Hep B Blog

Forget Surface Antibodies, If You Have Both Undetectable Viral Load and HBsAg, You Might Be Functionally “Cured”

Dr. Robert Gish
Dr. Robert Gish

By Christine Kukka

For decades, people living with chronic hepatitis B were told they would be “cured” only when they lost the hepatitis B surface antigen (HBsAg) and developed surface antibodies. It represented the holy grail of recovery that everyone hoped for, but very few achieved.

Today, experts are redefining what constitutes a “functional cure” from chronic hepatitis B and taking the surface antibody out of the equation.

Researchers, including expert Dr. Robert Gish, suggest if people have an undetectable viral load (HBV DNA), undetectable HBsAg, and no signs of liver damage, they may be “functionally cured,” even if they haven’t developed surface antibodies. The cure is called “functional” because the only cure for hepatitis B is when the immune system controls or suppresses the virus.

People with chronic hepatitis usually experience several infection stages, starting with a high viral load (called immune-tolerant or immune-trained) during childhood and early adulthood, followed by years and even decades of “active” hepatitis B where the immune system tries to clear the infection, indicated by elevated liver enzyme tests.

In some lucky people, the “active” phase successfully eradicates HBsAg and infected liver cells. They test negative for HBsAg, their viral load drops to undetectable levels and their liver enzyme tests (for ALT or SGPT) show no signs of liver damage. Despite their “inactive” infection, studies show two-thirds of these people will never develop surface antibodies, said Dr. Gish, medical consultant to the Hepatitis B Foundation and professor consultant of gastroenterology and hepatology at Stanford University.

But isn’t developing surface antibodies the gold standard for recovery from hepatitis B? Not any more, explained Dr. Gish. Historically, medical guidelines dictated that chronically-infected patients must generate at least 10 mIU/mL of surface antibodies to be “functionally cured.” That level was used because most adults who had a short-term or acute case of hepatitis B were able to generate lots of surface antibodies once they’ve cleared the infection, and people who were vaccinated also tended to generate high surface antibody levels.

“But we’ve learned that standard is no longer useful for patients who’ve been chronically infected,” Dr. Gish explained. “Hepatitis B surface antibodies are very specific in their mission, and we’re learning that the body may be making other types of surface antibodies that we cannot measure. Today, we’re only measuring one type of surface antibody, and for some reason we don’t know yet, it may never become positive in people who have been chronically infected and cleared HBsAg.

Dr. Gish speculates that the surface antibodies that labs measure may all bind to any HBsAg that remain following infection, so there may not be any excess of this one type of surface antibodies to measure.

It may be similar to what happens in vaccinated people who over time no longer test positive for surface antibodies. “In the old literature, people thought having lots of surface antibodies meant better protection, but now we know people who’ve been vaccinated remain protected by their immune system’s T-cell response and also ‘memory B cells’ even if their surface antibodies decline or become undetectable,” he said.

Bottom line, “immune memory” and antibodies that labs may not be able to identify remain ready to fight infection following vaccination and even after a chronic infection.

As a result of these findings, people who have gone two or more years with undetectable viral load and HBsAg, and no signs of liver damage just might be “functionally cured”, Dr. Gish suggests, even if their surface antibodies remain undetectable. “It’s clearly a new gold standard,” he added, referring to recent studies that found no hepatitis B reactivations in these “inactive” patients who were followed for up to eight years.

However, Dr. Gish cautions, it’s important to remember that once infected with hepatitis B (indicated by presence of the hepatitis B core antibody – anti-HBc), people will always retain low levels of the hepatitis B virus in their bodies — even if they develop surface antibodies. Like the chicken pox virus, the hepatitis B virus remains suppressed only as long as the immune system remains healthy enough to keep it in check. Old age, other illnesses, chemotherapy or drugs that suppress the immune system can allow a reactivation of hepatitis B in the same way that chicken pox returns as “shingles” in older adults. Unfortunately, there is no cure available that totally eradicates all hepatitis B virus from the body.

Today, chronically-infected people can look forward to a new, more accurate benchmark that represents a functional cure: clearing both HBV DNA and HBsAg, and experiencing no liver damage for two or three years. All three goals must be achieved–especially undetectable surface HBsAg–otherwise they remain at risk of reactivation, according to recent studies.

According to Dr. Gish, once patients achieve two or three years of consistently undetectable viral load (HBV DNA below 8-12 IU/mL) and HBsAg levels (below 0.05 IU/mL), they do not require frequent monitoring unless they have a history of cirrhosis or signs of liver damage.

Why has it taken so long for researchers to figure this out? Historically, researchers have focused on patients with active infections that damaged their livers and led to cancer in their search for effective treatments. For the first time, researchers are also monitoring “inactive” patients who clear both HBV DNA and HBsAg and are publishing studies about their long-term outcomes.

Comments on this blog are closed. If you have questions about hepatitis B or this blog post, please email info@hepb.org or call 215-489-4900.

121 thoughts on “Forget Surface Antibodies, If You Have Both Undetectable Viral Load and HBsAg, You Might Be Functionally “Cured””

      1. What is the situation for HBsAg positive for over six months, HBeAg negative, Viral load undetectable? What is the best way to understand that situation? Any other tests recommended to this?

        1. thankss doc, i am a dentist , i am inactive carrier for virus b, can’t work 😔,pcr is 600iu/ml, i need to made HBSag negative to return to my work , need advice

          1. Hello: In the United States and elsewhere, having hepatitis B does not stop you from working as a dentist, doctor or other type of healthcare worker. Studies show hepatitis B-infected healthcare workers do not pose a threat to either patients or coworkers. Your viral load (HBV DNA) is also quite low.
            The U.S. CDC has published guidelines (https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6103a1.htm?s_cid=rr6103a1_w) explaining that healthcare providers with hepatitis B should not be discriminated against. Please show this to your supervisors. We must change these discriminatory policies!
            Good luck.

        1. Hello: You were either vaccinated against hepatitis B or you were infected at some point in the past and cleared the infection. Today, you have immunity against hepatitis B. Congratulations! Good luck.

  1. Okay, but what about Occult Hepatitis? My understanding is that ALL MARKERS are negative, including HBsAg. What about those? Is it true that for that people only HBV DNA is positive while all other markers remain negative? If that is true…what type of treatment those patients can have??

    1. Hello: Occult hepatitis B occurs when the surface antigen has mutated and is not identified by a lab test, however that person still tests positive for HBV DNA and can have liver damage. So this “functional cure” with undetectable viral load, surface antigen and healthy ALT levels (with no sign of liver damage) is different than occult hepatitis B. If a person has occult hepatitis B and has signed of liver damage and detectable viral load, they are eligible for treatment despite the fact they test negative for HBsAg. Thank you.

