Hello everyone! Need some help making sense of my latest lab report please…
I’m 59 male Asian and have been a carrier (HBeAg-negative / HBeAb-positive) for at least 30 years. My viral load has been up & down but mostly around 1000 (spiked once to 2060 9 years ago), even down to 260 last year; ALT has been all normal. My recent lab report however showed a sharp increase of viral load. Here are a few markers (comparing to last year):
HBV from 260 to 2990 IU/mL
ALT from 17 to 21
AST from 18 to 40
AFP <1.8, no change
My lifestyle hasn’t changed in the past year from before, no stress from work, and generally happy. I don’t smoke at all, and rarely drink. I had a few drinks on a trip with old friends back in October last year, and a few beers since then. I do moderate exercise (jogging / walking) a few times a week. Being Asian I think I generally eat healthy; I did start a low-carb diet about a month ago. I’m not on any medications, only take supplements like multivitamin for men, and mike thistle (for liver care). I have no other health issues like high blood pressure or heart problems.
I did suffered a fall late last September with no-so-serious broken ribs on right side, now healed and feel normal; the rib cage might be a bit out of normal shape though.
So all in all, I wonder what could have triggered the sudden spike? And, is it time to jump on antiviral drugs?
Sorry for the long post, and thanks in advance for your thoughts / suggestions.
Hi @rich88,
Welcome to the community. Thanks for sharing your results and your concerns. This new test showing an increase could be a sign of HBV flare-up. It can happen from time to time. And since this is the first spike in over 9 years, I will suggest you keep an eye on it and get another test in 3-6 months. If those results show more increase, then I will get concerned and probably start thinking about antiviral treatment possibly. I understand this is concerning but flare-ups can happen from time to time without anything happening. Continue to take care of yourself and repeat the test in a few months. Best, Bansah1
@Bansah1 Thank you very much for you quick reply! Really appreciated!
Yeah I had a call with my primary doctor this evening, he’s recommending me to start antiviral medicine now, though he also acknowledged that my ALT has been normal all these years. He said the spike may be due to my immune system having a set back in past few months. So I asked for a few months, and want to do everything I can to bring the load down. Maybe it’s because of some stress lately with my work, or maybe it’s simply I’m getting old … who knows…but I’m going to try.
Hi @ rich88
Chronic hepatitis is a complex and dynamic disease that staging of disease may change from time to time.In the past time ago , you were in the inactive immune control carrier phase. At present, there is higher amounts of HBV DNA in your blood stream ( > 2,000IU/ml ) which may be caused by your work stress that may impair your immune response to control virus or increased aging which causes the number of T cell lymphocytes to decrease and the wild type of viruses may increase proliferation . Another reason is that higher viral load may be due to pre core / basal core promoter regions of ccc DNA open reading frame that produce escape mutant viruses that your anti HBe cannot neutralize it. Your ALT may not elevate due to fluctuation of liver enzymes but necroinflammatory processes are ongoing in the liver. However, you may follow up 3-6 months for HBV DNA /ALT like @ Bansah1 suggests. In my opinion, I agree with your doctor to start treatment because the amount of virus can change and fluctuate all the time even though you can bring the viral load down but it may elevate in the near future and to prevent further HBV DNA integration into hepatocytes. I hope this may help you for decision making with your doctor.
chul_chan
Chulapong Chanta MD. Pediatric
Thank you for your explanation and suggestion! I have to admit that one of the concerns was that, from what I researched, antiviral drugs need to stay for long term even for life, once started, much like many people get stuck with blood pressure pills. I haven’t looked much into the possible long-term side effects of these drugs.
I just received the results of my latest exams and I confess that I still have great doubts about the evolution of the virus in me.
I was diagnosed three years ago and my viral load was 80 iu/ml.
A year ago the viral load rose to 20.000 iu/ml. I got scared and even had a biopsy which revealed only a low degree of inflammation and little fibrosis (A1F1).
Today, as I said, I took new tests and the result was a viral load of 8.000 iu/ml.
Throughout this time I remain with reactive HbeAg and non-reactive anti-HBe. ALT and AST always normal.
Is this fluctuation in viral load considered normal? Does this comment also fit in my condition? What else can I do? just wait and repeat my exams after six months?
