Understanding lab results

General Discussion Lab results
31

Thank you Thomas. You have been very helpful.

1 Like
32

Dear colleagues,
This is my lab test of today.
AFP is said to be 6.9 down from 18. what could be the cause?
Doctor says all the pain in my abdomen and back pain and fatigue is due to Multiple Renal Gravels at both kidneys.
Total billiribin is always higher than normal 1.1 instead of 0.2 to 1. Is this related to Renal Gravel or Liver from your experience?

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33

Hi @Wadani1,
Thanks for sharing this result. Your liver results looks fine to me. I think I have to agree with your doctor about the possibility of kidney stones. I have not had one personally, but I have spoken to others who have had it and they all share the same theme “painful”. I am sorry you are going through so much pain, I hope it can pass soon so you get some needed relief. Feel better soon. Bansah1

1 Like
34

Hello everyone and experts, I am new here. I’d like to ask for help interpreting my lab result. I was diagnosed with HBV at the age of 21 and I’ve been taking Tenofovir 300mg for almost 4 years already.

I have several questions regarding to my lab result because the doctor didn’t seem to provide me with thorough details.

  1. My viral load is decreasing (starting with 60,000,000 IU/ML and 7.78 for log) but my HBs Ag quantitative is still high, why is that? latest result was 1153 IU/ML (the first diagnosed was 2391 IU/ML)

  2. My viral load was uncertain and a little fluctuate from time to time, I have the time that it was <10 IU/ML, but later it can be 30 or 14 (I checked it every 6 months) and what does Log mean?

  3. I was wondering whether are there people who stop medication? And to what requirements that allow you to live without medication? Or do you have to take medicine for the rest of your life?

  4. My Hbs Ag was negative and Anti Hbs was Negative what does it mean?

  5. Is it okay if I do not take medication on time, maybe an hour late sometimes. Will there be any problem regarding to the medicine effectiveness?

  6. With Hepatitis b, are you not allowed to drink alcohol at all? Or maybe a glass of wine/beer from time to time (once in 3 or 6 months) is allowed? I am drink alcohol - I was just curious wondering if I can do it in social situations.

I have attached my lab results accordingly from past to present, please help me. (i cannot attach photos therefore I’ll list it down).

Result 08/2020
Hepatitis B virus (HBV)Viral Load by abbott Real time PCR (Plasma)

  • Result <10 IU/ml
  • Log <1.00 (IU/ml)
    HBs Ag Quatitative 1160.28 H IU/ml
    Remark:
    *Reference range: Detected range 10 - 1.000.000.000 IU/mI
    1 IU/ml = 3.41 copies/ml

Result 01/2021

  • Result 11 IU/ml
  • Log 1.05 (IU/ml)
    HBs Ag Quatitative 1092.97 H IU/ml
    Remark:
    *Reference range:
    Detected range 10 - 1.000.000.000 IU/mI
    1 IU/ml = 3.41 copies/ml

Result 07/2021

  • Result 30 IU/ml
  • Log 1.48 (IU/ml)
    HBV viral load 162 copies/ml
    Log equivalent 2.21
    HBs Ag Quatitative 1329.28 H IU/ml

Result 04/2022

  • Result <10 IU/ml
  • Log <1.00 (IU/ml)
    HBV viral load <54 copies/ml
    Log equivalent <1.73
    HBs Ag Quatitative 1412.14 H IU/ml

Result 10/2022

  • Result 14 IU/ml
  • Log 1.15 (IU/ml)
    HBV viral load 76 copies/ml
    Log equivalent 1.88
    HBs Ag Quatitative 1153.65 H IU/ml

My ALT and AST are always in normal range of 0-31 after medication.

And lastly I would love to hear all of your success story, maybe not fully recovered but going down to undetected if you experience something similar to me, I’d highly appreciated.

Sincerely,

Hopee

35

Hi @Hopee,
I want to welcome you to the forum, please take sometime to check out some of the discussions that have gone on or remain ongoing. I see from your results that your HBV Viral load has really gone down, that is the amazing thing about these antivirals as you can see these changes happen. I think it is possible to have all these normal markers but still have your HBsAg remain high. I have started treatment back in 2015, I reached undetectable level like within a year and half or so if I remember correctly. But my HBsAg has remained high for all these while. Some patients don’t seem to see a decline in their numbers here.

I have been undetectable since early or late 2017 and have remained there since. Those antivirals really does what it needs to do, sometimes not fast enough for some patients but they get there eventually. Alcohol can cause serious liver damage, but I do not think having a glass of wine once in a while during social events can cause such problem. I think the key here should be moderation and not doing it daily or regularly. Keep up with all that you do. An expert (s) will respond with their thoughts soon. Be patient, someone will respond to your questions. Thanks, bansah1

1 Like
36

Dear @Wadani1,

AFP is generally quite low. As long as it stays below the normal limit, it is nothing to be worried about.

It’s unclear whether this is due to your natural bilirubin levels being high or something to do with the chronic condition.

Also, welcome to the community @Hopee, and thanks for your questions:

  1. Viral load goes down because the medication works on stopping the production of new virus. However it does not stop the virus that is in the liver from making its own proteins (HBsAg). So the response you are having is completely as expected.
  2. It is also normal that your viral load levels fluctuate over time as small differences in hydration, who is running the lab test, time of day, etc. can affect these levels. What is more important is the long-term trends. Log is just another way of showing the number: 1 = 1.0 log; 10 = 2.0 log; 100 = 3.0 log; 1000 = 4.0 log, etc.
  3. There are stringent conditions as to when you should be recommended to stop treatment and you should only do it while under close monitoring by your doctor. This is because if you stop the treatment, the virus can reactivate (your viral loads shoot up again) and this can lead to severe inflammation. Generally the recommendations for considering stopping treatment are: at least 3 years of undetectable HBV levels, HBeAg should be negative; no severe liver damage.
  4. Unclear what you mean here, as you said in the point above that your HBsAg levels are high at 1153IU/mL.
  5. Differences in an hour or 2 are unlikely to affect the effectiveness of the medication.
  6. It is recommended to limit any additional injuries to your liver, which includes minimising alcohol intake. There are several options for non-alcoholic beverages which might be worth considering, but there are definitely people with Hep B that do still drink. See this thread for further discussions: Vices - alcohol marijuana etc
2 Likes
37

@Bansah1 Thank you very much for your kind welcoming and response. I am so happy to hear your story!