        1. Hello: Occult hepatitis B occurs when the hepatitis B surface antigen (HBsAg) mutates, so that a lab test cannot identify the presence of HBsAg in a blood sample. However, a person with occult hepatitis B still tests positive for viral load (HBV DNA), and may even have liver damage, indicated by elevated ALT or SGPT liver enzyme tests. Some studies suggest occult hepatitis B may even progress faster and cause higher rates of liver damage. I hope this explanation helps. Thank you.

  2. Very interesting read. Just want to clarify…. Based on your theory, although there is a presence of SAG with undetectable levels of DNA and healthy liver, the person may be considered “functionally cured”. Is correct? I’m currently at this stage with no anti-virals. Please advise.

    1. Hello: One correction, you must have cleared — test negative for — the hepatitis B surface antigen (HBsAg), in addition to having undetectable viral load and healthy ALT levels, with no signs of liver damage. If you achieve all three of those goals for at least two years, you may be functionally cured according to recent research. Thank you.

      1. Hello,

        I had undetectable viral load for 3 years and no liver damage the same. can I stop taking Viread?

  3. Hello again. Tq for all the answers.
    “Old age, other illnesses, chemotherapy or drugs that suppress the immune system can allow a reactivation of hepatitis B in the same way that chicken pox returns as “shingles” in older adults. ..”
    Drugs that suppress the immune System = immunosuppressant, right? Is this include
    Azathioprine & corticosteriod ie; prednisone Treatments for Autoimmune disease too?

    1. Hello: You are right, any drug that suppresses the immune system is an immunosuppressant, including the three drugs you mentioned. So, it’s important to ask your doctor about any drug that he or she may prescribe. Good luck.

  4. I have a question about my situation, I was first diagnosed in 1999, I had a biopsy that year, the doctor said my liver was fine and that my blood work shows reversal of Hbsag, I never took any medication, the last four years my results have been the same, Hbsag+, Hbeag-, Hbv DNA undetectable, Alfa Feto Protein is normal, Ultrasound is normal too, I appreciate you expert opinion

  5. Hi i am hep b postive gor 9 month now you say adults not get this virus but i am an adult when i got this this confuse me?before 2 years i donot have hbv,second is can a hbv paitent marry?this is important queation

    1. Hello: If you test positive for the hepatitis B surface antigen (HBsAg) for longer than six months, it means you have a chronic infection and may have been infected when you were a child. Sometimes our HBsAg levels change, so during your last test your levels may have been so low that the lab test did not pick it up.
      Yes, you can marry and have children if you have hepatitis B. But there are some important steps to take to make sure your partner and your future children do not become infected.
      Before you marry or have sexual relations, you must make sure your partner is vaccinated against hepatitis B and has enough hepatitis B antibodies to protect them.
      Have them go to a doctor and get screened for hepatitis B. If they are not infected and haven’t been vaccinated in the past, they should get the three shots of the vaccine. (They may have been immunized during childhood.) The second shot is given 30 days after the first, and the third shot is given six months after the first shot.
      About one or two months after the third vaccine shot, have your partner screened for hepatitis B antibodies/titers. Or, if they were immunized in the past, have them tested now to make sure they have enough antibodies to protect them. The number of antibodies should be more than 10 mIU/mL. That means they have enough antibodies to fight off infection.
      If they were immunized long ago, their titer levels may be under 10, if that is the case talk to your doctor and get one more hepatitis B vaccine shot (called a booster), and then test again to see if the antibodies have increased.
      Until you are certain that your partner has enough titers to fully protect them from hepatitis B, you must practice safe sex and use a condom.
      If you have children, an infected woman faces a high risk of infecting the newborn (because of virus in blood and body fluids). To prevent that, your baby must be immunized with the first vaccine dose within 12 hours of birth and given a dose of HBIG if it’s available. HBIG contains hepatitis B antibodies and helps fight infection.
      To protect your own health, it is important to eat healthy food and avoid alcohol and cigarettes. Also, do not share razors or nail clippers, and make sure all of your household members are screened and vaccinated against hepatitis B.
      Good luck.

  6. You say adults get rid of the virus and she was 25 years so if i have sex with her she will get rid of the virus by her ommune system so i can have sex with her because i read on diffrent sites if an adults is infected their immune system develop antibodies,so if i marry her and have sex this has no risk my hbeag is negative and hbvdna 345 this is low right?

    1. Hello: As long as you have detectable viral load (HBV DNA, which you do) and test positive for the hepatitis B surface antigen (HBsAg), you can infect her even if your HBV DNA is low. If she is currently not infected with hepatitis B and has not been vaccinated, you need to practice safe sex. She should immediately be vaccinated, if she has not been, and tested to see if she has immunity to hepatitis B. She should get all three vaccine doses over the six-month period, then tested one month after the third shot to see if she has generated enough antibodies (10 mIU/mL) to be protected against infection. Once she has, you can safely have unprotected sex without risk of infecting her.
      Good luck.

  7. Hello dear Doctor!
    Hbsag+, Hbeag-, Hbv DNA undetectable, Alt and AST is normal, Ultrasound is normal too. But a few month ago HBV DNA was 4.6 x 10*3 Iu/ml.
    I ask you to explain me about the situations. it means i am Functionally “Cured”?
    Can fresh juices reduce the HBV DNA viral load? i drink fresh juices every day : grapefruit, pomegranate, orange and apple juices.
    what you advice for protect my health and liver?
    thanks in advance

    1. Hello: According to experts, you are not “functionally cured” until you are undetectable for HBsAg, viral load (HBV DNA), and have normal ALT with no sign of liver damage for at least two years.
      Viral load can vary over time. It depends on a healthy immune system to keep it “in check” and suppress any viral reproduction. If we’re sick from an unrelated medical condition that weakens our immune system, that may contribute to an increase in viral load. Keep getting monitored regularly and talk to your doctor about any changes in viral load or liver health. Good luck.

  8. Hello doctor,
    I was diagnosed b and followings are my test result. hbsag+, hbsab+, hbeag-, hbeab-, hbcab+, hbsag quantative 17511.72, HBV DNA 30 copies/ml, 9IU/ml, AST22.9, ALT 30.1. I’m 39 years female, never married and no child. My doctor prescribed me Tenofovir for 6months and I have been taking it for 2 months. In those 2 months, I lost weight 2 kg but my body fat is increasing though. Also I feel nausea, headache, fatigue. I have to go toilet more often. Also I feel I am rapidly growing in those days because many new wrinkles come out. Before it, I did not like meat much but now I only wanted to eat much meat. So my question is that how is my condition? Is the medicine and my virus affect to have a healthy baby in future? Are those side effects are serious? Can I stop the medicine? What does it mean hbsag and hbsab positive toghether? Can i take calcium and D also?

