Hep B Blog

Can People with HBeAg-Negative Hepatitis B Ever Stop Taking Antivirals?

Image courtesy of rakratchada torsap, at FreeDigitalPhotos.net.
Image courtesy of rakratchada torsap, at FreeDigitalPhotos.net.

Medical guidelines suggest that individuals with HBeAg-negative hepatitis B with signs of liver damage face an “indefinite” or even lifetime commitment to taking daily antiviral pills.

In this week’s blog, we explore when—if ever—individuals with hard-to-treat HBeAg-negative hepatitis B can ever stop taking antivirals.

First of all, what is HBeAg-negative hepatitis B? Many people infected with hepatitis B at birth and who remain infected into their 40s, 50s or 60s, develop HBeAg-negative hepatitis B. Researchers believe that over time the virus mutates to evade the immune system. Though individuals may have lost the hepatitis B “e” antigen (HBeAg) and developed the “e” antibody, this mutated virus develops the ability to keep replicating despite the loss of HBeAg. And this mutated virus is capable of putting people at higher risk of liver damage.

Generally, doctors recommend treatment to HBeAg-negative patients when their viral load exceeds 2,000 IU/ML and their ALT liver enzyme levels, which rise when liver cells are damaged, are even moderately elevated. (Normal ALT levels are less than 30 for men and 19 for women.)

The most common antiviral treatments are either entecavir (Baraclude) or tenofovir (Viread). These two are considered the most powerful at quickly reducing viral load (HBV DNA) and have a very low risk of causing drug resistance, which is critical considering the long-term treatment required by HBeAg-negative patients.

But can individuals with HBeAg-negative hepatitis B ever stop treatment? Antivirals are expensive, without insurance tenofovir costs about $1,000 a month and generic entecavir costs about $407 in the U.S. Additionally, long-term antiviral treatment can cause bone loss.

Late last year, hepatitis B experts with the American Association for the Study of Liver Disease (AASLD) tackled this question and reviewed recent studies that followed HBeAg-negative hepatitis B patients who stopped antivirals. They found that even when these patients enjoyed two years of undetectable viral load and normal ALT levels during treatment, when they stopped only half of them were able to maintain a low viral low (below 2,000 IU/mL) and normal ALT levels.

The risk of dangerous “flares” after stopping treatment, “requires careful weighing of potential for harm and benefit,” the experts wrote. This is important because many HBeAg-negative patients are older and more vulnerable to liver damage and cancer.

In their new recommendations, AASLD experts make clear their findings are “conditional” and the quality of evidence found in the studies they reviewed is “low.” However, this is what they tentatively recommend:

  • Stopping treatment, “may be considered in persons who have (lost) the hepatitis B surface antigen (HBsAg). However, there is currently insufficient evidence to definitively guide treatment decisions for such persons.”
  • And, anyone who stops antiviral therapy should be monitored every three months for at least one year to see if their viral load rebounds or if they have signs of liver damage, including ALT flares.

Given the knowledge-gap about the long-term health consequences of HBeAg-negative hepatitis B, more research with longer durations of monitoring are needed, experts recommended. “Alternative treatment strategies for patients on long-term antiviral therapy, such as adding or switching to (pegylated interferon), warrant further study,” they concluded.

 

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194 thoughts on “Can People with HBeAg-Negative Hepatitis B Ever Stop Taking Antivirals?”

  1. I have been e.ant. Negative & anti hbe+ viral load over past 20+yrs has been low/undetected. Highest reading 500hbvdna. Latest undetected. Alt over past 4 tests 17,16,, 18,23, but latest 33. Do not know hbvdna or any other results. Could I be mutating? I have had hep. But for probably 50yrs. I am 66yrs old. I am very scared. My doc says nothing to worry about. Another consultant I saw said I would die WITH hepatitis B not From it. This was after my Alt of23 NOT 33.
    Have I got a mutatation?

    1. Hello: Given your healthy ALT levels, which indicates no liver damage, there is no evidence of viral mutations. Trust your doctor and keep getting monitored. Good luck.

  2. I’m a 42 year old female and known about my HBV since 16, but believe I contracted it from a transfusion as a newborn. I’m genotype A and HbeAg negative for decades. My viral load has never been above 2,000 and fluctuates from 150-900 iu/ml. My ALT for 15 years of monitoring regularly are from 21-34. 2 biopsies show no significant fibrosis and Elastography last year was 4.3 kpa. I was on Viread for 6 months because a doctor said it would reduce HCC risk, not based on personal labs or history. I had to move to a new specialist, who works with Dr. Gish and they said it wasn’t needed. I went off 4 months ago and viral load has been 700 iu/ml with alt of 22 and last month tested again viral load 85 iu/ml and alt 34. Was the advice to stop Viread right, and me to only go back on if DNA goes above 2,000 iu/ml, ALT rise higher, and show liver damage? My Hepaltologist said she would only consider Viread again if ALT is 50-60 and DNA rises over 2,000 iu.

    1. Hello: I agree with your doctor completely. The threshold for treatment, as your doctor pointed out, is an elevated ALT level, indicating liver damage, and a viral load of more than 2,000 IU/mL. I think you are in good medical hands. Good luck.

  3. In 2010 i diagnosed as hbv, i got viral load result was 20 ul. Liver biopsy result was, no malignancy first step, of hbv, Alt 54, hbeag negative.
    Having these tests a doctor started my treatment as enticavier, of 5 mg.
    After six months i met with a doctor in Dow university, he said me that, you are only career not infected, your Dr has given you a wrong treatment.
    While he continued my enticavier for 18 months. After, recheking the hbv, dna, result was negative. He stopped my treatment.
    In 2014, i retested my hbv, dna, positive, anti hdv positive, alpha feto protein result is, 15.56,
    till to date sgpt is 14,
    is my liver safe.

    1. Hello: Yes, given your report of an undetectable viral load (HBV DNA) and SGPT of 14, which means you do not have liver damage, your liver is safe. Good luck.

  4. I am a 53 year old Asian female who acquired HBV at birth. My mom and uncle both died from liver cancer and my older male siblings have been on Entecavir for years. I am not on antivirals as my specialist still thinks I am in the immune tolerant phase despite my age and family history. I am still eAntigen positive and have a very high viral load (in the millions). However, my liver function tests are normal and my ALT levels have been in the high normal to just slightly elevated. My latest Fibriscan score was 5.5 to 6 kPa. It was 4 kPa 3 1/2 years ago.
    I’m just wondering how common it is to still be eAntigen positive at this age. I’ve been told it’s not that unusual but I have not heard of others in a similar situation. Thank you.

    1. Hello: I shared your case with one of our liver experts, in part because I had not encountered anyone who was still in the immune-tolerant stage in her 50s. Here is his advice: “To be immune-tolerant at 53 is unusual, but not unheard of. I believe this woman should be on antiviral therapy, probably tenofovir. She has liver enzyme values that are not strictly normal, her Fibroscan is borderline abnormal, and her strong family history of liver cancer are persuasive to me. I would recommend that she get a second opinion from another liver specialist. Perhaps we can recommend someone from our specialist list.”
      The Hepatitis B Foundation has a list of liver specialists who are familiar with treating hepatitis B at http://www.hepb.org/resources/liver_specialist_directory.htm
      Good luck, and please talk to your doctor about treatment or see another specialist.

  5. hello: i m 35 year old Asian male. 9 years ago i diagnose Hepatitis B+. i have not knowledge about H B at that time gradually i have known. i retested and the reports last week and the reports are as under:
    HBeAg. Negative
    HB viral load=2200060 copie/mL
    HDV=Negative
    HCV=Negative
    ALT=55
    Protien=8.18
    the liver specialist suggested ENTECAVIR 0.5mg.
    i m having herbal dose also.
    is my liver in danger?
    what stage of HB now?
    kindly suggest what should i do?

    1. Hello: Your viral load is quite high and your ALT (liver enzymes that rise when liver cells are damaged) is also elevated. Normal ALT levels for men is 30 or less, and for women it’s 19 or less. When you have an elevated viral load and signs of liver damage, which you do, doctors recommend treatment, and entecavir is one of the top two antivirals that are recommended for hepatitis B treatment. Please be careful about herbal supplements and let you doctor know what supplement you are using. They are not regulated and their content can vary from bottle to bottle. Also, remember to eat healthy foods and avoid alcohol and cigarettes, practice safe sex, and get your family members tested and vaccinated if needed. Good luck.

      1. hello,thanks for reply and helpful suggestions,
        is the medicine(Entecavir) will reduce the viral load? how much it reduce?
        having the recent viral load, when i retest and followup checks?
        you did not tell me about the stage of my HB?
        thank u.

        1. Hello: Your hepatitis B is in the active stage, because your viral load is elevated as are your liver enzymes. Generally, antivirals work quickly, within one to three months, to lower viral load. It is important to keep monitoring your viral load and liver enzymes after you start treatment to make sure it’s working and your liver damage is reduced. Please talk to your doctor. The World Health Organization has issued hepatitis B treatment guidelines at http://www.who.int/hiv/pub/hepatitis/hepatitis-b-guidelines/en/ that you may want to review with your doctor. Good luck.

  6. After exposer in sex the next day i go for check up and found out i am hep b postive with hbeag negative,before no pain after this exposer one month pass i have pain around liver why hbeag quikely becomes negative?hbsag quantity is 21343 iu/ml,why it is high?this all is that sex exposer i am chronic or acute hbeag negative means chronic?is there spontaneously convert hbeag to hbeab like after 3~6 hours

    1. Hello: In all likelihood, you may have been infected with hepatitis B before this sexual encounter. It takes several weeks after exposure to hepatitis B for a lab test to detect the infection — specifically the hepatitis B surface antigen (HBsAg). If your test shows you are HBeAg-negative, it means you were infected previously. Continue to be monitored, if you continue to test positive for HBsAg after six months, it means you are chronically infected, and probably contracted hepatitis B as a child.
      Please talk to your doctor about your abdominal pain. The liver has very few sensory nerves and people with hepatitis B very rarely experience pain around their liver. The pain may be coming from another source, such as your gall bladder. For more information about pain and your liver, visit: http://hepbblog.org/2015/09/14/when-is-that-pain-hep-b-related-and-when-is-it-something-else/
      Thank you.

  7. I am starting my antiviral medicine tomorrow march 02,2016 since my hbv-dna is morethan 110,000,000 ui/ml. I will be taking .5mcg of my medicine with tha aid of my physician for this. My sgpt is 10u/l and alkaline phosphate 61.2u/l. Does my medicine could totally eliminate thr virus or could only lessen the activation of virus? If im not going to pursue my medicine what might happen? Thank you for your response.

    1. Hello: Given your high viral load and your “healthy” ALT/SGPT level, it appears you are not experiencing any liver damage and are still in the immune tolerant stage. Often, experts do not recommend antiviral treatment for people in the immune tolerant stage because your immune system hasn’t “woken up” and begun attacking the infection yet. Your doctor may be hoping that lowering your viral load might prompt your immune system to begin clearing the virus, though there is not a lot of documented success in that area.
      Unfortunately, antivirals will not totally eliminate the virus. However, please keep getting monitored for both ALT/SGPT and viral load so you can document what impact the antiviral has on your body. Also, what antiviral are you taking? And, of course be sure to eat healthy food and avoid alcohol and cigarettes. Good luck.

  8. Thank you very much for the quick reaponse. I will be taking entecavir for 60 days. After that i will check my sgpt again. Yes you are right i will take the antiviral to lower my viral load. If im going to take medicine, is there a chance that i will still take them in the future?

    1. Hello: Often, taking antivirals becomes a long-term commitment as a way to prevent liver damage and cancer. Your doctor will monitor your liver enzymes (ALT/SGPT) and viral load to see if the antiviral is working to lower viral load and improve the health of your liver. How long you take them depends on your age, gender, and medical history with hepatitis B. In some cases, if people eventually get rid of the hepatitis B surface antigen (HBsAg) and achieved undetectable viral load for a prolonged period, a doctor may try taking you off antivirals to see how you do. Talk to your doctor about this, and good luck with the treatment.

