Viral load surge on antivirals

What do my lab results mean?
1

Hello dear community members, peace and blessings to all of you. Today I want to share my story

I got to know that I had hepatitis b in july 2022 when my sister needed blood after the PCNL operation of kidney stone removal. Unfortunately, why i found my hep b positive result shocking was bcoz i had got vaccinated myself in 2012. So it was quite astonishing for me that I got the virus even after being vaccinated with three doses. During this period, I was looking for cure on the internet and then I was very much relieved when I found and joined the HepBCommunity.

My First Labs

I went to a gastroenterologist in Feb 2023. My first labs that came in March 2023 were;

Hep C > Non reactive

Anti HDV > 0.22 negative

HBV PCR Quantitative > 647 millions

HBe Antigen > 534.1 positive

SGPT (ALT) 36

The gastroenterologist did not initiate the treatment even though the HB viral load was in hundreds of millions

My Second Labs

I had my second labs in Jan 2024 and they were;

HB viral load increased to 867 millions. This means the viral load increased more than 200 millions in a single year.

Haematology Prothrombine Time result was

Patient … 15 sec

Control … 12 sec

INR … 1.25 > Normal Range 0.9 - 1.2

Chemical Pathology

Alpha Feto protein 2.78

SGOT (AST) 53.3

SGPT (ALT) 89.7

Serum Albumin 4.75

My Fibroscan result

The patient’s Fibroscan Score (Median) is 4.7 E(kPa), with a corresponding Fibrosis Stage of F0-F1.

During this time, my doctor was still reluctant to initiate the treatment but i insisted that treatment should be given and then he put me on Entecavir

My Third Labs

I got my labs after being on treatment for 7 months in July 2024. The viral load reduced drastically from 867 millions to just;

The viral load was 16900

Before the treatment i had severe heartburn issues which began in the early 2021. However, after the treatment my heartburn issues stopped with only occasional light reccurences.

My Fourth Labs

Since the End of May 2025, I noticed feeling little bit fever. I also noticed feeling light pain on right side above my abdomen and behind my right shoulder during my walking times in the evening. I immediately went to the doctor and he directed me for the following labs

Alpha feto protein 1.80

Liver Function Tests

Bilirubin Total 0.9 mg/dL

Bilirubin Direct 0.3 mg/dL

Bilirubin Indirect 0.6 mg/dL

SGOT/AST (Plain) 57 U/L

SGPT/ALT 88 U/L

Alkaline Phosphate 68 U/L

Gamma GT 32 U/L

Hepatitis Delta Antibody

Test Value: The patient’s test value is 1.468.
Cut Off Value: The cut-off value for this test is 1.00.

Result: The result is “NON REACTIVE.”

However, the most troubling part was the viral load that was 16900 in Aug 2024. And now it came as

HBV PCR 142700

Dear @availlant and @ThomasTu, kindly share some thoughts on my lab result.

2

Dear @Nawab ,

Can you tell us which medication you are taking for your HBV infection? Have you been taking it every day without fail?

@availlant

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Dear @availlant, i have been taking Entecavir. And yes, i have been taking it punctually. However, initially i used to take it in the morning, then i began to take in the night. I started taking it since 12th January 2024. My viral load at the time was 867 million and, within 7 months of the therapy in Aug 2024, it came to 16900. But now almost after one year, the PCR shows it is increasing.

4

Dear @Nawab ,

Your last two HBV DNA results do suggest that your HBV infection is rebounding on ETV therapy (I assume you are taking 0.5mg / day). This is rare except when a patient has previously taken lamivudine for their HBV infection.

Viral rebound on ETV is easily addressed by switching to TDF (Viread) or TAF (Vemlidy).

@availlant

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5

Dear @availlant

Yes I’m taking ETV 0.5mg. I’m quite shocked that i contracted this virus even though i had vaccinated myself in 2012 with 3 doses. Bcoz of the vaccination, i brushed off the symptoms that i felt in 2020 or 2019 when i got this virus. I thought i coud not contract the virus bcoz i was vaccinated.

6

@Nawab it is possible that you had hepatitis B already before getting the vaccine. I can’t say for sure, unless you were tested for it before getting vaccinated. I’m not sure what country you’re from, but the leading cause of (chronic) hep B worldwide is mother to child transmission. It would be wise to talk to your parents and siblings about this so that they can get tested as well.

Even if you’ve had it since birth, it is common for people not to have any symptoms whatsoever for years/decades (often there are no symptoms until liver disease is advanced). I’m glad you are being proactive and seeking treatment for your condition.

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7

Dear @et5656,

Dear it’s not possible bcoz i got vaccinated only after my blood was tested. My mother and father also don’t have hepatitis.

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8

Dear @availlant,

I would like to participate in Replicor’s Compassionate Access Program. Would you share some guidelines on how to join it. It is written on Replicor’s official website that the program is accessible in 5 countries such as France, Israel, Austria, Italy and Turkey. I live in Pakistan.

9

I am not a doctor. I think it is unlikely that he had HBV before the vaccination. Looking at his first labs in Feb 2023, he was HBeAg positive. His second labs indicated his fibrosis stage was F0-F1. All these seemed to indicate to me that his infection was new. His doctor did not treat because I think he was hoping that the patient may become inactive(HBeAg negative, ALT normal and hbvdna < 2,000 iu/ml) on his own. Why did he get infected after his 3-dose vaccination in 2012? I speculated that his HBsAb level dropped after vaccination and did not offer him protection. I agree it is rather unusual that Entecavir did not keep his hbvdna low, a switch to TDF (or TAF) is right. Furthermore, I think he should consider the result of this new antiviral before considering other options.