    Thank you

    1. Hello: I am confused about your lab results, you may have mistakenly indicated you are positive for the hepatitis B surface antibody (HBsAb). Assuming you are positive for HBsAg, your viral load (HBV DNA) is low and your ALT level, which indicates liver damage, is only a little above normal at 30. Healthy ALT levels for women are 19 and under. Under U.S. medical guidelines, you would probably not be a candidate for treatment unless your viral load has come down because of your antiviral (tenofovir) treatment.
      The side effects you’re reporting (changes in appetite, skin texture, nausea) are not normally associated with tenofovir. I encourage you to talk to your doctor about the side effects you are experiencing, they may result from another medical condition. Also, be sure to check in with your doctor before you take calcium and vitamin D supplements.
      Hepatitis B does not prevent you from having a baby. However, it will be very important that your newborn is immunized with the first hepatitis B shot within 12 hours of birth and be given a dose of HBIG to prevent infection.
      Good luck.

  9. Please help me with the interpretation
    HBsAg +
    HBsAb –
    HBeAg +
    HBeAb +
    HBcAb +
    No medications yet

    1. Hello: As you know, when you test positive for the hepatitis B surface antigen (HBsAg), it means you are currently infected with hepatitis B. Because you are testing positive for the hepatitis B “e” antigen (HBeAg), it may mean that your viral load (HBV DNA) is quite high. Have your had a liver function test to measure your liver enzymes (ALT/SGPT)? Talk to your doctor about getting that test. 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 your doctor to see if you require treatment. Remember to eat healthy foods, avoid alcohol and cigarettes, and practice safe sex (use a condom) to avoid spreading the infection. Good luck.

  10. Sir,
    My HBsAg test is negative when tested by Virucheck Kit and Positive (with a value 2825) when tested by Australia Antigen (ELFA). Please clarify me the difference between HBsAg test by Virucheck kit and HBsAg test by Australia Antigen (ELFA).

    Further, I want to know the difference between HBeAg and AHBe Total. Recently, I have tested with HBeAg with test result is 0.3 S/CO and AHBe Total with test result is 0.01 S/CO (CLIA Technology). Please interpret my test result.

    1. Hello: There are two types of hepatitis B surface antigen (HBsAg) tests used worldwide, one tests for detectable HBsAg down to a specific level (which can vary by lab) while other labs test for the actual amount of HBsAg, and they may test for a lower quantity of HBsAg.
      Europe and Asia labs test for specific quantities of HBsAg, while here in the US lab test for only detectable levels. I’m assuming the two lab tests you mention test for detectable/undetectable levels and for specific quantities of HBsAg. This is the only reason I can think that you would have “undetectable” levels at one lab and positive with a specific quantity at another lab.
      The hepatitis B “e” antigen (HBeAg) is present during the early stages of infection when your viral load is high and your immune system has not generated enough hepatitis B “e” antibodies to suppress viral replication and reduce your viral load. During the “tug of war” period when the antibodies are fighting to eradicate the antigens, you will have varying levels of antigens and antibodies. Your lab tests for specific quantities of the “e” antigen and antibodies, and to date you have slightly more “e” antigen than “e” antibodies.
      What is also important to know is what your ALT/SGPT liver enzyme and viral load (HBV DNA) are to evaluate your overall liver health. Good luck.

  11. Dear Doctor greetings,
    I tested negative for HBV in 2006 took the first 2 shots can’t remember going back for the 3rd shot. And I have never had sex. My mum was diagnosed with HBV too she was always sick but was given drugs, and when she went back to test again they told her she was becoming less reactive to HBV. She was finally told she no longer has the virus and was vaccinated .

    During a routine check, I was told I tested for +ve for HBV I was shocked to my bones. Now my question is was it because of the incomplete vaccination that i was exposed to the virus? And i have never had sex. Here is my serology report it reads:

    HBsAg positive, HBsAb negative, HBeAg negative, HBeAb positive, HBcAb positive and I also had a liver function test which the Doc said is okay and no need for trea ment except for check ups. Could you kindly help me explain my situation? And what can I do to bring it to functional cure? Thanks

    1. Hello: It is possible that you were infected at birth, when your mother was infected. It sounds like you have “inactive” hepatitis B, which is good news. This means the virus is not harming your liver as indicated by your good liver function test. It could be possible that when you were tested for hepatitis B in 2006 that your hepatitis B surface antigen (HBsAg) levels were low and were not picked up by the test.
      There is no cure yet for hepatitis B, however you do not need treatment at this time. Just continue to eat healthy foods and avoid food and alcohol.
      If you marry, make sure your husband is tested for hepatitis B and vaccinated if needed. And, if and when you have children, make sure the newborn is vaccinated within 12 hours of birth and treated with HBIG (hepatitis B antibodies) to make sure he or she is not infected.
      Good luck.

      1. Why the doctor gave her and her mother HBV vaccination? Do vaccination is a treatment for chronic HBV?
        How much actually the level of HbsAg and HbsAb considered as low ?

        1. Hello: If you have hepatitis B, a vaccination will not help you fight the infection. Immunization is not a treatment for hepatitis B.
          If you have at least 10 mIU/mL of hepatitis B surface antibodies (HBsAb), you are considered to have cleared the infection and be protected against infection.
          Ideally, you want as little hepatitis B surface antigen (HBsAg) in your body as possible.
          People with HBV genotype B or C who have low HBV DNA levels (less than 2,000 IU/mL) and HBsAg levels below 1,000 IU/mL have lower risk of liver damage and cancer. In fact, if HBsAg is under 100 IU/mL, patients may be on their way to clearing HBsAg from their blood.
          Hope this is helpful. Good luck.

  12. My labs are consistent with Chronic inactive carrier ( I was infected at birth).
    I do have a high VL= 13 million. On tenofovir 1.5 months now.
    Liver bx: mild portal inflammation.
    MRI: +hemangimona
    Heres the million dollar question. Hypothetically: say after being on tenofovir I’m still a chronic inactive carrier but just undetectable VL. What if I gave myself HBIG and the 3 dose vaccination? Could it possibly ramp up my immune system for HBs-AB. I was thinking of going to the ER and telling them I got a needle stick with hepatitis B so I can see if this works. I don’t think my hepatologist would agree at all.

    1. Hello: If you have had a high viral load (which 13 million IU/mL is), it means you are in the immune-tolerant stage. Your immune system hasn’t recognized the virus or the infection, and hasn’t started attacking your infected liver cells or generating lots of hepatitis B “e” antibodies. Are you still HBeAg-positive? Hopefully tenofovir will lower your viral load and your immune system will start attacking the virus.
      At this stage, getting HBIG or the vaccine will not help. The vaccine contains only hepatitis B surface antigen (HBsAg), which you already have in your body.
      Be patient, hopefully the antiviral will trigger your immune system to generate “e” antibodies and suppress the virus.
      Good luck.