  9. Im just 25 year old. Also i forgot to mention that iam anti hbe total reactive. What does it mean? Thank you again.

  10. Hbeag postive hbeab negative means acute infection and hbeag negative hbeab postive chronic infection,for hbeag to convert naturaly from postive to negative it needs at lease 3 years right?

    1. Hello: When healthy adults are infected with hepatitis B, most of them experience an “acute” infection. It can take them up to six months for their immune systems to get rid of the acute infection. However, when we’re infected at birth or as children, our immature immune systems don’t notice the hepatitis B virus and it becomes a long-term or chronic infection. Unfortunately, if you have tested positive for hepatitis B (specifically the hepatitis B surface antigen – HBsAg) for three years, it means you are chronically infected. Please get monitored regularly, especially for liver damage through an ALT/SGPT blood test, and avoid alcohol and cigarettes. Also, practice safe sex (use a condom), and we recommend your family members get tested and vaccinated if needed. Good luck.

  11. My queation.is about hbeag not hbsag
    Hbeag postive hbeab negative means acute infection and hbeag negative hbeab postive chronic infection,for hbeag to convert naturaly from postive to negative it needs at lease 3 years right

    1. Hello: Whenever your are infected with hepatitis B–no matter if it is a chronic or acute infection–you test positive for the hepatitis B “e” antigen (HBeAg). It is one of the antigens the virus produces, along with the surface antigen. If you are infected as a healthy adult, it may only take several months for your immune system to generate enough “e” antibodies (HBeAb) to clear or eradicate the “e” antigen (HBeAg). If you were infected as a child and have a chronic infection, it can take years to lose HBeAg and develop HBeAb. There is no timeline for HBeAg seroconversion. Thank you.

  12. Dear Dr I have a concern I have upper abdominal pain in the side of the liver but when I went for scan they said every thing is normal my viro load is 4511u/l what could that be , if gallbladder what can Couse the pain and even skin burning around the bally

    1. Hello: Our livers have very few sensory nerve endings around it, so we rarely experience any physical pain from hepatitis B. Also, if you have had a scan recently, that should confirm all is normal. You should definitely talk to your doctor about the pain you’ve been experiencing, and discuss if it’s a gall bladder problem. For more information about abdominal pain and hepatitis B, please read: http://hepbblog.org/2015/09/14/when-is-that-pain-hep-b-related-and-when-is-it-something-else/
      Thank you.

  13. Sir,
    I am 38 years old Asian male. 16 years ago I have diagnosed HBV. However, I have started treatment 18 months ago on Entecavir 0.5mg. My genotype is C and our family history has HCC as one my cousin brother is diagnosed and expired.
    Before starting antiviral my Viral Load is 1250 IU/ml, Hepatitis B e Antigen is Non-Reactive, ALT is 69, AST is 37, Fibroscan is 4.7 kpa, Ultrasound inference is Mild hepatomegaly with fatty liver, Alfa Feto-Protein is 3.1 IU/ml.
    After 3 months on antiviral treatment my Viral load is undetectable i.e. below 3.8 IU/ml and from the last 18 months my viral load is undetectable. Now, My ALT is 19 and AST is 24, Alfa feo-Protein is 3.5 IU/ml, HBeAg is 0.3 S/CO, AHBe (Total) is 0.01 S/CO, Ultrasound inference is Mild hepatomegaly with fatty liver. My physician advised me to stop antivirals as I have achieved HBeAg sero-conversion, HBV DNA negative > 1 year and to monitor with HBV DNA /LFT after every 3 months and also explained me about the chances of relapse is 50% and if relapsed, will continue antiviral.
    Please advise me whether I can stop antiviral treatment in this condition. My Physician told me that I have started antiviral in the carrier state as the antiviral was prescribed by another physician. I am scared about viral relapse, hepatic decompensation, hepatic flares and other unwanted things.

    1. Hello: Your previous physician started you on entecavir because your viral load was slightly elevated and your ALT (liver enzyme test) was slightly above normal indicating some liver damage, especially given your family history of liver cancer. Since starting the drug, both your viral load and ALT levels have declined to normal. Because you have maintained healthy ALT and undetectable viral load your doctor wants to try to take you off the antiviral, but continue to monitor you closely to see if you have any reactivation. If you are nervous about this, talk to him about your concerns. Continued monitoring after you go off antivirals is critical. Good luck.

  14. I am 24 year old male. I was suddenly diagnosed with Hep B positive in 2011. My physician prescribed me ENTECAVIR for 6 months. After 3 months of treatment I went for Hep B DNA PCR which become negative. Anti HDV is negative. I have been regularly monitoring my LFT in which SGPT/ALT and Alkaline Phosphatase has never exceed its normal level.

    Now For Routine checkup I went for Hep B DNA PCR Quantitative which show 247 IU/ml DETECTED. I am Hep B e Ag negative. In LFT test SGPT is 21 U/L, Alkaline phosphatase is 89 U/L. Gamma GT is 16 U/L. My anti HDV os 0.945 (Negative)

    My LFT has always been normal.

    What should I do now.? Should I again start Entecavir.? Is any thing to worry about.?

    1. Hello: If I understand your report, your liver function tests (ALT/SGPT) have shown no liver damage, and your viral load (HBV DNA) is very low at 247 IU/mL. It appears you have “inactive” hepatitis B, which means your immune system is successfully keeping the infection in check. According to medical guidelines, you do not require any treatment because your viral load is low and you have no signs of liver damage. Continue to get monitored regularly, and eat healthy foods, avoid alcohol and cigarettes, and practice safe sex (use condoms). Make sure your family members have been tested for hepatitis B and immunized if needed. Keep up the good work!

  15. Dear sir,

    My wife is diagnosed with hbsag postive after that we prescribed for other test which are

    Hbeag: negative
    Dna pcr: 6020 iu/ml
    ALT: 16

    I want to know is my wife is infected with acute or chronic hepatitis b and i also want to know is there any chance for her to completely get rid of this virus and please recommend me either we start taking anti virals or wait for certain time

    1. Hello: The only way to find out if she has a long-term (chronic) infection or a short-term (acute) infection is to get tested over a six-month period. If she tests positive for the hepatitis B surface antigen (HBsAg) for longer than six months, it means she has a chronic infection.
      The good news is, from the lab results you provided, it appears her liver is healthy (healthy ALT levels for women are up to 19).
      There is no cure for hepatitis B, though experts predict a cure will be developed in the next few years.
      Please make sure she is monitored regularly, and if you have children, the newborn must be immunized with the first dose of the hepatitis B vaccine within 12 hours of birth and also given HBIG (hepatitis B antibodies) at birth to prevent the baby from getting infected. Good luck.

  16. Hello Sir,

    I am 37 African male, was diagnosed with hep b in 2004 and dr thought i probably got it from birth. I am hbe ag negative. In july 2016 i tested for liver function: ALT was 43, DNA 5,350. Does this mean my liver is damaged? My dr had me test again in early October 2016 to see if Viral load is increasing or decreasing. Ultrasound results show liver and the rest are normal. Do I need to start treatment? If yes, what type of medicine? Thank you.

    1. Hello: Generally, people do not require treatment unless they have signs of liver damage and a viral load exceeding 2,000 iu/ml. Liver damage is indicated by a blood test for the liver enzyme ALT. Liver cells release ALT into the bloodstream when they are damaged. Healthy ALT levels for men are up to 30 and up to 19 for women. Each lab has its own healthy range, so your ALT of 43 may not be very high, and your ultrasound shows your liver is healthy. Treatment may not be recommended at this time, based on what your doctor finds, however it is important that you continue to be monitored frequently, and avoid alcohol and cigarettes, practice safe sex, and eat healthy foods. Good luck.

  17. Pls Dr. I did a profile test of HBv. The result is below .HBsAg positive
    HBsAb negative
    HBeAg negative
    HBeAb. positive
    HBcAb positive
    Can you kindly interprete it for me. Am Gracious.

    1. Hello: When you test positive for the hepatitis B surface antigen (HBsAg), it means you are currently infected with hepatitis B. Your HBsAb negative tests shows your immune system hasn’t generated enough surface antibodies yet to eradicate the surface antigen. The good news is you test negative for the hepatitis B “e” antigen (HBeAg) and positive for the “e” antibody (HBeAb), which means your immune system is fighting the infection. Also, when you are E antigen negative, it means your viral load is probably not high. The core antibody (HBcAb) result also means you have been infected in the past. This is the first “antibody” against hepatitis B to appear.
      You must get tested again in six months to find out if this is a new or acute infection, or if you were infected during early childhood and have a chronic or long-term infection. If you continue to test positive for HBsAg, you should also get a test to see if you have experienced any liver damage. Good luck.

  18. Hello Dr. my result of my hep b profile:
    HBsAg:reactive
    Anti-HBs:non reactive
    HBeAg:non reactive
    A-Hbe(reverse):reactive
    A-HBc IgG(reverse):reactive
    A-HBc IgM:non reactive

    and I’m 8mos. Pregnant.
    Tnx.

    1. Hello: As you may know, when you test positive for the hepatitis B surface antigen (HBsAg), it means you are currently infected with hepatitis B. The good news is you test negative for the hepatitis B “e” antigen (HBeAg) and positive for the “e” antibody (HBeAb), which means your immune system is fighting the infection. Also, when you are HBeAg negative, it means your viral load is probably not high.
      It is absolutely critical that you make sure that your baby is vaccinated with the first dose of the hepatitis B vaccine within 12 hours of birth and also is given a dose of HBIG, otherwise there is a high risk that the baby will become infected because of exposure to blood and body fluids during delivery.
      Please talk to your doctor and make sure the baby will be vaccinated with the first vaccine dose, and then 30 days later with the second dose, and five months later with the third dose. Hopefully this will stop the chain of hepatitis B infection. Good luck.

  19. I was diagonised with HB in 2014 when I had gone to get immunised. In 2015 August, I was started on tenofevir until todate. Last tests showed HB Viral load as undetectable, HBeAntigen :Negative and HBe Antibodies :positive. liver tests are normal except ALT which is slitely higher than normal, scan shows size of 5.4cm and no smooth surfaces. My doctor is suggesting to win me of the drug but am still worried. Please advise.

    1. Hello: Your doctor knows your general health, family history, your gender and age, which all play a role in deciding when to treat or not treat. Assuming you’re fairly young, with no family history of liver cancer, your doctor probably want to see how you would do off tenofovir. It is important to get monitored frequently during this period, which I’m sure your doctor has recommended, to identify any “flares” — sudden increases in viral load (HBV DNA) and ALT levels, indicating liver damage. As long as you’re monitored, both you and your doctor can track your liver health and decide if and when you need to return to antiviral treatment. Tenofovir is an excellent antiviral, it sounds like your doctor knows what he/she is doing. Good luck.

  20. Hello Dr,
    I am a patient of 72 years old with HBe-Ag negative chronic hepatitis B (Anti Hbe positive at baseline) and I took tenofovir for already 36 months. Every 6 months the follow up is: HBVDNA undetectable, ALT normal, HbeAg negative, AntiHbe positive. However, lastly in October 2016, the results are as follow: HBVDNA undetectable, ALT normal, HBeAg positive, AntiHbe negative. Can you kindly interpret it to me. Thank you in advance

    1. Hello: That is most unusual, I assume you have not stopped taking tenofovir? Sometimes, the HBeAg can flipflop if you stop taking antivirals. Also, how labs report HBeAg and HBeAb is confusing. Talk to your doctor, he or she may want to retest you earlier. The good news, however is that your viral load remains undetectable and your ALTs are normal, indicating no liver damage. Please check in again when you get your next tests run. Good luck.

      1. Yes, I saw that my case is quite unusual. Even my doctor seemed perplex. I am still taking tenofovir and I know that I can only stop it when there is new breakthrough in CHB treatment. The next test will be six months later, in April 2017, may be earlier. I shall inform you on that occasion as soon as possible. Once more thanks.

    1. Hello: Your HBV DNA (viral load), hepatitis B antigens and antibodies, your liver function tests (including ALT/SGPT), an ultrasound if recommended, and also an alpha fetoprotein test (AFP) for liver cancer. However, these recommendations vary between countries. You can also consult the World Health Organization’s hepatitis B treatment and monitoring guidelines at: http://www.who.int/hiv/pub/hepatitis/hepatitis-b-guidelines/en/
      Good luck.