I hope you are doing well. According to your information about HBV profiles and normal ALT which compatible with HBeAg +ve chronic infection , however, your HBV DNA was not high as seen in immune tolerance phase CHB. . I think that you may be adult acquired HBV infection or HBeAg +ve CHB with low to intermediate HBV DNA levels and your viral load was fluctuations. Your liver biopsy results showed no sign of necroinflammatory process which indicates good clinical outcomes. From some HBV treatment guidelines, the recommended start treatment are at advanced age( > 35 years) and persistent HBV DNA > 2,000 IU/ml . You should consult with your doctor for decision making about start treatment or follow up periodically. May be any comments that will benefit to share idea and experience about this issues.
chul_chan
Well my ultrasound report is out and all is normal, just wanted to share this with you all. This further firmed up my decision to try doing my best to lower my viral count back down to the 2000 iu/dl threashold.
Hi all, I’m back here to report on my status after my posting 5 months ago. Yesterday my latest blood test showed my viral load has come down from 2990 to 2050, also my Hemoglobin A1c has come down from 5.7 to 5.4. In short, I followed a low-carb-high-fat diet (not strict keto diet), with increased exercise. I believe this not only helped with lowering A1c, but probably made my liver healthier in general to keep the virus in check. I believe I’m on the right track.
I’d love to hear any further suggestions from you all. Thanks!
And I’m glad I didn’t just rush onto the medicine last time, and thank you @Bansah1 for your encouragement back then!
Hi @rich88,
We appreciate the update, and happy to hear that things have gone well since we last messaged. Sure, you can continue with the new diet and exercise, please make it a point to remain in care. Try not to fall off, as frequent follow-ups are critical.
You are always welcome and glad to be helpful. Please keep us posted. Best, Bansah1
This has always bothered me. You said you didn’t rush into medication, my question is how bad is it to rush into medication and yet it is advocated to do early diagnosis and if hbv positive, early medication/treatment is recommended.
The medications for hepatitis B are incredibly well-tolerated. I have been on TDF for years and never had any side effects. In my opinion, the only major downside to starting treatment early is the cost. But there are people who are advocating for treating everyone who is positive for HBV, like we do for HIV. Unfortunately, the current treatment guidelines for hepatitis B are complex and confusing, and there are a lot of people who fall into kind of a “grey zone”. I lean more towards thinking that it’s better to start treatment earlier, but I’m not a doctor.
Early treatment is good, as it leads to a good prognosis. Remember, no two HBV patients are the same, nor are any two HBV cases the same. These decisions are based on each patient and their case. As mentioned by @et5656 cost is a huge challenge for some patients (those in low-middle income countries), hence they may decide to delay treatment. Access to these medications is also a reason why someone may choose to delay. The antivirals are not readily available to all patients, and the worst thing one could do is start treatment, then have to miss a month or two because the medicine is unavailable or they cannot afford it. I will definitely fall in the camp of those advocating for treating any patient who wants to be treated, but due to the challenges highlighted above, this is not possible for all patients.
Early treatment is good, but it will depend on each patient’s case. Since some patients might require immediate treatment, while others can wait for some years with just monitoring. I hope this helps. Bansah1
Thanks for the follow-up question, @Opa. So I didn’t reply immediately, partly because I was traveling a lot past few months, also because I did want to see it through first how my approach would work out. And I’m happy to report that my blood test two weeks ago showed the viral load down from 2050 in July to now 910 IU/mL. All I did was continuing with my diet and exercise, and making conscious effort to reduce stress.
I think I have 2 takeaways from this past year’s experience. One, viral load itself does fluctuate and it alone should not be the sole marker to focus on (all my other liver markers (ALT, AST etc) have been normal), it’s the trend and overall liver / and health condition in context that weighs more in guiding our decisions; and two, the good old strategy of proper diet + exercise + less stress, still is the best long-term approach to keep HBV at bay.
@Bansah1, thank you again for encouraging me to stay on the right track last time.
Kindly share with me a sample of your diet because it has become more difficult for me to eat some foods due to many comments on food restrictions and as such, I even starve my self because of the risk that would come out as a result of poor diet. My meal for eexample includes gnuts paste, meat, milk, pork, rice, greens etc
Diet is a very personal thing, I think, because the body and its digestion pattern differs from one to another. I always have a bowl of freshly cooked rolled oats in the morning, adding 1 egg, some milk, mix of walnuts / pumpkin seeds, and 1 tbsp of chia seeds, no sugar. Lunch is mostly greensalad, adding carrots, purple cabbage, avocado and olive oil, often also add some deli meats, or salmon / sardine etc. Dinner is eastern Asian style dish, with various meats and fish, always a cooked vegetable dish, but rarely have rice. Max 2 cups of coffee daily, no sugar. This has been working for me.
… who knows…but I’m going to try.