  13. Thanks for the speedy response back.
    Im HbeAb+ and E-Ag – . Don’t understand how the virus is actively replicating with E-Ab being positive. ?Mutation. When should you repeat your viral load after starting tenofovir.

    thanks for responding back

    1. Hello:
      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 SGPT/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 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. Good luck.

  14. Thats a rude awakening. Thanks for sharing the information. My hepatologist tells me 2-3 beers a week is ok just never binge. Is that ok?

    1. Hello: The choice is yours, our livers process alcohol so any alcohol beverage puts stress on the liver. The fewer beers the better. Good luck.

  15. Hi there: I’ve been a chronic carrier since childhood, and have rarely touched alcohol. I’m currently pregnant and a recent prental blood test procedure in January 2016 showed that my result for HBsAG was – (non-reactive) and my Hep B DNA Viral Load was also undetectable. When my doctor did follow up tests in April 2016 to see if I would be eligible for cord blood banking, results seem to show that I’m “functionally cured” if taken together with the January 2016 results: HBcAB + (detectable) and HBsAB + (low level at 4.7). The thing is, I’ve had fluctuating +/- HBsAg results over the years, although before, my HBsAG results were always + (reactive). My Hep B DNA Viral Load has also fluctuated between detectable and undetectable over the years but has stabilized and remained undetectable since 2013. With my latest January and April 2016 results, can I be considered “functionally cured”, even with low levels of HBsAB? Thanks.

    1. Actually, I made a mistake in my post above – I meant that I had fluctuating +/- HBsAb results over the years, whereas my HBsAG results were always reactive, until my most recent test. Thank you.

      1. Hello:
        It’s not unusual to have fluctuating hepatitis B surface antibodies (HBsAb) levels. As long as you have detectable (reactive) hepatitis B surface antigen, you are infected. Basically, antibodies and antigens are at war with each other, the antibodies are trying to eradicate the antigens but until you test negative for surface antigens, the surface antibody levels don’t mean much. Thank you.

    2. Hello: Congratulations on your pregnancy. If you have had no signs of liver damage (normal ALT or SGPT levels), undetectable viral load (HBV DNA) and undetectable surface antigen (HBsAg) for two to three years in a row, you are considered functionally cured even if you do not have detectable (above 10 iU/mL) surface antibodies (HBsAb). If you are still testing positive every so often for HBsAg, then you may not be quite there yet. Make sure your baby is immunized within 12 hours of birth with the first hepatitis B vaccine dose and given HBIG to make sure he or she is not infected, even though your viral load is low.
      Good luck!

  16. Hello. So I am a strange case. I was infected with HBV over twenty years ago. When infected, I had already received two doses of the vaccine. It took me slightly longer than 7 months to clear the virus. Since then, I have consistently tested HBV DNA neg. and surface and core antigen neg. However, I have also lost all surface and core antibodies. My blood work looks like I was never vaccinated and never infected. My doctors are baffled. Any ideas?

    1. Hello: I’m a bit baffled too. Have you ever tested positive/reactive for the hepatitis B surface antibody (anti-HBs)? In some people, the immune system is able to repress the virus to the degree that they have an undetectable viral load (HBV DNA) and they clear the surface antigen. However, they never completely eradicate the infection and never generate surface antibodies. This is called inactive hepatitis B. You may be one of those people.
      However, if you were one of those people you would still test positive for the core antibodies, so I’m a bit confused too.
      The key is whether or not you ever developed surface antibodies.
      You may be in a seesaw situation where sometimes you test negative for the surface antigen and perhaps sometimes you test positive, given the strength of your immune system at the time of the blood test (and the sensitivity of the lab equipment used.)
      Keep getting monitored, it’s important especially even if you have an “inactive” infection. Good luck.

      1. So an update. I just had another test by a new doctor, as my old one retired. My MD says this is more sensitive than previous tests I have taken. Liver ALT(32)/AST(21) are normal. HBV PCR is undetectable, as has been the case in every test for for 20 years. Core AB is reactive and surface AB is 3.14 mIU/mL. Core IGM is non-reactive. My doctor says I am not a chronic carrier and wants me to retake the vaccine. Any thoughts?

        1. Hello: As long as your test positive for the hepatitis B surface antigen (HBsAg), which I assume you do, you remain infected with hepatitis B, no matter how low your viral load (HBV DNA) is. If you test negative for HBsAg and have a healthy liver and undetectable viral load, then you are considered not infected (though a small amount of virus always remains in your liver), even if you don’t reach the benchmark level of hepatitis B surface antibodies of 10 mIU/mL, which is considered a sign you have cleared the infection. Good luck.

          1. So if he cleared the virus (HbsAg <1 S/CO) but his HbsAb remain below 10 mIU/ml, what will happen if he exposed by HBV one day ?

          2. Hello: He has already been exposed to the virus, so it’s unlikely that getting exposed to it again will cause an increase in liver damage or viral load. Keep getting monitored, and of course avoid alcohol and cigarettes, and eat healthy foods to keep in that inactive state. Congratulations.

  17. I am 24 years old male,
    was diagnosed with hepatitis B in pre operative tests, it turned out I had it since my birth and my mom is also positive.. I had ~80 SGPT, Normal ultrasound, normal alphafetoprotin, HbeAg negative.. then ny doctor suggested combination therapy of tenofovir and peginterferon, It wasnot so good experience but I somehow cleared that phase, now I have undetectable viral load, normal alts, anti HBeAg positive ( I am not sure if I had that since very first day or after treatment I DEVELOPED them because I wasn’t checked for it previously). My only question is can I consume alcohol in limited/less quantity once a while?

    1. Hello: I’m glad the treatment helped you achieve undetectable viral load and stopped any liver damage. Experts would tell you that no alcohol is better than an occasional drink, given the stress it places on our liver. We recommend avoiding alcohol and smoking, and eating healthy food. All you can do is try for a healthy lifestyle as much as you can. Good luck.

  18. Hi Sir,
    I am 30 years old, HBsAG positive, ALT normal, no harm to my leaver as per the report. My viral load is not detected. Kindly confirm what is my health status and do I need to get treatment.

    1. Hello: Medical guidelines recommend treatment only if your viral load is elevated and you have signs of liver damage. If your ALT and other tests show your liver is healthy and viral load undetectable, you do not need treatment. Good luck.