  21. My sister in law is suffering from chronic Hbv having hbeag negative and normal alt and undetectable hbv DNA.she is entacavir treatment from four year.she has two children both are hbsag negative and vaccinated
    My question is how they are hbsag negative is any lab result error.
    Should I check their anti hbv lebel

    1. Hello: When newborns of infected mothers are vaccinated within 12 hours of birth, they are usually protected from hepatitis B. Also, her undetectable viral load also reduced the risk of infecting her newborns. If the children have tested negative for HBsAg, there is no reason to retest them, other than assuring you they have enough hepatitis B antibodies to avoid infection. Good luck.

  22. Dear Doctor,
    My fiance, 35 years old is HBsAg Positive, HBe Ag Negative, HBV DNA 37.3IU/ml, ALT 54U/L and fibroscan for liver stiffness is 11.8 kpa and 15 years of regularly having alcohol . Does he need to take antiviral therapy in urgent? I need suggestion for people living with HBV positive husband. I am HBV vaccinated.
    Thanks in advance for reply.

    1. Hello: His liver enzyme levels at 54 are slightly elevated. Healthy ALT levels for men are around 30. However his viral load (HBV DNA) is quite low. He should continue to be monitored by his doctor, but most of all he should avoid alcohol as that may be causing the elevated in his ALT levels, depending on how much he drinks. Good luck.

  23. I just went for a hepatitis b test and the initial test was positive. I was asked to go to a lab and take further tests. They were liver function tests, Hepatitis B cores, and HbeAg. They however just gave me results and did not interpret. The liver function tests were all within the reference intervals and showed that my liver function was ok. However, I could not understand or interpret the other tests. Can someone please help with interpreting the results below:

    1) Hepatitis B e antigen (eclia): negative
    2) Anti-Hepatitis B core antibody (igM eclia): negative
    3) Anti-Hepatitis B core antibodies (igG and igM eclia): positive

    Thank you for your help in advance.

    1. Hello: As you probably already know, when you test positive for the hepatitis B surface antigen (HBsAg), it means you are currently infected with hepatitis B. When you test positive for HBsAg for longer than six months, it means you have a chronic infection.
      Your other results show your have cleared the “e” antigen, which is good because it means your immune system is trying to eradicate the infection by producing antibodies. The core antibody tests confirm that you have been infected.
      I am glad your liver function tests show no liver damage.
      Please try to eat healthy foods, avoid alcohol and cigarettes, and continue to get monitored to see if you have a chronic or acute infection. Good luck.

  24. Hello,
    About 30 months ago, my doctor put me on entecavir .5 mg daily. A month
    Or so later I started having terrible headaches. MRI, visit to ENT and neurologist cleared me of any abnormalities.luckily the headache resolved by itself after 12 weeks of misery. Now about two years later I am having a similar headache. same time of the year( fall) almost at the same date, end of September, early october. Would be this caused by entecavir?

    1. Hello: Side effects from a medication usually do not pop up annually. Perhaps it’s caused by allergies — with the guilty allergen blooming in September perhaps? Please talk to your doctor, perhaps he or she can recommend a screen for allergies or a change in diet. Good luck!

  25. Hello all

    my husbund has tested HBs ag posetive and the doctors asked him to test different lab with the list blow with result T.cholesterol 157 triglyceride 88 triglyceride 36 lDL 103 urea 18 creatinine 1.0 uric acid 3.1RPR /VDRL KAt HCV ab negative albumin 4.4HBe Ag negative PT 15.7 Ptt 36.7 InR 1.18 HBc Ab-Igm or IgG Negative so what do you advice for him please
    Thanks in advance!

    1. Hello: As you may know, a positive test for the hepatitis B surface antigen (HBsAg) means he is currently infected with hepatitis B. Is this the first time he has tested positive for hepatitis B (HBsAg)? To find out if he has a long-term or chronic infection, or whether he was just recently infected, he needs to be tested again in six months. When healthy adults are newly infected, their immune systems are usually able to clear the infection in six months. If an infection last longer, it is a chronic infection and he was probably infected when he was a newborn or child, and his young immune system wasn’t able to fight the infection.
      The lab tests you copied showed he is not infected with hepatitis C, which is good. However, I don’t see a lab test for the liver enzyme ALT (also called SGPT). This test reveals whether the hepatitis B virus is causing any liver damage.
      Please have him tested again in six months, and also get his liver enzymes tested to find out if the infection is harming his liver. Good luck.

  26. Thanks all i will attached the result SGPT test after lab. and also should i take the vacination of HB. we leave together 11 years but my lab test is negative result and we have three child but my babys are vacine when they are befor nine month baby.

    thanks again

    1. Hello: Please send copies of your lab test to info@hepb.org if you are looking for assistance interpreting them. Please email your questions to that email address for more information. Thank you.

  27. Hi sir i m chronic Heb B patient with normal LFT test
    And Negatibe HBeAg
    And positive HBeAb
    With No detectable DNA
    Means PCR is negative 6 years ago
    Butt now few month before i have right abdominal pain with lever inflammation butt still normal LFT’s….
    What do u suggest??? Thanks
    And my wife has thee shots 6 years ago… Is she need to b again vaccinated???

    1. Hello:
      First, your wife is fine. As long as she had the three vaccine shots, she should be immune. However, to be on the safe side you can have her hepatitis B surface antibodies tested to make sure she has at least 10 mIU/mL, which guarantees she is protected.
      Abdominal pain is fairly rare in people with chronic hepatitis B (please read: http://www.hepb.org/blog/when-is-that-pain-hep-b-related-and-when-is-it-something-else/), especially given your healthy liver test results. I encourage you to talk to your doctor in the event it results from another medical condition (ie. gall bladder etc.) Good luck.

  28. I have HBsAG positive, HBeAG Negative, HBe Antibody positive, HBc Antibodies IgM Negative.

    AST=25 & ALT=34 (ALT was 51 one year ago)
    HBV DNA was fluctuating last year from 3000 to 8000 to 19000 IU/ML, and my doctor advised to go for Baraclude. I was very afraid since it is a life time medicine, and I decided to quite smoking, sleep early, drink Zamzam water every day.. Surprisingly after 3 months the HBV DNA went down to 600 IU/ML..

    But after returning back to smoking, and running through some stress at work, my HBV DNA results now are 5900 IU/ML.

    Do I really have to go for the medicine ? or Should I try again to eat well, sleep well, to see if this can help ? And is there any cance -given the history I mentioned – that my immunity can get rid completely from the virus ?

    1. Hello: Generally, medical guidelines recommend treatment if you are experiencing liver damage. This is indicated by an ultrasound (Fibroscan) and a simple blood test for the liver enzyme ALT (also called SGPT). Our liver cells release ALT when they are damaged or die. Healthy ALT levels for men are up to 30 to 40, and for women they are up to 19. Yours at 34 appear healthy. Your viral load (HBV DNA) fluctuates a little, but not dramatically. As you can see from your lab results, smoking very much impacts our health, as does alcohol. If you eat healthy foods and avoid smoking and alcohol you may be able to postpone treatment, however it is very important to continue to get monitored regularly. The other factors that doctors take into consideration when recommending treatment is any family history of liver cancer, how long you have been infected, your gender, age and overall health. Please consult with your doctor and continue to monitor your ALT levels. There is no cure for hepatitis B yet, but remember that most people live long and healthy lives with hepatitis B, and there are effective antiviral treatments, including entecavir (Baraclude) if you ever require treatment. Good luck.
      If you ever do, there are two very effective antiviral medications that are recommended: tenofovir (Viread) and entecavir. Good luck.

  29. Hi sir, i am 27 yrs male Indian. in October 2015, i was hbsag(elisa) non reactive. But in December 2016 i am tested hbsag positive. So my doctor advised few more tests. 1.Hbeag(negative)
    2. Hbvdna quantitative ( 1323 iu/ml)
    3.liver function test (alt 52, total protein 8.1).
    My doubt here do i have acute hepatitis or chronic hepatitis.
    If i have got this infection recently what are the possibilities to get the symptoms. I have no symptoms yet.
    My doctor says you are chronic hepatits carrier and my old report might be wrong. Please clear my confusion. How to know whether i have acute or chronic hepatits.

    1. Hello: Hello: When you test positive for the hepatitis B surface antigen (HBsAG), it means you are currently infected with hepatitis B. Most healthy adults who are infected are able to get rid of the virus on their own within six months. This is called an acute infection. However, if you continue to test positive for HBsAg for longer than six months, it is considered a chronic infection. It means you were probably infected at birth or during early childhood, when your immature immune system could not fight it.
      You need to be tested again in six months to find out if you have been able to clear the infection (test negative for HBsAg and positive for the hepatitis B surface antibodies – HBsAb).
      Many people who become infected with hepatitis B never have any symptoms, which is why it’s called the silent infection and explains why nearly two-thirds of those infected don’t know they have hepatitis B.
      If you continue to test positive for HBsAg after six months, it is possible that you have an “inactive” infection with a low viral load and low levels of HBsAg. It may be the last time you were tested in October 2015 that your HBsAg level was so low, the lab test did not capture it. Good luck.

  30. Hello doc.
    I want to ask.
    Is there a chance a newborn baby from a mother who is infected with hep b virus to live noninfected. I know about a vacsin but if the baby had the vacsin is that mean the baby is safe from hep b foerever? Or it just so that the baby survive. Is there a case that the baby is not infected even the mother has hep b.

    1. Hello: If an infant born to an infected mother is vaccinated with the first dose of the hepatitis B vaccine within 12 hours of birth, and then receives the remaining two vaccine doses on schedule (the second 30 days later, and the third five months later), the baby should be protected FOREVER from hepatitis B. It is also recommended that the baby also receive a dose of HBIG (hepatitis B antibodies) at birth if it’s available, however the vaccine is the most important treatment to prevent infection.
      If it is possible, the mother should have her HBV DNA (viral load) measured early in her pregnancy. If it is above 200,000 IU/mL, she should receive antivirals during the last few months of her pregnancy to reduce her viral load and further reduce the risk of infecting her baby.
      Unfortunately, without the vaccine, a baby born to an infected woman faces a high risk of infection because of exposure to blood and body fluids during delivery. Good luck.

  31. hi. im asian. 23 yrs old currently HBsAg: reactive. together with that i have an SGPT :226 last drc 2016. now this january i got another test of HBeAg: non reactive anti- BHe: reactive. my doctor test me again after two week for my sgpt. is there any chance that i can still survive or be hepa b negative? im still a student of hospitality course and graduating next year 2018. i starting to get depressed since i really want to work abroad.

    1. Hello: It is impossible to say if and when you will clear hepatitis B. I want to confirm, was your SGPT (liver enzyme level) at 226? This is serious and indicates liver damage. Was that the first time you have been tested for hepatitis B and found to be positive? To find out if this is a new infection, which you recently contracted, or a chronic infection that you have had since early childhood, you will have to be tested again in six months. If you still test positive for the hepatitis B surface antigen (HBsAg) after six months, it means you have a chronic infection.
      In the meantime, I am glad to hear your doctor is monitoring your liver enzymes. When our liver cells are damaged, they release the enzyme SGPT (also called ALT). Healthy SGPT levels for men range up to 30 or 40, and for women up to 19. It is important for you to eat healthy foods and avoid alcohol and cigarettes. If you were recently infected, you want to be as healthy as possible to help your immune system clear the infection. Good luck.

      1. thank you for your response.

        i got confuse what it means with this result?

        HbsAg:Reactive
        HBeAg: NonReactive
        AntiHbe: Reactive

        got my ultrasound my liver is good. my doctor just want again to test my SGLT.

        1. Hello: Reactive means you have tested positive for that antigen or antibody. The “reactive” or positive HBsAg (hepatitis B surface antigen) result means you are currently infected with hepatitis B. The nonreactive rsult for hepatitis B “e” antigen (HBeAg) means you tested negative for this antigen and you tested positive, reactive for the “e” antibody (antiHBe) which is good, it generally means you should have a low viral load. Good luck.

    1. Hello: This indicates “inactive” hepatitis B, your viral load (HBV DNA) is very low at 2,224 copies/mL (which is equal to about 390 IU/mL) and your ALT (liver enzyme) is within normal ranges at 19, indicating no liver damage. Continue to eat healthy foods, avoid alcohol and cigarettes, and get monitored regularly. Good luck.

