations). These changes are not cause for concern.

With current NUC therapies (ETV and TDF / TAF), real HBsAg increase while HBV DNA is well controlled is extremely rare (I am not aware of such a case actually).

@availlant

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Thank u so much @availlant :pray:

Does TAF 25 MG damage kidney…??

Dear @Guru777,

25mg TAF dies not have any long term issues with kidney dysfunction.

@availlant

Hi i am 36yrs old male

My hbsag is 2800iu/ml

Hbv dna 890 iu/ml

ALT NORMAL

FIBRO SCAN 5.6 KPA

HBEAG NEGATIVE

HBEAB POSITIVE.

FATTY LIVER GRADE 1

Am i active carrier or inactive carrier??

@availlant
@Bansah1
@ThomasTu

@Guru777 looking at the initial analysis it says you are in inactive carrier phase. Better word for it is immune tolerant. However recently my doctor suggested me liver accumulates fat to protect liver at times in HBV. There are no proper studies done for this fact but there seems to be a link. This also indicates very mild inflammation is going on. Liver inflammation can be one of the factor of fatty liver. My doctor suggested me antivirals even when my ALT is normal. I would suggest starting treatment since it has shows in several studies it cut down risk of liver cancer by 70% and risk of cirrhosis by almot 90%.

Yes i have started treatment … but i am confused about what u r saying… immune tolerant and inactive carries i think both are different phases of hbv…
As my viral load was below 2000 iu/ml ALT was normal hbeag negative and antihbe was positive so how can i be in immune tolerant phase…

@Ash_Malhotra

Dear @Guru777,

Thanks for your question. These results are consistent with someone in HBeAg-negative "inactive carrier’ phase. Active vs. Inactive refers to whether there is liver inflammation or not - in this case, since ALT is normal, these blood tests are not detecting any inflammation.

The treatment you have started essentially keeps you in this phase by lowering inflammation and reducing viral loads.

Hope this helps,
Thomas

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