  19. Hi I Hbv was detected when am trying to give blood donation in June 2015 with no any symptoms, I never go to doctors office until may 2016 when test was confirmed they give me tenofovir for one with all the side effect I finished it I did not go again until October 2016 when I start experiencing weight loss, joint pain then I go to doctors office he order Viral load test and liver function test the result show undetectable viral load and ALT & SGT is normal finally doctors said no need of treatment now.
    But am skeptical any help sir

    1. Hello: 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. Unless you were experiencing liver damage, you may not have needed treatment in May. Please consult with your doctor and see what your ALT levels are to determine if you require treatment. Good luck.

  20. Hello, i have an undetectable viral load for hbv, and am still on viread tablets, what are the chances of infecting someone through oral sex if they are not vaccinated? Please i need an urgent answer.

  21. hi, three years back i was diagnosed with chronic hep b and viral load count is 462 miu/ul but all other tests are normal and with out any damage. So once in a while i am checking LFT tests on advice of doctor and the LFTs are normal with out any elevations, Now i am not taking any treatment.To keep monitoring, Is LFT test is enough or i need to check any other tests too? Sometimes i feeling mild pain in lower abdomen part, is it related to Hep b?.. TIA

    1. Hello: I am glad to hear your hepatitis B is “inactive” with low viral load (HBV DNA) and no signs of liver damage from your LFT tests. You are correct that you do not need treatment.
      Usually people with hepatitis B do not experience abdominal pain because there are very few sensory nerves around the liver. Please share the information about your discomfort with your doctor, as it may result from another medical condition. For more information about abdominal pain, please read: http://www.hepb.org/blog/when-is-that-pain-hep-b-related-and-when-is-it-something-else/
      Good luck.

  22. I am HBsAg positive but my viral load is less than 100 mIU/mL and liver is also working properly. I want to treat Hepatitis B(positive) completely to Hepatitis B(negative) because I want to apply in the armed forces please tell me what should I do ?? I wa

    1. Hello: Unfortunately there is no drug or cure that will make the hepatitis B surface antigen (HBsAg) go away. You have “inactive” hepatitis B, even though you still have HBsAg. The good news is you are not experiencing any liver damage. Please keep getting monitored regularly, avoid alcohol and cigarettes, and eat healthy foods. That may not make your HBsAg disappear, but you will be in the best position to be healthy and perhaps clear HBsAg one day.
      Good luck.

  23. Hi, i have come across three terms: acute infection, chronic infection and “virus is cleared by the immune system”. Are there serological tests that could differentiate between chronic and cleared infection? If I understand correctly, chronic infection means the person could pass on the virus to others, and “cleared infection” means the virus no longer persist in the body. Most of the cases, people with chronic infection has undetectable virus load as well. Thank you.

    1. Hello: You are correct, a cleared infection means a person’s immune system has cleared all of the hepatitis B surface antigen (HBsAg), and the person now tests positive for the hepatitis B surface antibody (anti-HBs).
      Anyone who still tests positive for the hepatitis B surface antigen is still considered infected and capable of spreading the infection, even if they have an undetectable viral load.
      The “functional” cure that this blog refers to is when you have cleared HBsAg but do not test positive for surface antibodies. Doctors contend that if you have undetectable HBsAg and viral load, then you are not contagious.
      You didn’t ask, but an acute infection is a new infection in a healthy adult that is cleared by the immune system within six months.
      Good luck.

  24. Sir,
    I tested hep b positive and then hep b antigens positive.. My doctor said I had just been exposed to the virus but luckily my antibodies are strong and tht in adults it will normalise. It’s now six months and have not tested again.. If i test could my results read negative.. Is mandatory for me to have a liver check

    1. Hello: I cannot predict what it will be. Only by waiting the six months, which you have, and then getting the test will you find out if it was a new infection and you have cleared it, or whether it is a chronic infection. Be brave, I know it is very hard to go for these tests with so much at stake. Our thoughts are with you. Good luck.

  25. Hi I am 26y old when I am infected by heb b I am not know but I fill some problem in my abdomen and weakness and joint pan from 2010 in year 2016 I known I having hep b now l treating with intavir thereby from 9 month now dna quntitiv load is 8010ui/copies alt is 38 plz suggest me can I able to living normal life my weight is also very low 44kg hight 5.65fit plz help me with your suggestions

    1. Hello: I am sorry but I cannot find out what intavir is…. Is it entecavir? If so it is one of the recommended antivirals for hepatitis B treatment.
      Your viral load appears moderate and your ALT level is close to normal (I don’t know your gender.) Were you experiencing liver damage before your doctor had you start entecavir?
      Please continue to eat healthy foods, avoid alcohol and cigarettes, and continue to be monitored regularly. Good luck.

  26. please,I was diagnosed with hepatitis B since 2007 while in high School,I was always told I had inactive infection but I havnt been well and was also diagnosed of Duodenal ulcer which I was treated and remained healthy for 3 years,just last year(2016) I started experiencing pains in both upper right and left abdomen,sensational pain in my feet,upper shoulder pain and fatique,I reported to Hospital and underwent LFT and had all functioning but GT Gamma was high ,I also did Scan and was told I had fatty liver with liver little enlarged n t the fat consistent with the liver, My Viral Load report shows that Viral Load DNA not detected,Viral Load below 20iu/ML with the viral log at 1.30 Do I need treatment what food shouldn’t I be taking ?

    1. Hello: Did you also get tested for the hepatitis B surface antigen (HBsAg) and the surface antibody (HBsAb)? This is recommended to make sure you are still infected, given your low viral load.
      To lower your risk of liver disease from fatty liver, it is important to lead a healthy lifestyle, eat a healthy diet and avoid alcohol and cigarettes.
      The symptoms you experienced may be from something other than hepatitis B/fatty liver. Please continue to consult with your doctor to find out the cause.
      Good luck.

    1. Hello: Treatment is not recommended unless you have both high viral load AND signs of liver damage, indicated by an ultrasound of the liver or a test for the liver enzyme ALT (also called SGPT). Liver cells release the enzyme ALT/SGPT into the bloodstream when they are damaged. Healthy ALT levels usually range up to 30 in men and 19 in women.
      If you have a high viral load without liver damage, the best you can do is eat healthy foods, avoid alcohol and cigarettes, and continue to be monitored regularly. Good luck.

  27. Hello sir. I have done some test recently it says hbsag- negative,anti-hbc total- reactive.my untrasound report is normal it says no abnormality detected. And Dna Pcr says no hbv dna was detectec.another thing is in blood report down bellow it says anti hbs done the range 87.30 mlu/ml. And another thing dna is not detected but there is some number that i dont understand which is Linear detection range: 50-5 x 10 to the power 9 copies / ml. (10-1 x 10 to the power 9 lu/ml. Please help

    1. Hello: It appears you were infected with hepatitis B in the past, but your immune system has cleared the infection, indicated by your positive test for the hepatitis B surface antibody and undetectable viral load.
      You do not need any treatment, congratulations! Good luck.