  32. Thank you! my doctor just want to have another test after six months if it is accute or chronic. hoping that i will heal after 6months. you guys are great provide us reliable info about hepB. i will share this page to my groups in facebook who has hepB also.

  33. Hi,

    Last October 27, 2016 I found out from my lab results that I have Hep B. Results are:

    HBsAg -Reactive
    Anti-HBs – Non Reactive
    HbeAG – Non Reactive
    Anti-Hbe – Reactive
    Anti-HBc IgG – Reactive
    Anti-HBc IgM – Non Reactive
    Viral load – 43,000IU/mL

    Does this mean that my virus is inactive? If it is, why is my viral load more than 2,000? Do I have acute or chronic hep B? Thank you very much for your help! God bless you.

    1. Hello: When we are infected with the hepatitis B virus, we test positive or reactive for the hepatitis B surface antigen (HBsAg). Another of the viral antigens that labs test for is the hepatitis B “e” antigen.
      As our immune systems start to fight the infection, they produce antibodies to eradicate or get rid of the hepatitis B antigens. It’s a good sign to test negative for the hepatitis B “e” antigen (HBeAg) and positive for “e” antibodies (anti-HBe).
      Is this the first time you have been tested for hepatitis B? To know if you were recently infected and have a short-term “acute” infection, you need to be tested again in six months.
      When healthy adults are infected, it takes about six months for their immune systems to get rid of the infection. When newborns or children are infected, their immature immune systems don’t recognize and fight the infection and it can become chronic and last for many years.
      Keep in mind that not everyone with hepatitis B requires treatment, many people live long and healthy lives with hepatitis B. Generally, medical guidelines recommend treatment if you are experiencing liver damage. This is indicated by an ultrasound and a simple blood test for the liver enzyme ALT (also called SGPT). Our liver cells release ALT when they are damaged or die. Healthy ALT levels for men are up to 30, and for women they are up to 19. Please consult with your doctor and see what your ALT levels are to determine if you require treatment, especially considering your high viral load. Also, please get tested for hepatitis D to rule out a coinfection. Good luck.

    1. Hello: It may not necessarily mean you are infected with hepatitis B. Discolored urine is a side effect for hepatitis B, and other medical conditions as well. Please see your doctor and talk about your symptom. If you are concerned about having hepatitis B, please get tested and if you test negative, please get vaccinated as soon as possible. Good luck.

  34. Hi, Iam 36 years old. I discovered that Iam hep b positive when i was pregnant for second baby in 2011. Iam very sure i got virus around that time since i tested negative for it in 2009 during the routine test i did for my first baby.

    My ALT E is up 25u/l normal range is up 41 u/l from lab interpretation.
    My AST E is up 20u/l normal range is 40u/l. this has been my liver function test results consistently for 6 years. i did one this month which gave the same result.
    i did a fibroscan yesterday which is 4.9kpa.
    the problem is my hbv dna viral load is 30500iu/ml. I have also been hepatitis b e antigen negative and hep b e antigen antibodies positive for the past 6 years.

    Iam worried about the high viral load. am still in the immune tolerant phase? My doc suggested Istart tenofovoir 300mg one daily. I really do not want to start the treatment because of the complications. am I in the pre core mutant stage? thanks

    1. Hello: Your liver enzyme (ALT) tests do not show any liver damage. Does your doctor want to start treatment simply because your viral load (HBV DNA) is high? Or was there something in the ultrasound that concerned him or do you have a family history of liver cancer? These are all good questions for your doctor.
      Taking antivirals is a long-term commitment, you may end up taking them for several years, so it’s important that you truly requirement treatment for liver damage before you start them.
      Talk to your doctor, and ask if monitoring every six months and taking a wait and see approach might be better.
      If you live outside of the U.S., you can review the World Health Organization’s hepatitis B treatment guidelines with him at: http://www.who.int/hiv/pub/hepatitis/hepatitis-b-guidelines/en/
      Good luck.

  35. Hi! I’m 60 yrs old with chronic HBV infection since I’m born. Taking 0.5mg/day of entecavir monohydrate for 10 years and my blood test of last month gives me a surprise:-
    Hepatitis B Surface Ag : Not Detected
    Hepatitis Be Ag : Not Detected
    Hepatitis Be Ab : Detected
    Hepatitis B Viral DNA : <20 IU/ml (below the linear range of the assay)
    AST: 19 U/L (within normal range)
    ALT: 12 U/L (within normal range)

    The pathologist comment I'm not infected in Hepatitis B anymore. Is it true? Can I become a blood donor?

    1. Hello: Congratulations!!!! Increasingly, most doctors would consider you to have cleared hepatitis B, even if you have not yet developed hepatitis B surface antibodies (you didn’t list that result in your lab reports.)
      Hepatitis B experts suggest if people who have had hepatitis B for many years have an undetectable viral load (HBV DNA), undetectable HBsAg, and no signs of liver damage, they may be “functionally cured.”
      For more information on this read: http://www.hepb.org/blog/forget-surface-antibodies-if-you-have-both-undetectable-viral-load-and-hbsag-you-might-be-functionally-cured/
      The only question for you is whether you should stay on entecavir for six more months — and have another test — to solidify your clearance of hepatitis B.
      After you stop taking entecavir, please continue to get monitored every three to six months to make sure you don’t experience any kind of reactivation.
      Unfortunately, you will not be able to donate blood. Even when we clear HBsAg and have undetectable viral load, there are small amount of virus that remain embedded in our livers, similar to the chicken pox virus that can reactivate and become shingles if and when our immune system weakens. Doctors prohibit anyone who has had chronic or acute hepatitis B from donating blood to make sure no virus is transmitted.
      Good luck.

      1. Thanks for your quick reply and extending my knowledge of this complicated virus. It seems I’m better to keep on the entecavir for six months, then have another test (must include the anti-HBsAg to check the level of surface anti-body developed).
        Even if the anti-HBsAg will be < 10 IU/L, it is no point to have the (0,1,6)months HBV vaccination as the HBs anti-body developed may not be the one for those remnants of HBV tribe hidden somewhere in my body (liver).
        Hopefully, I can be classified as functional cure in 2 years time.

  36. Hi ,

    I am 38 old man from India. Last month i have diagonsed with Heptites B. Here is test result:-

    HBsAg +ve
    HBeAg -ve
    HBeAb +ve

    HBV DNA 409 IU/ml

    AST 22

    ALT 18

    My doctor has not suggested any treatment at this point.

    Could you kindly tell what is condition of Heb B infection .

    Thanks !

    1. Hello: It appears you are very healthy, and the infection is not causing any liver damage at this time. Your liver enzymes (ALT of 18) shows your liver is healthy, and your low viral load of 409 IU/mL is close to undetectable. You certainly do not need any treatment at this time.
      Eat healthy foods, avoid alcohol and cigarettes, and continue to be monitored regularly and enjoy your life. Good luck.

        1. Hello Doc ,

          Do I need to do Fibroscan to access liver’s state more accurately ?

          Can I wait till next test ….which I will be doing in June .

          Kindly advise

          Thanks !

          1. Hello: Fibroscan (also called transient elastography) is a test that fairly accurately reveals any fibrosis or fatty deposits in the liver. It is a non-invasive, quick and simple test that works using ultrasound and gives an immediate result. Medical guidelines recommend an ultrasound to assess the health of your liver, in addition to the blood test for the liver enzyme ALT/SGPT. If your tests have not shown liver damage to date, your doctor is probably simply waiting for your next monitoring appointment to run this test. Good luck.

  37. My fathet age is 51 from last two days we had check up and we found that his liver has some infection we had a test on hepataitis and its negative. But he is in border line.About his result i will write briefly, E (kpa) medain-17.1, IOR-0.9,IQR/med-0.5.METAVIR SCORE-f3/f4. Could you please explain me in brief what does it really means and is he suffering badly or how could we prevent and what to do or not to do please hlep me so that i can see ma fathet healthy and fine

    1. Hello: If your father’s hepatitis B surface antigen (HBsAg) test is negative, his liver damage may be caused by another virus, such as hepatitis C, or fatty liver or some other cause. We wish him good luck. Make sure he avoid alcohol and cigarettes and eats healthy foods.

  38. hello, i was diagnosed with acute hepatitis b , here are the results:

    Hepatitis B Core IgM Antibody – POSITIVE
    Hepatitis B Surface Antigen – POSITIVE
    HBV DNA Viral Load – ~6,000,000 copies

    Due to the viral load and upward trend of ALT/AST(>3k and >2k respectively), doctor prescribed viread.

    I am 25 this year, what are the chances of my body gaining antibodies and not required to go on medication 6months later?

    1. Hello: I assume this was the first time you were ever tested for hepatitis B? When you test positive for the hepatitis B surface antigen (HBsAG), it means you are currently infected with hepatitis B. Most healthy adults who are infected are able to get rid of the virus on their own within six months. This is called an acute infection.
      However, if you continue to test positive for HBsAg for longer than six months, it is considered a chronic infection. It means you were probably infected at birth or during early childhood, when your immature immune system could not fight it. You need to be tested again in six months to find out if your infection is chronic or acute.
      Treatment is not recommended unless you have liver damage. An ultrasound of the liver and/or a blood test for the liver enzyme ALT is needed to determine if you are experiencing liver damage. Liver cells release ALT/SGPT when they are injured. Healthy ALT/SGPT levels range up to about 30 for men and 19 for women.
      If I understand you correctly, your current ALT level is more than 3,000? That is quite serious and your doctor has appropriately prescribed antivirals.
      Unfortunately, you will not know if your infection is acute until you are retested in six months. Hopefully you will have developed hepatitis B surface antibodies and your liver damage and viral load will decrease. Good luck.

      1. Hi, thanks for the prompt reply.

        You are right, my ALT/AST reached over 3,000 and 2,000 respectively at its peak. But it has gradually came down after taking tenofovir.

        However, is it possible that my body might not be able to produce the antibodies due to taking tenofovir?

        1. Hello: Antivirals such as tenofovir make it hard for the virus to replicate in your liver, so in theory your immune system will have a better chance at fighting the infection if there are fewer virus to fight. The key thing right now is to prevent liver damage and lower your viral load, which your doctor is doing. You should continue to be monitored regularly. If you continue to test positive for the hepatitis B surface antigen (HBsAg) for longer than six months, it means you are chronically infected. However given your severe infection, you may have an acute infection which will hopefully go away within a few months. Needless to say, eat healthy foods, avoid alcohol and cigarettes, and continue to be monitored.
          Have family members and recent sexual partners tested and vaccinated to safeguard their health. Good luck.

          1. Hi,

            I just came back from the hospital with new test results.

            ALT – 22
            AST – 25
            HBsAG – Not Tested
            HBsAB – Not Tested
            HBeAG – Negative
            HBeAB – Positive
            HB DNA Viral Load – Detected, unable to quantify as it is under 20 umol/L.

            Since DNA viral load is still present, does it mean HBsAG will definitely still be positive even though i have not tested it?

            Doctor still recommended me to continue my medication(tenofovir) for another 3months before going for another test in late August. Should i visit a private GP to do a bloodtest rather than waiting for the 3months? Since it would be almost close to 8 months if i were to wait for my next appointment.

          2. Hello: I assume you tested positive for the hepatitis B surface antigen (HBsAg) in the past, which is why your doctor did not test you this time?
            The good news is it appears your hepatitis B is well-controlled by your tenofovir treatment, given your healthy liver (normal ALT) and nearly undetectable viral load. How long have you been on tenofovir? Were you experiencing liver damage and is that why your doctor began treatment? How long have you been on treatment?
            Medical guidelines do not recommend treatment unless you have liver damage.
            As long as you are monitored within a few weeks of stopping tenofovir, you may not need to see another doctor. It’s important to be monitored after stopping an antiviral in the event you experience a flare — a sudden increase in viral load or ALT levels, indicating liver damage. Good luck.

          3. Hi,

            Unable to respond to your latest reply. I was diagnosed with acute hepaitits B in early February this year, HBsAG positive. The doctor said that it was too early for me to test for HBsAG(which i dont know why). I have been on medication since February, as my ALT/AST are very high(3000/2000), and was being told to stay on medication till my next test which is in late August.