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10

Dear @Stephenw,

I don’t know why the vaccination did not work but i doubt it was due to insufficient sleep. I used to have sleep problems which may have caused my vaccination to fail. And i also doubt to have contracted HB in 2019 or 2020 bcoz i had unprotected sex a couple of times and i clearly remember that during this time my mother had once told me to see a doctor bcoz my skin had become pale. Moreover, the experts on this forum will have better explanation.

11

The HBF (Hepatitis B Foundation) has this advice:
“If it has been years since you have been vaccinated, you may need or may request a hepatitis B surface antibody titer blood test to confirm that you are still protected. A person is considered protected if they have a positive anti-HBs or HBsAb test result greater than 10 mIU/mL. Sometimes these test results are under 10 and there is concern whether these low levels will still provide protection against hepatitis B. Anti-HBs or HBsAb test results can decrease over time, but an individual can still be protected even if the test results are less than 10 mIU/mL.”
I don’t think insufficient sleep leads to a decline of HBsAb after vaccination, because it is quite natural and frequent to lose protective HBsAb level over time. However, losing HBsAb level does not necessary mean losing immunity. So, it is still a mystery whether infection will occur when your HBsAb level becomes less than 10 iu/ml. I doubt “pale skin” can indicate that a person has HBV infection. A person with severe liver disease may have jaundice, yellowing of the skin, but I think it takes a long time for HBV to damage the liver to cause jaundice.

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12

There are also people who don’t respond to the vaccine. I know that @john.tavis has talked about this on the forum before.

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I don’t think i have ever experienced jaundice. Right now, I’m waiting for my gastroenterologist in the hospital and i will share the updates with the HBcommunity.

14

Hi all,

The HBV vaccine is one of the best ever made! It is very safe because it contains on HBsAg, not the full virus, so there is absolutely no chance of getting HBV from the vaccine. 93 to 95% of people respond well to it (ie, become immune to HBV infection) if they complete the vaccination series. The most commonly used vaccine has 3 doses, given at the start of the series, then 1 month and 6 months later. A simple blood test for anti-HBsAg antibodies after the vaccination series is completed will tell you if the vaccinated person responded well.

When the first vaccine dose is given to a baby within 24 hours after birth, it efficiently blocks vertical transmission (ie, from infected mother to infant at or shortly after birth). So the vaccine is great for infants, adolescents, and adults!

John.

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15

Dear @john.tavis sir,

Thanks for your response. I could not go for anti-HBsAg antibodies test after the vaccination bcoz neither i was aware about that nor the ones who vaccinated me told me about that. Before the vaccination, they got my blood and a couple of days later when the test came negative, they vaccinated me with 3 doses on the monthly basis. It was in 2012. And bcoz of this when i had symptoms of acute HB infection which im sure was in 2020, i brushed it off as HB bcoz i knew i was protected due to the vaccination.

16

I would like to inform the community members that my gastroenterologist has put me on vemlidy. Moreover, I’m also planning to change this physician as I’m not satisfied with him. When i asked him why there was rebound in viral load on ETV therapy, he could not give a proper answere. On the other hand, he said what can we do? I showed him the labs, he told me that there are two options. (1) he said we can continue Entecavir by adding another antiviral. (2) we can switch to another antiviral. I told him that i would go with the 2 option. During this time, i told him that i was the member of HepBCommunity and i had already shared my labs with the experts in the community. Then he asked me what did they say, i answered that I’m told to switch to TDF or TAF. Then he put me on the Vemlidy.

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17

Hi @Nawab,

Sorry to hear about what you’re going through.

If you confirm that your HBV DNA levels remain high (rather than going down after ongoing treatment) and you know your antivirals come from a reputable source, then (as @availlant has mentioned) there is a high likelihood that there’s a resistant HBV infection and switching antivirals would be the first thing to consider.

Given the information you’ve provided, it may still be possible that you had been asymptomatically infected before your vaccination or that the vaccination was not successful in inducing protective levels of antibody (which happens in some cases and is not related to sleep levels as far as we know)

People in the immune-tolerant phase of chronic HBV infection can have these results for decades (>40 years old), so being HBeAg-positive and low liver damage is not indicative of recent infection.

I hope this helps,
Thomas

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Dear @ThomasTu,

I switched to Vemlidy on 21th of July. With regard to the reputable source of Entecavir, i used to buy it from any shop where it was available. However, there have been concerns from the authorities on the qualities of drugs sold in those markets and this was the reason my gastroenterologist put me on Vemlidy which is not manufactured here. Right now, I’m having this Vemlidy

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19

Hello guys,

I need your support bcoz I’m very scared. Isn’t quite strange that vaccine failed to protect me from HBV. Entecavir, one of the very strong antivirals, also failed to suppress HBV replication in my body. I’m wondering what if Vemlidy also fails to respond to the virus. What scared me most was my physician telling me that vemlidy was my last chance. I don’t what he meant by that or what was the context of that statement. What am i supposed to do in that situation when Vemlidy fails to maintain viral suppression?. Though i have already shared my labs with you, now I’m posting the pics for your better understanding.

20

Hi @Nawab,

To answer your concerns:

Some people’s bodies do not respond as effectively to the vaccine: ~10% do not raise protective antibodies after 3 doses (in these cases, booster shots can help), but we don’t know the underlying biology of why. So there is always the small risk that people remain vulnerable to HBV after vaccination.

Regarding treatment, resistance to Vemlidy has not been reported even after millions of people around the world are taking it. There’s a extremely good chance that your viral load will respond Vemlidy.

Hope this helps,
Thomas

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