  28. HI sir,
    My HBsAg : 8860
    Anti HSbAg: 5
    HBVDNA : 630
    AntiHbeAg : Reactive
    HbeaAG : NonReactive
    ALT : 27
    AST: 26
    Serum Creatinine : 0.90

    Please let me know, Can I still be active ? I had no symptoms

    1. Hello: Your report is good, you are not suffering any liver damage (ALT at 27) and your viral load (HBV DNA) is quite low. You may have inactive hepatitis B because your infection is not currently causing any liver damage. However, even with inactive hepatitis B, you need to be monitored regularly and you can still spread the infection as long as you test positive for the hepatitis B surface antigen (HBsAg). Keep up the good work, eat healthy foods, avoid alcohol and cigarettes, and practice safe sex. Good luck.

  29. Hello i have my result if HBV DNA 5.19IU/mL or 35 copies/mL ultrasound of my liver is normal ALT/SGPT slightly elevated to 74 i dont drink any kind of alcohol or even smoke. Now i,m taking viread tenofovir for almost 1 month to be undetectable my result. Please kindly let me know your opinion. Thank you

    1. Hello: You’re right, it’s always baffling to have a nearly undetectable viral load, such as you have, and still have signs of liver damage (indicated by elevated liver enzymes.)
      There are other factors that can increase liver enzyme levels, including exposure to toxins, over-the-counter painkillers such as acetaminophen, and fatty liver. Keep getting monitored and consulting with your doctor, and aim for a healthy diet and even increasing your level of physical activity to see if that has any impact on your liver health. Good luck.

      1. Hello my liver is normal and i don’t have a fatty liver i’m done my ultrasound last month it indicates my liver is healthy is there any way my HBV DNA result to be undtectable i’m taking viread tenofovir almost 1month.

        1. Hello: A viral load of 5.19 IU/mL is nearly undetectable. Keep in mind viral load can range up to millions, so yours is pretty undetectable in the overall scheme of things. You are fortunately to be healthy and have a low viral load.
          One point, medical guidelines do not recommend treatment if your liver is healthy and your viral load is low. Did you have signs of liver damage or a high viral load which prompted your doctor to recommend treatment? Good luck.

          1. Thank you for the rply all my result is normal and i don,t have liver damage and my viral load is only this result. I,m working in passenger ship but my company doctor here in philippines like this result to be undetectable that,s why i asked my private doctor what should i do and she said this is nearly undetectable no need to treat and no have sign of liver damage but i explain to her that the company doctor like this result to be undetectable she gave me a prescribed medicine viread tenofovir now i almost finish my medicine for 1month this coming aprl17 i willndo my test of HBV DNA VIRAL LOAD.

    1. Hello: When we are first infected with the hepatitis B virus, we test positive (reactive) for the hepatitis B surface antigen (HBsAg) and the hepatitis B “e” antigen ((HBeAg). As our immune system starts to fight the infection, it produces antibodies to get rid of these hepatitis B antigens.
      The first antibody we develop is the hepatitis B “e” antibodies (anti-HBe), which you have. It’s a good sign to test positive for the hepatitis B “e” antibody, it generally means your viral load is low, as yours is undetectable.
      Your viral load (HBV DNA) is undetectable. This means your hepatitis B infection is “inactive,” which is good news.
      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 only 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. Good luck.

  30. Hello I just had a parental blood work and was told I was positive for hep b. I’m a bit confused since I’ve been vaccinated, donated blood and was negative three years ago with my last pregnancy. Im having more blood work done, I’m not sure why the OB didn’t really explain much except that of it was active I would have to see a high risk dr. If you can give me more info, that would be nice since I’m soo confused

    1. Hello: We’re confused also, unless somehow you are a vaccine nonresponder and this is a new infection, which is unlikely.
      When you get the next round of lab tests back, please submit them as they may provide a more accurate and thorough picture. Good luck.

  31. Please help to interpret this
    Bilirubin’s total 1.2mg/DL
    Bilirubin’s direct 0.4mg/DL
    AST 41.7
    ALT 43.1
    Alkaline 90.2

    HBAsag positive
    HBsab negative
    Hbeag negative
    HBeAb slightly positive
    HBcAb negative

    What does it mean? Always having running stomach.

    1. Hello: Your positive hepatitis B surface antigen (HBsAg) test results shows you are currently infected with hepatitis B. It is good that you have tested positive for the hepatitis B “e” antibody (HBeAb) as it shows your immune system is starting to fight the infection by producing antibodies.
      Your liver enzyme (ALT) test checks for liver damage. Our liver cells release ALT into the bloodstream when they are damaged or die. Healthy ALT levels range up to 30 to 40 for men and up to 19 for women.
      It is important that you continue to be monitored at least every six months. Has your doctor discussed running a viral load (HBV DNA) test to see how much virus you have in your body. Doctors look at ALT levels and viral load when determining if someone requires treatment.
      Please eat healthy food, avoid alcohol and cigarettes, and practice safe sex.
      If this is the first time you have tested positive for HBsAg, you will need to be tested again in six months to find out if you have chronic or acute hepatitis B.
      Good luck.

      1. New liver function test reveals
        ST _ 25.4
        SGPT ALT _ 35.2
        ALP _ 69.6
        T. PROTIEN _ 7.8

        Is it a good sign its still less than six months from the first test. No viral test yet.

  32. SGPT 14.90
    AntiHCV –
    AntiHAV Igm –
    AntiHAV IgG 9.74 reactive
    HBsAg 5286.92 reactive
    AntiHbs –
    HBeAg –
    AntiHBe –
    Anti HbcIgm –
    Anti HBc 10.80 +
    Viral load 16 437 IU/ml
    95 663 copies/ ml
    Pls. interpret thanks do i need to take medicines im a breasfeeding mom

    1. Hello: You do not require treatment based on the information you shared. Your liver enzyme (SGPT) at 14.9 indicates no liver damage. In fact, up to 19 is healthy for women.
      I hope your baby was vaccinated with the first dose of the hepatitis B vaccine within 12 hours of birth, and was also given HBIG (hepatitis B antibodies)?
      Please make sure your baby gets the next two hepatitis B doses (the second is 30 days after the first, and the third is five months after the second dose) so he or she is protected.
      Also, please continue to get monitored regularly. You may experience an increase in viral load following childbirth, which is natural as your body and its hormones readjust after delivery.
      Also, as long as your baby has been vaccinated, breastfeeding is very safe.
      Good luck.