          4. Hello: I believe your doctor did test you already for the hepatitis B surface antigen (HBsAg) when he made the diagnosis in February. Please follow your doctor’s instructions and keep taking your medications because your ALT levels are very high. Good luck.

  39. Mughal. I’m 28 years old female from Asia. I’ve screening in 2008 that my hbsag found Reactive. Hbvpcr non-reactive.
    Hbeag non reactive.
    Hbeab reactive
    Sgpt within normal range. Again done pcr in 2011 & 2013 & found non-reactive

    1. Hello: This is good news. Because your viral load is undetectable and you have no signs of liver damage, it means your hepatitis B is “inactive” and your immune system is doing a good job at suppressing the infection.
      Please continue to get monitored regularly, and continue to take good care of your health. Good luck.

  40. Hi! I’m 26yrs old from west Africa. last three weeks ago I was tested positive for HbsAg. My doctor direct me for further test today and these are the result…..

    HBSAg positive
    HBsAb. Negative
    HBeAg. Negative
    HBeAb. Negative

    HBC Total. Positive
    HBC Igm. Negative

    Please can you read this result for me? have I been infected from birth? or am acute or chronic carrier? has my liver been damage?

    1. Hello: When you test positive for the hepatitis B surface antigen (HBsAG), it means you are currently infected with hepatitis B. Most healthy adults who are infected are able to get rid of the virus on their own within six months. This is called an acute infection.
      However, if you continue to test positive for HBsAg for longer than six months, it is considered a chronic infection. It means you were probably infected at birth or during early childhood, when your immature immune system could not fight it.
      Knowing whether your hepatitis B is acute or chronic will help you and your doctor determine your next steps. Please get tested again in six months to find out if it’s chronic or acute. If you are unsure of what your blood test results mean, please visit: http://www.hepb.org/prevention-and-diagnosis/diagnosis/hbv-blood-tests/
      The reason you are testing negative for the hepatitis B “e” antigen and antibody, may mean that you are in the processing losing the “e” antigen (HBeAg), but you don’t have enough “e” antibodies (HBeAb) to show up in a lab test yet.
      Good luck.

  41. I an 24 year old male vet student I look healthy I just found out that Iam Hbsag – positive and Hbsag – negative
    My cbc showed lymphocytopenia, and thrombocytopenia
    My liver function tests came out completely normal
    My doctor says that I don’t require any medication rather Improve my diet for my immunity to clear the virus
    Am I safe, will I ever cure

    1. Hello: Your doctor is correct, no treatment is needed because your hepatitis B infection is not harming your liver, as indicated by your liver function tests. Be assured, many people with hepatitis B lead long and healthy lives and never need treatment. As your doctor recommended, eat healthy foods, avoid alcohol and cigarettes, practice safe sex, and make sure your family is tested and vaccinated. Good luck.

  42. Hi i lives in pakistan.i visited more than 3 doctrs,two doctor’s says no need to start treatment yet and two doctors says to start treatment,they made me confused whether to start treatment or not.please suggest me what should i do?
    Can i come to USA for my treatmen and can you take oppointment for me?

    1. Hello: Medical guidelines recommend treatment only if you are experiencing liver damage, which is indicated by elevated liver enzymes (ALT/SGPT) or a liver ultrasound, and you have a high viral load. Please post your ALT/SGPT levels and viral load, which will help indicate if you need treatment. Your doctor will also take into consideration your overall health, age, gender and family history of liver disease. Good luck.

  43. Dear Doctor, greetings of the day! I am a 42 yr, male. here are my reports.

    HB S ANTIGEN—-REACTIVE
    ANTI H.C.V——NEGATIVE
    ALT (SGPT)——25 U/L (REF 10-50)
    HGB————-11.3 (12.0-17.5)
    HBV PCR——– 22 IU/ML(20-170,000,000)
    CERUM CEA——-1.95 (< 3 nanograms)
    SERUM ALPHA-FETOPROTEIN–0.396 (<10ng/mL)
    SERUM HBE AG—-NON-REACTIVE
    CT Scan iv contrast: LIVER—few small
    areas of perfusion abnormality in right lube.
    Portal veins & hepatic veins are normally enhancing.
    GALL BLADDER, PANCREAS, SPLEEN, BOTH ADRENAL GLANDS & KIDNEYS appear unremarkable. Non-obstructing right renal calculi identified.

    My Doctor is concerned over the low HGB and suspects that the HBV might have affected bone morrow causing Anemia. According to my doctor Perfusion Abnormality in right lube of the liver could grow into fibrosis later on. I am predisposed as well, since one of my brother has liver cirrhosis and would be going for transplant.

    My doctor is strongly suggesting to start Viral Therapy with Entecavir .5 mg.
    I am bit confused about viral therapy, as my viral load is not very high, ALT is within the range, HBe AG is non-reactive but liver has few small areas of perfusion abnormality.

    I needed second opinion on whether starting viral therapy is the right decision under the circumstance or not? I would really and deeply appreciate your kind help and time. Thanks. J. S

    1. Hello: You are correct, medical guidelines do not recommend treatment unless there are signs of liver damage AND a high viral load, usually above 2,000 IU/mL.
      Your viral load is already near undetectable so antivirals will not impact you. Your liver enzyme (ALT/SGPT) is normal, showing no immediate liver damage. I know your doctor is concerned because of your family history of liver damage.
      However, talk with him and see if continuing to monitor your viral load and ALT/SGPT levels might be a good choice. Also, I assume you eat healthy foods, are not overweight, and avoid alcohol and cigarettes.
      Good luck.

      1. Dear Doctor, I really appreciate your reply.
        So, you think that I shouldn’t be worried about the current state of my liver (LIVER—few small areas of perfusion abnormality in right lube.) and the low HGB?

        Yes I am very active and into football.

        I will definitely continue monitoring the ALT/ SGPT. J. S

        1. Hello: It’s always important to continue to be monitored, please talk to your doctor for details about the ultrasound result and HGB, and of course lead a healthy lifestyle and avoid alcohol and cigarettes. Good luck.

  44. Dear Dr

    Please help me
    I am suffering from hepatitis B reactivate but my HBV DNA results is 31IU/ML and my SGPT.& Billirioum is also normal I have ni any symptoms and no any problems created .I have geting good opportunity for KSA but GCC medical test is unfit me so I want to know how many days my HSBAG results is non reactivate and what treatment taken now .
    Doctor told me is 90% chances is not negative results why ?
    So please advise any suggestions how to negative.
    Please reply.

    1. Hello: When you test positive for the hepatitis B surface antigen (HBsAG), it means you are currently infected with hepatitis B. Most healthy adults who are infected are able to get rid of the virus on their own within six months. This is called an acute infection.
      However, if you continue to test positive for HBsAg for longer than six months, it is considered a chronic infection. It means you were probably infected at birth or during early childhood, when your immature immune system could not fight it.
      If you are chronically infected, there is no cure or drug that will make HBsAg disappear, I am sorry. Researchers are working hard to find a cure.
      Knowing whether your hepatitis B is acute or chronic will help you and your doctor determine your next steps. Please get tested again in six months to find out if it’s chronic or acute. If you are unsure of what your blood test results mean, please visit: http://www.hepb.org/prevention-and-diagnosis/diagnosis/hbv-blood-tests/
      Good luck.

  45. Hlo, i am from south asia,

    Three years earlier my report is as below:
    SGPT:51U/L(Normal value as report: 30-65 U/L)
    HBeAG: 1.94(Cut off 0.17, Positive)
    HBV DNA: 64.72 IU/ml

    then i adviced to take entecavir 1mg/day

    Few days earlier again i tested again and my latest report is as follows:

    SGPT: 43U/L(Reference: 0-55U/L)
    AFP : 2.08ng/ml(Reference: <15ng/ml)
    HBeAG: 0.08(Cut off: 0.17, negative)
    HBVDNA: Undetected

    Now i also adviced to take the Entecavir 1mg/day(that means, my dose has not changed)

    Any Comment?

    1. Hello: Medical guidelines recommend treatment with an antiviral only if you have a high viral load AND signs of liver damage, indicated by an ultrasound of your liver or a liver enzyme test (ALT/SGPT) that is above normal. It appears you were not experiencing liver damage before starting treatment, as your SGPT level, which indicates liver damage, was in the normal range. However, your doctor may have prescribed it because your family has a history of liver cancer, or for some other reason.
      I don’t know how old you are or your gender, but it might be helpful to talk to your doctor about whether you should continue taking entecavir. The good news is you appears to have lost the hepatitis B “e” antigen (HBeAg), which is a good sign that usually results in a lower viral load. Your doctor may want you to continue entecavir in order to sustain the HBeAg seroconversion.
      Talk to him about your results, and you can review the World Health Organization’s hepatitis B treatment guidelines at: http://www.who.int/hiv/pub/hepatitis/hepatitis-b-guidelines/en/ with him.
      Good luck.

      1. I am male, age: 29, and my family has no history of liver cancer but only my mother has HBSAG positive, others are negative.

  46. is possible to drink coffee with hepatitis B
    what type of food good is healthy fro hepatitis B
    please mention

    thanks!

    1. Hello: Good question. For reasons scientists still haven’t figured out, coffee appears to protect the liver, so one or two cups of coffee daily is actually a good thing! (See: http://www.hepb.org/blog/want-to-avoid-liver-cancer-there-are-things-we-can-control/)
      Try for a healthy lifestyle with exercise, and a diet including lots of fruits, vegetables, low-fat protein, and low sugar. And of course, avoid alcohol, cigarettes and be cautious with over-the-counter painkillers such as acetaminophen.
      Good luck.

  47. I m 32 years old and pregnant women ,i am HbsAg positive,hbvdna=5910 IU/ml ,HBeAg =negative=0.27.
    Can my stage is critical plz breif me.

    1. Hello: Congratulations on your pregnancy! The good news is your viral load, at 5,910 IU/mL is not extremely high, so you do not need any pre-emptive antiviral treatment during your pregnancy to lower your viral load to prevent infecting your newborn.
      However, what is very important that you must do, is make sure your baby is vaccinated with the first dose of the hepatitis B vaccine within 12 hours of birth, and also is given a dose of HBIG (hepatitis B antibodies), if it’s available. By doing this, you prevent your baby from becoming infected.
      Make sure your doctor monitors your liver health through a blood test for the liver enzyme ALT (also called SGPT) to see if the infection is harming your liver. Healthy ALT/SGPT levels for women range up to about 19. Over the course of your pregnancy, and after delivery, you may find your ALT levels fluctuate as your body adjusts following delivery.
      Keep getting monitored, it’s important to take care of your health. Good luck.

    1. Hello: There may be another medical condition contributing to your elevated ALT/SGPT levels. Are you overweight and could you have fatty liver disease? Do you smoke or drink alcohol. Continue to be monitored and discuss this with your doctor. Good luck.

  48. Hello, I’m a Hep B chronic carrier, 28 years old, male HBeAg negative, latest viral load results dropped to 60 IU/ml(I’ve never had a viral load >2000 IU/ml). I also had a liver surgery 10 years ago for echinococcosis, the surgery was succesful. However, the fibromax results indicated a 0.38(F1-F2) score, ActiTest 0.26(A0-A1), SteatoTest 0.09(S0), NashTest 0.25m AshTest score 0.00. This scared me a little bit, but my doctor told me the fibromax scores were viciated by my high unconjugated bilirubin score(50 umol/l and told me I also have something called Gilbert Syndrome. I usually avoid alcohol(I drink only at special occasions), I eat healthy…is my hep b the cause of my fibrosis, it has to do with my liver surgical intervention or is it something else?