Dear Thomas @ThomasTu Thank you very much for very thorough information. I would like to further ask to have the “undetectable” status means to to have viral load undetectable or the HbsAg undetectable? Is it possible to have Viral load undetectable but still have HbsAg quantitative.

Thank you very much for create this safe space for everyone.

38

@Hopee,
You welcome, we try to make this place home and comfortable for every patient. I think being undetectable applies to the viral load, not with HBsAg. @Thomas can correct me here if I am wrong. Keep doing what you doing my friend, we shall overcome hepatitis B and its complexities. Best, bansah1.

39

Hi @hopee,

Thanks for your question. Your results show that your HBV DNA (viral load) is undetectable (more accurately, detectable but under quantification level) while your HBsAg is still detectable. These are expected results for someone on antiviral treatment.

Hope this helps,
Thomas

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41

@Hopee ,

It is important to understand that oral antiviral therapies work by preventing the production of infectious virus (which is measured by the HBV DNA test). HBsAg is almost entirely produced by a separate mechanism as non-infectious “subviral particles” which is not affected by these oral antiviral therapies.

In your case, your antiviral therapy has efficiently suppressed the production of infectious virus (which is very good for restoring normal liver function and halting the progression of liver disease) but your liver is still producing subviral particles or HBsAg (which is the reason why oral antiviral therapy is typically life long).

This is why it is possible to have undetectable HBV DNA but detectable HBsAg.

Best regards,
Andrew

2 Likes
42

Thank you very much @ThomasTu and @availlant for further clarification. I have one follow up question, I wonder how can I reduce the HBsAg? Or what are way to help reduce it down? When HBsAg is high what does it mean to our health and liver?

Thank you very much

Sincerely,

Hopee

43

Dear @Hopee,

The persistence of HBsAg in the liver has no overall negative effect on your health but unfortunately has the effect of preventing restoration of immune control of the viral infection in the absence of therapy (functional cure). So the persistence of HBsAg during therapy with direct acting antivirals means that you will still have to keep taking these therapies. This is the case for the vast majority of people on antiviral therapy for HBV.

In some rare cases, there are people who achieve HBsAg loss and these people can have their antiviral therapy removed and in most cases will not need to take treatment anymore. We do not have a good understanding about what happens in these rare cases of HBsAg loss.

The single approved immunotherapy for HBV (pegylated interferon) can achieve HBsAg loss in a small fraction (~6%) of certain genotypes of virus (but not all).

There are many agents in clinical development to target HBsAg which you can find discussed in this forum.

The best approach (and this applies generally for all people with chronic HBV) is to eat well, exercise regularly and avoid drinking alcohol.

Best regards,

3 Likes
44

Hi Andrew, @availlant,
does this mean that a child who has been vaccinated at birth and completed three courses of the vaccination is still at risk of having the virus activated because they were born to a hep b positive mom? My children´s result show no sign of any hbv markers. Are they still at risk?

45

Dear @Natti,

There are two issues in your question actually.

  1. Many people are infected with HBV and subsequently achieve functional cure of HBV without ever knowing they had HBV infection (this is the most common outcome of infection with HBV). In these people, reactivation of HBV can occur if they subsequently undergo immunosuppressive therapy for cancer or autoimmune disorders or organ transplant. This is because the continual suppression of reactivation of HBV by the immune system is reduced during these therapies. Persons with inactive HBV infection (where there are still low levels of virus made in the absence of therapy) can also spontaneously reactivate their HBV infection as well.

  2. HBV breakthrough following vaccination in children is rare in most ethnic groups (the curious outlier here is indigenous Australians) and most likely occurs by the development of HBV variants which escape the vaccine response and not from a specific depression of immune function. This is a specific issue with children who get their HBV via maternal transfer during birth.

If you child has an anti-HBs response > 10 mIU/mL (you might need to get a test to check this), I would not worry about the possibility of reactivation if your child is healthy.

Best regards.

1 Like
46

Hi @natti,

Agree with @availlant’s points above, and just want to add that if your children are negative for anti-HBc antibodies, then the risk of reactivation is essentially zero and should not be a worry.

Thomas

47

Thank you @ThomasTu , I actually thought there is no risk at all because they were never infected but it seems there is still no definite answer to that? No sign of anti hbc or anti hbe, just anti hbs.

48

Yes, this is our current understanding that if there is no anti-HBc there has been no infection.

TT

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49

Hello guys. So I was first diagnosed for Hepatitis B in August of 2018. My viral load was 9,620 IU/mL, today my viral load went down to 976 IU/mL. I’ve never been on medication. My Hepatitis BE Antigen has always been “non-reactive” does this mean my hep B virus is suppressed? Or what does non-reactive means?

Since my viral load went down. Does this mean I have a chance of recovering from hepatitis B sometime in the future?

Thanks,
Mich

50

Hello…i would like to ask what does it mean if I have high Gamma T,but my GLT,AST is normal?

51

Hey @Mich,
Thanks for your question and one of the experts will respond soon. Thanks, Bansah1.