      1. Thanks for the reply but my child pedia want him to test for tither first before she would give the 2nd dose and 3rd dose vaccine by the way he receive the first dose and and immunoglobulin after birth

        1. By the way my baby is 5months old already and does not yet receive the 2nd dose and 3rd dose vaccine

        2. Hello: The CDC recommends a baby born to an infected mother get all three doses on schedule, and then one or two months after the third dose, get tested for both the hepatitis B surface antigen and antibody.
          Your doctor is incorrect. Where do you live? The World Health Organization guidelines are at:
          Who to test for hepatitis B:
          http://apps.who.int/iris/bitstream/10665/254621/1/9789241549981-eng.pdf?ua=1
          Treatment guidelines for hepatitis B:
          http://www.who.int/hiv/pub/hepatitis/hepatitis-b-guidelines/en/
          And the CDC guidelines are at: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6439a6.htm?s_cid=mm6439a6_e
          Good luck.

    1. Hello: The hepatitis B vaccine requires three shots, after the first dose, the second shot is administered 30 days after the first, and the third shot is administered five months after the second. Hope this is helpful. Good luck.

  33. Hi,
    I have hbv since I was born. I found it out first time during 2006, and I later found out that my mother and sister have it. Anyway, from 2006 until 2012 my results were showing more than a billion copies of HBA DNA and my hbeab was negative (hbeag positive) and of course hbsag postitive. ALT and AST were near 200. I tried pegasys for 6 months and it didn’t work. I tried baraclude for 3 but it didn’t either and since it was so expensive i discontinued. I didn’t test again until 2015 where I had developed the hbeab and my viral load was 1300. My hbeag had become negative and my ALT was at 11. Recently I only tested the liver enzymes (I don’t have a lot of money to do the exams) and it was 20. Is this an indication that I might lost the hbeab? I was on antibiotics and antiinflamatory pills those days because of a tooth inflmation.

    1. Hello: It appears that your immune system is fighting your infection. When it generated enough hepatitis B “e” antibodies to get rid of the “e” antigen, your viral load (HBV DNA) dropped from the millions to 1,300, which is excellent news. Also, you are no longer experiencing any liver damage. When liver cells are damaged, they release the enzyme ALT into the bloodstream. Healthy ALT levels for women range up to 19, and for men up to about 30. Your ALT is 20, which is healthy, and a much better level than the 200 it was in 2006.
      It appears you are doing well, please continue to lead a healthy lifestyle, avoid alcohol and cigarettes, and continue to get monitored regularly. Good luck.

  34. My hep b surface antibody is (reactive)Can I still get reactivated from hep c antiviral drugs?

    1. Hello: Good question. If you test positive or reactive for the hepatitis B surface antibody (anti-HBs), it means you have cleared the hepatitis B infection. When your hepatitis C antiviral drugs clear the hepatitis C infection, you will not be at risk of a hepatitis B reactivation because you no longer have hepatitis B. The hepatitis B surface antibody proves you are not at risk of reactivation once your hepatitis C infection is eradicated.
      The only risk of hepatitis B reactivation would be if you were ever prescribed immune-suppressing drugs for a cancer or rheumatoid arthritis. Other than that, you are fine. Good luck with your hepatitis C treatment!

  35. Sorry for the typo. My HbsAg is 0.250 S/CO. The cutoff is 1.
    So how it is compared with 0.05 IU/ml I asked previously?

    1. Hello: You will have to ask the lab that conducted the test that question. Labs vary in their reporting procedures, so please clarify with them what that means. Good luck.

  36. Dear sir
    I am Mintu kumar singh from bihar.
    HbsAG is positive but hbeAG is Negative.
    HbsAG positive is longer than 4 years but no effect.please about the position.
    HbsAG Quantity is=2840

    1. Hello: When we are first infected with the hepatitis B virus, we test positive for the hepatitis B surface antigen (HBsAg) and the hepatitis B “e” antigen ((HBeAg). As our immune system starts to fight the infection, it produces antibodies to get rid of these hepatitis B antigens.
      One of the first antigens we lose is the hepatitis B “e” antigen. It’s a good sign to test negative for this, because it often means we have fewer virus in our body.
      Please continue to get monitored every six to 12 months. And, you should also get tested for liver damage, which involves a blood test for the liver enzyme ALT, also called SGPT. This is an important test to find out if the infection is harming your liver.
      Good luck.

  37. Hi Doctor, thanks for your good work here.

    I tested positive to HBV in 2015. I did a further test in 2016, the liver function test was normal meanwhile my viral load was 1200UI/ml. I was advised to start Tenovofoir immediately to reduce the viral load. I had a follow up test last week(after about a year of using Tenovofoir) and the viral load was undetected. I’m yet to test for HBAg again, but will do soon. Please can you advice if I can stop Tenovofoir since the virus migth not be there anymore?

    1. Hello: When you were prescribed tenofovir, was it because you had liver damage? (Indicated by liver function tests, such as for the liver enzyme ALT or SGPT)?
      Medical guidelines recommend antiviral treatment if you have a high viral load and signs of liver damage. If that was the case, what do your liver tests reveal now?
      Doctors generally do not recommend you stop antiviral treatment unless you have had undetectable viral load (HBV DNA) and no signs of liver damage (with normal ALT/SGPT results) for at least 12 months.
      Also important is your hepatitis B “e” antigen (HBeAg) and “e” antibody (HBeAb) test results.
      For more information about when it is safe to stop antiviral treatment, please read: http://www.hepb.org/blog/can-hepatitis-b-patients-stop-taking-antivirals-experts-finally-answers/
      Good luck.

  38. last year my blood test was postive for HB core sntibody ,rest of the HBsAG,hcv,cbc,alt,were found normal……after two month of that report by suggestion of doctor i again cheked my blood sample for HBsAg ,,,that report was also normal….after that never i cheked my blood..am i now normal or not?..if yes then can i donate blood ?kindly reply me

    1. Hello: As long as you test positive for the hepatitis B surface antibody (HBsAb), then you have resolved your hepatitis B infection and are fine.
      However, anyone who has been infected in the past and tests positive for the hepatitis B core antibody cannot donate blood under current guidelines.
      Be thankful you and healthy and cleared the infection. Good luck.

  39. hello..my 25yo brother died last year due to primary HCC due to hep b..he was hbsag+ hbeag+ hbeab- at that time. due to the incident..we all tested for hep b..here are the result..

    me: hbsag- hbsab+ hbeag- antihbe+ antihbcigm- antihbcigg+ hbvdna undetected alt 60 ast 40 utz fatty liver and normal elastogram

    2nd brother: hbsag- hbsab+ antihbcigm- antihbcigg- hbeag- hbeab- normal utz

    mother: hbsag+ hbsab- antihbcigg+ antibcigm- hbeag+ antihbe- normal utz

    father: hbsag- hbsab+ hbcigg+ hbcigm-

    did we really contracted this from our mother? how come only 2 of us has hep b while our other brother was negative? we are 3 males..i am 29yo today..and did i really cleared my hep b? our doctor told us that we are at high risk of hcc since my late brother had it..am i still at risk of hcc even if ive cleared hep b? and will my hep b reactivate again?