    Also, how infectious/dangerous am I for my ex-girlfriend? She had been vaccinated and after her third vaccine, we started to have unprotected sex. I have a fear of contaminating other people, don’t know how real is my fear, maybe it’s safe is was vaccinated. also, if my semen gets in contact with someone else’s skin…can that person be infected with hep b? Wolud love to hear your thoughts on this. 🙂

    1. Hello: Unfortunately, I am unfamiliar with your other medical condition and surgery, so I don’t know how much those interventions have affected your fibrosis vs. your hepatitis B.
      What you did not mention are your liver enzyme levels (called SGPT or ALT). Our liver cells release ALT/SGPT into the bloodstream when they are damaged, and are good indicators of liver damage. Because they offer such an immediate snapshot of your liver health, they might be useful to a better perspective of how your hepatitis B is affecting your liver currently. Healthy ALT/SGPT levels range up to 30 in men and 19 in women.
      Your viral load (HBV DNA) at 60 IU/mL is nearly undetectable, which is excellent news. The lower your viral load, the lower the amount of virus in your blood and semen. However, you still must consider yourself as infectious and practice safe sex, disclose your infection, and make sure your partners are vaccinated against hepatitis B.
      Before you practice unsafe sex, your partner should receive all three vaccine doses, and get tested for both hepatitis B surface antigen (HBsAg) and surface antibodies (anti-HBs). If she has at least 10 mIU/mL of anti-HBs, she has full immunity against hepatitis B. Until then, be a responsible sexual partner and safeguard your partner’s health. I suspect you would want to be treated the same.
      Good luck.

  49. I tested positive for hepatitis b last year December precisely.
    my test results are as follows :
    hbsag positive
    hbeag negative
    hbeab positive
    hbcab negative
    hbsab negative.

    four months after, all symptoms have subsided except the dark coloured urine.
    I’d like to know why the urine colour remain dark for so long and when is it expected to be back to normal.

    1. Hello: Everyone’s response to hepatitis B is different, and that includes abnormal urine color. Your urine color should return to normal once you have cleared the infection.
      If you tested positive for HBsAg in December, you should return to your doctor in June for another round of tests to see if you have cleared the infection.
      Also, have you contacted your doctor and explained that your urine color remains abnormally colored? He may want to run a liver enzyme test (a blood test for ALT/SGPT) to make sure the infection is not causing liver damage.
      Good luck.

    1. Hello: Your results are good, your liver enzyme ALT level of 27 shows you are not experiencing any liver damage and your viral load at 630 IU/mL is quite low. Your hepatitis B appears to be “inactive” and not causing any liver damage. Please continue to avoid alcohol and cigarettes, practice safe sex, and eat healthy foods. Good luck.

  50. I got hepitats b positive am 25 yrs old I recently got married..can I continue martial life with my husband ..is there any problem to my husband …if I get a children how do I protect my children to not infect the virus…I got hep b antigen negative hep b antibody negative what does it mean..and I want to go to abroad asap is it possible ..is it curable am so tensed..what to do..is it be cured if any medicines available for this..

    1. Hello: Your husband must get tested for hepatitis B and vaccinated as soon as possible. Once he has been vaccinated with all three shots over the six-month period, he should get tested again to make sure he has at least 10 mIU/mL of hepatitis B surface antibodies. Once he has antibodies, he is forever protected against hepatitis B.
      When you have children, it is very, very important that when they are born that they are given the first hepatitis B vaccine dose within 12 hours of birth, and also a dose of HBIG (hepatitis B antibodies) if it’s available. Your blood and body fluids carry the virus, and during delivery a baby is exposed to the virus and will almost always become infected unless they are immediately vaccinated.
      Just a quick review, when you test positive for the hepatitis B surface antigen (HBsAg), it means you are infected. You may have tested negative recently for the hepatitis B “e” antigen (HBeAg) and positive for the hepatitis B “e” antibody (anti-HBe). Actually that is good, it means your immune system is fighting the infection and generating antibodies to the virus. If you are “e” antibody positive, it means your viral load (HBV DNA) is probably low.
      While there is no immediate cure for hepatitis B, there are effective antivirals that reduce viral load and your risk of liver damage if you should ever need them. Please continue to get monitored.
      Good luck.

  51. My wife is 44 years old. 13 years before she was tested HbsAg poistive. She is under continuous monitoring. Recent test shows following results.
    SGPT: 11.7
    HIV: Negative
    HCV: Negative
    HbsAg: Negative (0.02)
    HbsAb: Negative(<10 IU/L)
    HbeAb: Negative (0.07)
    HBc IgG: Postive(0.04)
    Hbc IgM: Negative (0.06)
    HBV DNA: Not Detected (<100 UI/ml)
    USG shows normal Liver

    Should she needs anti viral medicine or continue monitoring

    1. Hello: Thanks for your note correcting the information about her HBsAg, that she does test positive for it.
      Her results are very good. She has no signs of liver damage and has an undetectable viral load, which is excellent.
      As her doctor also explained, she tested negative for hepatitis C and HIV.
      Please make sure she is monitored at least once a year for hepatitis B, and that you are vaccinated. Also, if she has children, they must be vaccinated within 12 hours of birth with the first hepatitis B vaccine dose and given a dose of HBIG (hepatitis B antibodies) if it’s available. Good luck.

  52. hi,
    I have hbv and was diagnosed on the 15/01/17 and my doctor said I should go and come back in 6 mouth time
    here are my hape b profile results
    hbsag +
    hbsab –
    hbeAg –
    hbeab +
    hbcab +
    I’m 20years male
    tell me
    is that I’m affected chronically or acute

    1. Hello: Unfortunately, the only way to find out if you have were recently infected and have an acute (short-term) hepatitis B infection is to wait the six months after your March test and get retested. If you have lost the hepatitis B surface antigen (HBsAg) at that point and developed surface antibodies (HBsAb), then it was an acute infection.
      If you continue to test positive for hepatitis B, it means you were probably infected during childhood.
      If it is available to you, we recommend you get a viral load (HBV DNA) test, this will help your doctor understand what stage of infection you are in if you continue to test positive for hepatitis B after your next test. Good luck.

  53. Hi,
    I have hbv and was diagnosed on the 15/01/17 and my doctor said I should go and come back in 6 mouth time
    here are my hep b profile results
    hbsag +
    hbsab –
    hbeAg –
    hbeab +
    hbcab +
    please help me doctor interpret this

    1. Hello: When you test positive for the hepatitis B surface antigen (HBsAg), it means you are currently infected with hepatitis B. Your HBsAb negative tests shows your immune system hasn’t generated enough surface antibodies yet to eradicate the surface antigen. The good news is you test negative for the hepatitis B “e” antigen (HBeAg) and positive for the “e” antibody (HBeAb), which means your immune system is fighting the infection. Also, when you are E antigen negative, it means your viral load is probably not high. The core antibody (HBcAb) result also means you have been infected in the past. This is the first “antibody” against hepatitis B to appear. You must get tested again in six months to find out if this is a new or acute infection, or if you were infected during early childhood and have a chronic or long-term infection. If you continue to test positive for HBsAg, you should also get a test to see if you have experienced any liver damage. Good luck.

  54. Hello! My husband was diagnosed with hep b,year 2015..He told me but i was unaware of the danger of it…Now im currently four months pregnant but i had my HBsAg screened two days ago and it was non reactive..What does it mean? Also he had his Hepa profile done and the results are as follows:
    HBSAg reactive-6046IU/L
    Anti HBS- negative – <2.00 IU/L
    Anti HBC IgG- reactive – 0.010 IU/L
    Anti HAV IgM-negative – 0.497 IU/L
    HBE Antigen-negative- 0.117 IU/L
    Anti HBE-reactive- 0.002 IU/L
    SGOT-35.0 U/L
    SGPT-54.0 U/L
    What do these values mean? And could i also get vaccinated although im four months on the way…Thanks in advance

    1. Hello: Please look carefully at your own hepatitis B test result. Were you non-reactive (negative) for the hepatitis B surface antigen? If so, it means you are not infected with hepatitis B. My next question, did the lab test look at hepatitis B surface antibodies (anti-HBs)? If you have been infected with hepatitis B in the past, perhaps by your husband, and your immune system was able to clear the infection, you should test positive for hepatitis B surface antibodies. If you test negative (non-reactive) for both the surface antigen and surface antibody, then you need to be vaccinated as soon as possible.
      Getting vaccinated against hepatitis B during pregnancy is safe.
      When you give birth, it is important that your baby is immediately vaccinated with the first dose of the hepatitis B vaccine, followed up with the two other vaccine shots one month later, and the third five months later. This will ensure that your child is forever protected against hepatitis B.
      Your husband’s test results confirm he has hepatitis B (by testing positive for HBsAg). The anti-HAV test means he has not been infected with the hepatitis A virus. If he can get the hepatitis A vaccine, that is recommended to protect his liver from another infection.
      He appears to test positive/reactive for the hepatitis B “e” antibody (anti-HBe), which is good as it shows his immune system is starting to fight the infection and has produced “e” antibodies.
      His liver enzyme (SGPT) is a little elevated. When our liver cells are damaged, they release the enzyme SGPT into the bloodstream. He should avoid alcohol and cigarettes, and of course eat healthy foods. I hope he is being monitored regularly.
      Good luck.

  55. Hello!

    I have HBV, gone through the below tests, kindly check and confirm the status.

    HBS AG: Positive
    Anti-Hbe: Positive 0.01
    Hbe Ag:Negative
    HBV DNA(Viral Load): Not detected.
    Liver Function Test:
    Total Bilirubin 0.50 mg/dl
    Direct Bilrubin 0.13 mg/dl
    indirect Bilirubin 0.37 mg/dl
    Aspartate transminase(SGOT): 31 IU/L
    Alanine Transaminase(SGPT) : 41 IU/L
    Alkaline Phosphatase(PNPP) : 82 IU/L
    Gamma Glutamyl Transferase : 16 IU/L
    (G – Gluamyl-P-Nitroanili)
    Total Protein : 7.20 g/dl
    Albumin(Bromocresol purple) : 4.40 g/dl
    Globulin: 2.80 g/dl
    A;G Ratio: 1.57

    Ultrasound of the Abdonmen And Pelivis:

    No evidence of choronic parenchymal liver disease.

    Kindly check and confirm the disease test.

    1. Hello: Based on your test results, it appears you have “inactive” hepatitis B, and that your immune system is doing a good job at suppressed the infection.
      You have no detectable viral load (HBV DNA), and your liver enzymes and liver ultrasound found no signs of liver damage, which is excellent.
      Please lead a healthy lifestyle, avoid alcohol and cigarettes, and continue to be monitored regularly. Good luck.

  56. Hi,
    I am male of 40 years old, of african origin and was diagnosed with hbv in 2010. Sometimes about 2011/2012, i was on pesasy interferr….alfa… for 12 months(eastern europe) and my viral load dropped considerably. In 2014,a lab result showed a very low viral load and late august 2016, a different lab result indicates “not detected”. A routine family med check up(australia) indicates
    hbv dna quantitation of 5.4 x 10^1,
    hbv dna quantitation log (10) of 1.73
    Alt of 24.
    Please what do these results indicate?
    Really don’t know what is happening with these contradictions. Its really stressful.
    Please help!

    1. Hello: The good news is your liver enzyme (ALT) is healthy and you are not experiencing any liver damage.
      I’m a bit confused by the reporting of your viral load (HBV DNA). Does your recent test show if you are testing negative or positive for the hepatitis B surface antigen (HBsAg) and negative or positive for the surface antibody (HBsAb)? That will help clarify your current status. Good luck.

  57. hello doctor.

    since 2000 ive got positive in hepa b.last march 2016 i got my result of my dna viral load and it was almost 8 million iu.and my sgpt is 81 that time and my anti hbe is negative.then immediately i took tenofover and after 6 months taking of tenofover it was found out again my hbv dna viral load is 20 iu only and my sgpt drops to 31.and continue again taking of tenofover.then after 11 months of taking of tenofover i checked again my dna viral load and it was found out undetectable and sgpt is 21 iu only.and now my doctor advise continue taking of medicine tenofover til june firstweek.then will check again another lab test.

    on my case.since my viral load is undetectable do you think that i have a chance that my body can create an anti body and immediately give a vaccine for hbv until become negative in hepa b?or completely clear in hepa b?

    1. Hello: The European Association for the Study of the Liver recently came out with guidelines about when patients can stop taking antivirals. They recommend you can stop:
      – Once you have lost the hepatitis B surface antigen (HBsAg), even if you have not developed surface antibodies
      – If you have lost the hepatitis B “e” antigen, and developed “e” antibodies, and have had healthy liver enzymes and undetectable viral load for at least 12 months
      – Or, if you have maintained an undetectable viral load for longer than three years.
      If you have achieved any of these benchmarks you can consider stopping antiviral treatment after consulting with your doctor. However, it is very important that you are closely monitored — about every three months — after you stop antivirals. Some patients can experience a reactivation of their hepatitis B that can cause liver damage.
      Unfortunately, getting vaccinated with the HBsAg will not make your immune system create antibodies. Even though you have an undetectable viral load right now, you probably still have HBsAg in your body. Good luck.

  58. Hello Dr,
    I have been diagnose chronic hepatitis b 7 months ago and my result is moderate viral load, mildly elevated ALT, HBV e -antigen negative, e -antibody positive HCV/delta/HIV negative, nave to antiviral therapy please can u help me with the explanation

    1. Hello: It appears that your hepatitis B infection is not harming your liver if your liver enzymes (called ALT or SGPT) are within normal ranges, which is up to 19 in women and up to 30 to 40 in men. (Each lab has its own definition of “healthy” so their reports may be a bit higher than these.
      Your immune system is starting to fight the infection, which is indicated that you have cleared the hepatitis B “e” antigen (HBeAg) and have tested positive for the “e” antibody.
      Please continue to get monitored regularly, about every six months especially if your liver enzymes are moderately elevated, and of course avoid alcohol and cigarettes, eat healthy foods and make sure your family members are tested for hepatitis B and vaccinated if needed.
      Most people live long and healthy lives with hepatitis B, but monitoring your condition is important. Medical guidelines do not recommend treatment unless your viral load AND ALT are elevated.
      Good luck.

  59. I was treated with peg interferon and was undetected at 12 wks and same at the end of the 48 wks of treatment but hbv DNA got up to 379 iu/ml at 6 months post stoppage of treatment.
    Please could you kindly give some explanations on what happened and the indications.
    And also, can one possibly have hbv infection and not be infectious towards others?
    Looking forward to your response.
    Thank you

    1. Hello: You were lucky to achieve an undetectable viral load (HBV DNA) following interferon treatment. Among those treated with interferon, about one-third management to lose the hepatitis B “e” antigen (HBeAg) and develop the “e” antibody (HBeAb). What impact did interferon have on your HBeAg/HBeAb? Also, what impact did it have on your liver health? Has your liver enzyme test (for ALT or SGPT) improved?
      Only 3 percent of people treated with interferon clear hepatitis B completely. It is important to continue to be monitored to see over time what happens to your liver health and HBeAg.
      You must consider yourself infectious if you test positive for the hepatitis B surface antigen (HBsAg), even if your viral load is low. Good luck.

  60. I am 32 years old

    I did a blood test and got this result
    HBeAg negative
    ALT 36.8 U/L
    ALBUMIN 46.3 g/l
    AST 46.3 U/L
    GGT 44.1 U/L
    ALP 132.0 U/L
    TOTAL BILIRUBIN 13.37 UMOL/L
    ALFA FETROPROTEIN 2.3 UG/L
    HBV-DNA 4084 IU/ML
    HBV-DNA 3.62 Log IU/ml

    The problem is I couldn’t understand these reading and I don’t have any doctor who could provide advise on my case. My question is do I need a treatment or not?

    Thank you in advance

    1. Hello: I will try to explain your results. You didn’t include this result, but when you test positive for the hepatitis B surface antigen (HBsAg), it means you are currently infected with hepatitis B.
      The good news is you test negative for the hepatitis B “e” antigen (HBeAg), which means your immune system is fighting the infection. Also, when you are E antigen negative, it means your viral load (HBV DNA) is not very high. Yours is 4,084 IU/mL, which is moderate.
      The ALT test result of 36.8 shows your liver is healthy, which is also excellent news. When liver cells are damaged, they release the enzyme ALT into the blood stream. An ALT level of 30 to 40 in men is healthy.
      You must get tested again in six months to find out if this is a new or acute infection, or if you were infected during early childhood and have a chronic or long-term infection.
      In the meantime, practice safe sex, avoid alcohol and cigarettes, and lead a healthy lifestyle.
      Good luck.

      1. Dr Doctor

        Thank you for your explanation,
        The first time I know that I have hepatitis B positive is in 2009.
        I am worried that I won’t be able to get a scholarship if I provide this result to overseas medical assessor but now you have given me a hope and confident. What makes me more worried is when I look in the internet and it says that you should have HBV DND not greater than 2000um/l. That why I still holding this test result and not yet sent it overseas to find more clear information and explanation.

        Thank you again

        Cheers

        1. Dear Dr

          May I ask if the HBV-DNA result could be affected due to sample are inadequate or being thawed while sending overseas.

          Also can you give your opinion whether I will pass the medical assessment or not. I need your good advice on this before I sent my medical result to medical assessor. If not then can you recommend anything that I need to do.

          Thanks for your time and looking to hear from you.

          1. Hello: I’m sorry I can’t answer any of these questions. And I do not know if you will pass the medical requirements or not. Perhaps you can just try and see what happens.
            Good luck.

  61. hello Dr
    i have successfully completed my vaccines, so my fiancee was detected HBeAG positive and went for further testing including bilirubin AST ALT, everything was normal and they wrote hepatitis past Negative what is the meaning of that.
    i am confused can you help me?

    1. Hello: First, congratulations on protecting your health and getting immunized against hepatitis B.
      Just to clarify, exactly what antigen is your fiancee testing positive for? When you test positive or reactive for the hepatitis B surface antigen (HBsAg), it means you are currently infected with hepatitis B. If she still tests positive for HBsAg, it means she is still infected. Only when she no longer tests positive for HBsAg, and positive for the hepatitis B surface antibody (anti-HBs), will she have cleared the infection.
      The hepatitis B “e” antigen (HBeAg) is another antigen doctors test for to find out what stage of infection she is in.
      Hope this is helpful, good luck.

  62. Hello doctor, I was diagnonized of hep b positive in feb 2017 due to some illness that I was mistaken for malaria. So I went for a lab test and result confirmed that I’m help b positive. I started treatment naturally and been better and healthier ever since then. I asked my mom to go test and she tested hep b negative. While my other 2 married sisters tested positive. And my mom is 57. I’m confused and worried about this. How did we get it if mom is negative. Or can it be, we contracted it different ways? I was thinking from birth but mom is negative. But I’m feeling more better and healthier as time goes on. It’s been 4months now that have been diagnosed and have cleared every symptoms like pains around the liver, pale stool and dark urine, loss of appetite and fever. Hope to hear from you soon. Thanks

    1. Hello: Many people will never know how they became infected. Your mother may have been infected when she gave birth to you and your sisters, and has since resolved the infection. Also, hepatitis B is often spread through re-used or improperly sterilized medical equipment and other ways.
      If you continue to test positive for HBsAg for longer than six months, it is considered a chronic infection. It means you were probably infected at birth or during early childhood, when your immature immune system could not fight it.
      Knowing whether your hepatitis B is acute or chronic will help you and your doctor determine your next steps. Please get tested again in six months to find out if it’s chronic or acute. If you are unsure of what your blood test results mean, please visit: http://www.hepb.org/prevention-and-diagnosis/diagnosis/hbv-blood-tests/
      Good luck.

  63. i just find out that im hepatitis b patient , how would i know that its two months or three months and what should i do to know am hbsag negative or positive

    1. Hello: When you test positive for the hepatitis B surface antigen (HBsAG), it means you are currently infected with hepatitis B. Most healthy adults who are infected are able to get rid of the virus on their own within six months. This is called an acute infection.
      However, if you continue to test positive for HBsAg for longer than six months, it is considered a chronic infection. It means you were probably infected at birth or during early childhood, when your immature immune system could not fight it.
      Knowing whether your hepatitis B is acute or chronic will help you and your doctor determine your next steps. Please get tested again in six months to find out if it’s chronic or acute. If you are unsure of what your blood test results mean, please visit: http://www.hepb.org/prevention-and-diagnosis/diagnosis/hbv-blood-tests/
      Good luck.

  64. Can you explain or interprete this result for and your recommendation: HBs Ag negative
    HBs Ab negative, HBe Ag negative, HBe Ab negative, HBc Ab positive

    1. Hello: Your results are confusing. You appear to test negative for all antigens and antibodies normally associated with a hepatitis B infection except for the hepatitis B core antibody (HBcAb). When you test positive for the core antibody, it usually means you have been infected at some point. I would recommend that you get retested again and if possible also get tested for HBV DNA (viral load). There is a mutated form of hepatitis B that does not produce hepatitis B surface antigen (HBsAg), yet the virus is present. This is called an occult infection. To clarify your status, the HBV DNA test will prove conclusively whether you are infected. Good luck.

  65. Hello, Thank you.

    I am diagnosed with Chronic Hepatitis B.I recently stopped taking Viread on April 18th. I did new lab work on May 23rd and I got this result back:
    ALT: 38 U/L
    HBVQNT IU/mLREF: 30 IU/mL
    HBVQNT logIUREF: 1.48 Log IU/ml log 10
    AST: 31 U/L

    Should I start the Viread again?

    1. Hello: It’s only been a month since you stopped tenofovir (Viread), but your labs look good! Your ALT is good (each lab has its normal range, which falls in the 30-40 range) and your viral load (HBV DNA or HBV QNT) at 30 IU/mL is nearly undetectable. Please keep getting monitored regularly and watch for increases in ALT or viral load. Good luck.

  66. Your comment is awaiting moderation.

    Hi Doctor I am 29 years old .
    5 months ago I checked HBsAG
    My HBV was positive and my below lab result is
    Ast=29
    Alt= 31
    Phosphates = 112
    Bilirubin total = 0.6
    Con- bilirubin = 0.4
    Uncon- bilirubin = 0.2
    Please say how is my liver condition and also I am
    Useing selymarin medical. Thanks

    1. Hello: Your liver enzyme level of ALT 31 shows your liver is healthy, which is excellent news.
      You indicated you are using silymarin (milk thistle.) The National Institutes for Health has published fact sheets on various herbal supplements, including milk thistle. The home page is at: https://nccih.nih.gov/health/herbsataglance.htm and the fact sheet on milk thistle is at https://nccih.nih.gov/health/milkthistle/ataglance.htm
      The NIH reports, “Previous laboratory studies suggested that milk thistle may benefit the liver by protecting and promoting the growth of liver cells, fighting oxidation (a chemical process that can damage cells), and inhibiting inflammation. However, results from small clinical trials of milk thistle for liver diseases have been mixed, and two rigorously designed studies found no benefit.”
      Please keep in mind that herbal remedies and supplements are not regulated so you don’t really know for sure what is in them, and that the contents could change from one bottle to the next.
      The other problem with herbal remedies in general is there is typically NO evidence (no clinical trials or data) to back up a claim for a cure, which is why the NIH fact sheets are so valuable.
      We at the foundation cannot recommend any claims for a cure that are not backed by scientific data or endorsed by the U.S. Food and Drug Administration. Sometimes, supplements and remedies can harm the liver more than help it.
      I would encourage you to discuss the use of these herbal remedies or supplements with your liver specialist, along with learning more about your HBV and liver health. I would also encourage you to focus adopting healthy lifestyle choices which go a long way towards maintaining the health of your liver.
      Remember to eat healthy food and avoid alcohol and cigarettes, and get monitored regularly.
      Good luck.

  67. Your comment is awaiting moderation.

    Hi
    I am 29 years old man and lab result is

    Ast=29
    Alt= 31
    Phosphates = 112
    Bilirubin total = 0.6
    Con- bilirubin = 0.4
    Uncon- bilirubin = 0.2
    Please help me .

    1. Hello: I assume you have tested positive for the hepatitis B surface antigen (HBsAg) and have hepatitis B?
      These tests primarily address the health of your liver, and your liver enzyme level of ALT 31 show your liver is healthy, which is excellent news.
      If you have hepatitis B, remember to eat healthy food and avoid alcohol and cigarettes, and get monitored regularly.
      Good luck.