    1. Hello: If you have cleared (test negative for) the hepatitis B surface antigen (HBsAg) and positive for the hepatitis B surface antibody (HBsAb), then you have cleared the infection and are not at risk of liver damage or reactivation.
      You were probably all infected by your mother, however it is not unusual for some siblings to have hepatitis B and others not. It may be that your mother’s viral load (HBV DNA) varied over time and was higher (resulting in infection of her newborn) during some pregnancies vs. others. Were any of you immunized at birth?
      However, because you have a relative who had liver cancer, please take care of your health and your liver. Avoid alcohol and cigarettes, and of course eat healthy foods.
      One last point, if years from now any of you require any immune-suppressing drugs, such as chemotherapy for cancer, you must tell your doctor you have had hepatitis B in the past. In some people, hepatitis B reactivation has occurred after immune-suppressing drug treatment.
      Good luck, I am sorry about your brother.

  40. I did a more detailed blood test and my the test said that I had Hepatitis B but my imunne system cured myself.

    Usually for the last 3 – 4 years I was doing every year the Hepatitis test but just the Ag HBs and always it was negative.

    Here its my last test:

    Ag HBe – Negativ
    Ag HBs – Negativ
    Anti HBc – Pozitive
    Anti HBS 394 UI/L
    DNA – Undetectable

    ALT/AST looks good as well.

    My doc said I must have a acute hepatitis and the imune system was doing a great job.

    My question is, I am 29 years old, from now on I have to be more careful on how many drinks or bad food I have or I should act like a normal young person? If it was just acute and now I am cured I should still think about this or from now on I am safe?

    thanks a lot!

    1. Hello: Your tests indicate you had a hepatitis B infection in the past, but your immune system was able to clear it. This is indicated by your negative hepatitis B surface antigen (HBsAg) test and your positive hepatitis B surface antibody (anti HBs) test.
      You have cleared hepatitis B, but it is a good idea to take care of your health and not over-indulge or drink too much. Good luck.

      1. Thanks for the reply. The idea to take care of the health and not over-indulge or drink too much goes to a person without hapatitis B as well or it is in special for those who had hepatitis B cleared?

        I have to act differently from my friends? I mean I don’t drink daily but one a weekend I want to go out in the club and drink with my friends.

        As I read on internet its very rare the case when the hepatitis B reactivate and that is ussualy when you take hard tratamanet for cancer not just a ibuprofen from time to time, right?

        Thanks for you help, it means a lot to me as I am scared on how to act from now on. Basically today are 300 Million people with chronic hepatitis B and 2.7 Billion who cured it and everywhere they are saying you are cured for life.

  41. Sir it’s 27 Male,
    I was detected hbsag in 2010 but hbe ag was negative at that time, my doctor advised to repeat hbe ag test after 6 every months to check. At remained negative for 4,5 years but last year in September 2016 my hbe ag showed positive. Hbv DNA showed the following results after that,
    2016 September 264 iu/ml
    2016 December 124 iu/ml
    2017 February not detected
    2017 May 207 iu/ml

    My latest LFT showed normal ALT level.

    My main concern is about the fluctuations in hbv DNA level in PCR. Please advise on my reports and specially on the issue that is it possible that once DNA become undetected and become again detectable again?

    1. Hello: It is not unusual for your viral load (HBV DNA) to fluctuate over time. Remember that HBV DNA can reach into the millions, so the small changes you are experiencing are not considered “clinically” significant.
      What is important is your liver function tests, including the blood test for the liver enzymes ALT/SGPT and AST, to make sure the infection is not harming your liver.
      So please continue to get tested every six to 12 months for viral load, HBeAg and HBeAb and ALT/SGPT so your doctor has a comprehensive picture of your liver condition and hepatitis B infection.
      I don’t know where you live, but the World Health Organization has monitoring and treatment guidelines that you may want to review with your doctor at: http://www.who.int/hiv/pub/hepatitis/hepatitis-b-guidelines/en/
      Good luck.

  42. I carried Hep B since I was born in Asia. In the last few years, I have been praying to the Lord, Jesus, Buddha and whoever up there could give me some blessing to cure my Hep B. I am not Christian, but sort of admiring the God, Jesus and Buddha. I started going to church, any church occasionally, mainly asking them to cure my hep B. Hard work, and a bit of luck, I quit smoking cigs, weeds & drinking. I eat more vegetables, exercise moderately and guess what? No virus detected in my blood test in the last two years, my liver is 3.8 as the doc said, better than a normal liver about 5 ( whatever it represents, I don’t know). I go to church again this Sunday. As long as you have a vision and believe it, your body and soul will lead you to it. It’s a placebo cure with some luck on the way and free.

  43. Hello
    I am 40 years old chronic since birth and never taken meds. I am e antigen negative with fluctuating alt (last year it was in the 70’s) and now it’s in the 50’s with a DNA viral load of 75,500.

    I am genotype D. I don’t want to undergo any meds but my the doctor is pushing me. What kind of antiviral is good with minimal side effects and what if after a year I come off the antivirals?

    I am trying to take the natural route and not take meds. So far all my ultrasounds are fine and I did show recenly mild fatty liver but I can monitor that.

    I have a fibroscan in a month.

    I don’t have any other hepatitis as I was tested for all of the other kinds and are negative.

    THank you

    1. Hello: There are three antivirals currently recommended for treatment: tenofovir, entecavir and a new formulation of tenofovir called Vemlidy or TAF, which reaches liver cells more effectively and therefore requires a lower dose of tenofovir. Any of these three antivirals are highly effective.
      I know no one wants to commit to taking a daily pill long-term, but if you are experiencing liver damage (healthy ALTs range up to 30 in men and 19 in women) and have a fairly high viral load with genotype D, medical guidelines recommend treatment.
      However, it is likely that you will be taking an antiviral for more than a year. Are you HBeAg-positive? Antiviral treatment may help your immune system to seroconvert and lose HBeAg and develop “e” antibodies.
      Good luck in your deliberations, and your fibroscan results may give you more valuable information. Good luck.

  44. my father is hepatitis b positive and now suffering from liver cancer with multiple tumor in liver.
    if we able to make hepatitis to negative.can it make effect on cancer as well.
    will cancer is reduced if virus is removed frm body

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