  68. I was diagnosed with HepB in 2014, in 2015 on a follow up check with my GI doctor, my results showed that the viral load was 590 iu/ml, HBeAB + and HBeAG -, HBsAG + and no signs of liver damage on ultrasound. Being off of medical insurance, I couldnt go for a follow up test in 2016 but went for one in 2017 where the doctor (different one) did some tests that showed my Viral load had gone up to 2803 iu/ml, HBsAB <5, my ALT level were 115 (a week before at my pcp, it was 51) and on an ultrasound, I was told that I had a "mildly coarsive echotexture" on my liver

    I had a biopsy done and i'm waiting for my result but my doctor says that she wants to start me on baraclude to reduce the viral load and give my liver a chance to heal. She didn't test for HBeAG/ HBeAB at this time but said that I met criteria to start treatment due to elevated ALTs and Viral load (we don't yet have the liver biopsy result to know if there is damage or I just have a fatty liver)

    I'm worried because i'm in my mid 20s and don't want to start a medication that docotrs say I likely will be on for life (as ive heard going off of it can lead to a spike in viral levels)I don't know if I should wait to see if my body fights it on its own and/or if going on baraclude will stop it from doing just that. What could have caused the flare up and isnt the presence of HBeAB a sign of immune clearance.

    What do you advice and should i seek a second doctor's opinion.

    Thank you

    1. Hello: Guidelines recommend treatment for people with HBeAg-negative hepatitis B who have elevated ALT levels and viral load exceeding 2,000 IU/mL. However, given your young age and the fact your elevated ALT was 51 the prior week (do you drink alcohol? and 115 the next week, there is some variation going on. The question is how much of your liver damage is fatty liver vs. hepatitis B?
      Could you try to lose some weight, of course avoid alcohol and cigarettes, and eat healthy foods and then see what your ALT levels are? If they are back to normal, you may be able to avoid a long-term commitment to treatment. Your biopsy results should shed more light on your options.
      Good luck.

  69. hello doctor

    i am hepa b carrier since 2000 last feb 2016 ive got my hbv result and it was nearly 8 million IU,and sgpt 81 iu and immediately started taking tenofover last march 2017 and after 6 months taking of tenofover i checked again my hbv dna and it was found out 20 iu only with sgpt 24 iu only.and after 1 yr taking of tenofover i decided to recheck my hbv viral load and sgpt and it was found out that my viral load is undetectable and sgpt is 24 iu only but my hbsag is still positive and anti hbs is negative.and my doctor advice me to stopped completely taking of tenofover and will repeat again the sgpt and viral laod and hbsag and anti hbs after one year in order to check again the above mention lab test.
    since my viral load is undetectable and if i maintain healty life style and avoid cigar and alcohol.do you think that my viral load will maintain undtetectable even without taking of tenofover? is there any chance that my hbsag it become negative or my hbasag is positive but my anti hbs can develop own anti body?pls kindly explain if i have a chance if my anti hbs can develop own anti body without taking tenofover in one year if i maintsin helathy life style

    thanks

    1. Hello:
      Before you stop taking tenofovir, I recommend that you read this blog: http://www.hepb.org/blog/can-hepatitis-b-patients-stop-taking-antivirals-experts-finally-answers/
      Before you stop taking antivirals, you should have undetectable viral load and no signs of liver damage for a long period of time. Also, you should have your hepatitis B surface antigen (HBsAg) measured. If it is still high, you are at risk of a reactivation. Please review the blog with your doctor. You do not want to experience a sudden increase in viral load and liver damage that can result from reactivation.
      Good luck.

  70. Hello Doctor,
    I am taking tenofovir for 9 months, here belows are my test results:
    10/2016 (starting taking tenofovir, I got HBV by birth)
    HBsAg: possitive; Anti-HBs: negative; HBeAg: negative; Anti-HBe: positive; Anti-HBc: positive; HBV-DNA: 4020000copies/mL; AST (GOT): 59 U/L; ALT (GPT): 107U/L; GGT:43 U/L
    1/2017
    HBsAg: 368ng/mL; Anti-HBs: 2.38mIU/mL; HBeAg: 0.01NCU/mL; Anti-HBe: 18.5NCU/mL; Anti-HBc: 76.1NCU/mL; HBV-DNA: < 118 copies/mL; AST (GOT): 24 U/L; ALT (GPT): 25U/L; GGT:22 U/L
    6/2017
    HBsAg: 210.10ng/mL; Anti-HBs: 3.85mIU/mL; HBeAg: 0.01NCU/mL; Anti-HBe: 23.92NCU/mL; Anti-HBc: 68.63NCU/mL; HBV-DNA: < 118 copies/mL; AST (GOT): 27 U/L; ALT (GPT): 25U/L; GGT:20 U/L
    My question is: the Hbasg decreases as fast as 43%, the anti-Hbs increases, the anti-Hbe is already quite high, so is there any chance to stop the treatment? if I continue taking tenofovir, is there any chance for the hbsag loss?
    Thank you.

    1. Hello: Your test results show you are doing excellent on treatment, your liver damage has decreased as has your viral load. A small percentage of people taking antivirals do lose the hepatitis B surface antigen (HBsAg), especially if you take good care of your health and avoid alcohol and cigarettes.
      Your declining HBsAg levels is a positive sign. For more information on when people can stop taking antivirals, please read: http://www.hepb.org/blog/can-hepatitis-b-patients-stop-taking-antivirals-experts-finally-answers/
      Good luck.

      1. Thank you so much for your help.
        Although TDF is doing good, I learned that TAF even better with smaller sides effects. Can I just stop TDF to using TAF without losing the positive trend I am having with TDF? If not should I continue with TDF? (my Ure index is still normal but it slightly increases)

        1. Hello: If TAF is available to you, by all means talk to your doctor about switching. TAF is as effective as tenofovir, and some studies suggest it is even more effective at reducing liver damage, without affecting your kidneys or causing bone loss. Good luck.

  71. Hello dear I diagnosed with hepatitis b virus in 2010 first my hbv dna virus is 27 again 34 ,1211 after it reduced from 1211 to 46 iu/ml in 12.7.2016 reports and hepatitis be antigen hbeag serum 0.29 reference range [<1.00 ] I think hbeag negative is And My sgot 29 and sgpt 30 ,ALP 124 [ 30-120 range] ,bilirubin total 2.14 [0.30-1.20 ] little bit high bilirubin direct 0.33 and bilirubin indirect 1.81 total protein 7.19 normal ,albumin 4.88 normal and last A:G Ratio 2.11 [0.90 -2.00 ] little bit high I want to know that how is my condition and what about jaundice is it normal or high

    1. Hello: I can only address your liver enzyme (SGPT), which is 30, in the normal range. Your SGPT level does not indicate any liver damage at this time, of course it is important to continue to be monitored every six to 12 months.
      Jaundice can occur when the liver is damaged. If you are experiencing jaundice, please consult with your doctor. Good luck.

      1. My DNA viral load is 46 is it undectable and some people say sometimes hbsag becomes negative from positive

        1. Hello: Some people indeed lose the hepatitis B surface antigen (HBsAg) over time if they go for long periods with an undetectable viral load (HBV DNA), no signs of liver damage and a steady decline in HBsAg (if that test is available to you.) Don’t give up hope. Keep eating healthy foods, lead a healthy lifestyle and avoid alcohol and cigarettes. Good luck.

    1. Thanks for devoting time for us . One more question is that if I want to go canada with study permit or work permit will in medical they do hepatitis b test

      1. Hello: I don’t know if they require a hepatitis B test, but they will inquire about your overall health. Canada does not discriminate against people with hepatitis B. Good luck.

      1. Thank you so much and I am taking medicinal mushroom based medicine cordyceps, ganoderma,lion mane ,maitake ,shiitake,turkey tail and morinda cetrifolia called Noni . Earlier my virus was 1211 and after using above supplements it came to 46 ..I think these supplements working

  72. Hello
    i have hbv and was diagnosed in the 15/01/2017
    i went through all signs and symptoms. the only thing is that i feel discomfort in between my right chest and the ribs
    my question is that could this be one of the signs of the virus?

  73. Hi Doc,

    I’m working on a paper titled ‘Seroprevalence of HBV markers and liver enzymes alteration among pregnant women’ in a define locality.

    I ran HBV tests on the participants sera (including HBsAg, HBsAb, HBeAg, HBeAb and HBcAb) and also determined the abnormal levels of ALT, AST, ALP, Albumin, total bilirun and direct bilirubin in the samples. I seems to have problem interpreting some of my results which I believe you can help me with.
    Out of the 200 samples examined, 50 tested positive for HBcAb only, 3 tested positive for HBeAb only, 70 tested positive for HBeAb and HBcAb simultaneously, 5 tested positive for HBsAg and HBeAb simultaneously, 4 tested positive for HBsAg, HBeAb and HBcAb simultaneously. Almost all the combinations stated above have abnormal levels of AST, ALP, Albumin and bilirubin, however, all have normal levels of ALT except 5 out of the 50 that tested positive for HBcAb only. My question is which of these combinations suggests acute HBV? Which ones suggests chronic hepatitis? And what phase of CHB does it represent? Lastly, is it possible to be chronically infected with HBsAg being negative?

    Thank you in anticipation for your favourable response.

    1. Hello: You are asking many questions. First, the only way to determine if someone has a chronic or acute infection is to test them over a six-month period. If they test positive for HBsAg for longer than six months, then they are chronically infected.
      I am confused by your report, do you mean 50 tested positive for the core antibody (HBcAb) only, but negative for any other hepatitis B antigen or antibody? I am confused by how you’ve presented your findings.
      To your last question, there is a hepatitis B viral mutation that can replicate without the presence of HBsAg. It is called “occult” hepatitis B.
      Good luck.

  74. How if the results in hbsag was reactive and in hbeag was non- reactive what does it mean?

    1. Hello: When you are infected with hepatitis B, the hepatitis B surface antigen (HBsAg) remains until you clear the infection. However, other antigens, including the “e” (HBeAg) antigen are among the first to disappear as your immune system fights the infections. It is a good thing to lose HBeAg and develop the “e” antibody (HBeAb), but unfortunately gaining the “e” antibody is not enough to clear the infection. For that, you need to get rid of HBsAg. Good luck.

  75. Hello Doc,

    Thank you for your prompt reply and clarification. I thought HBV markers (when occurred in certain combinations) could help distinguish between acute and chronic infection.

    To your question, yes, I mean 50 tested positive for the core antibody (HBcAb) only, but negative for any other hepatitis B antigen or antibody.

    This is the full result of my findings:

    (HBsAg) only- 6 (acute or chronic infection).
    (HBsAb) only- 5 (immune due to vaccination).
    (HBsAb, HBeAb and HBcAb)-16 (immune due to natural infection).
    (HBcAb) only- 50 (?).
    (HBeAb) only-3 (?).
    ( HBeAb and HBcAb)-70 (?).
    (HBsAg and HBeAb)-5 (?).
    ( HBsAg, HBeAb and HBcAb)-4(?).

    I have problem interpreting the combinations with (?).

    I hope the question is clearer now.

    Thank you.

    1. Hello: I don’t think we can be too helpful, as the lab results are contradictory.
      As you know, anyone who has been exposed/infected will be hepatitis B core antibody (HBcAb) positive, and they all should test positive for either surface antigen or antibody and e antigen or antibody. I fear there may be something wrong with the lab reporting.
      Unfortunately, the only way to determine if someone has acute or chronic hepatitis B is to follow them for six months to see if they develop surface antibody.
      Good luck.

  76. I’m Stanley I tested hbsag positive and hbeag negative hbeab positive hbcag positive DNA 4000ul alt 53 ast 38 conjugate bilirubin 34 unconjugate 8.4

    1. Hello: When you test positive for the hepatitis B surface antigen (HBsAg), it means you are currently infected with hepatitis B. The good news is you test negative for the hepatitis B “e” antigen (HBeAg), which means your immune system is fighting the infection and has cleared the “e” antigen. Your viral load (HBV DNA) is moderate at 4,000 IU/mL.
      The ALT test measures a liver enzyme in your bloodstream. When our liver cells are damaged, they release ALT. Healthy ALT levels range up to 19 in women and about 30 to 40 for men, so yours are a bit elevated.
      You must get tested again in six months to find out if this is a new or acute infection, or if you were infected during early childhood and have a chronic or long-term infection.
      Please avoid alcohol and cigarettes, and eat healthy foods. Good luck.

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