Hep B Blog

I’ve Lost the Hepatitis B “e” Antigen (HBeAg), So When Can I Stop Treatment?

Image courtesy of Naypong at FreeDigitalPhotos.net
Image courtesy of Naypong at FreeDigitalPhotos.net

Eighteen years ago, doctors started treating hepatitis B patients with antivirals and today liver specialists have a wealth of knowledge about how these drugs stop the virus from replicating and reduce viral load. But one thing they’re still not certain about is when patients can safely stop taking their daily antiviral pill.

In this week’s blog, we’ll explore when experts think it’s safe for patients, who have lost the hepatitis B “e” antigen (HBeAg) during antiviral treatment, to stop . Next week, we’ll look at when it’s safe for patients who were already HBeAg-negative when they began antiviral treatment to stop.

Today, doctors prescribe one of two antivirals—either entecavir (Baraclude) or tenofovir (Viread). Among the antivirals developed since 1998, these two are considered the most powerful in quickly reducing viral load (HBV DNA) and they carry the lowest risk of drug resistance. Doctors usually prescribe antivirals when our viral load is elevated and we have sign of liver damage–indicated by elevated liver enzymes (ALT or SGPT).

Antivirals quickly knock down viral load, which in turn is believed to lower our risk of liver damage and cancer. But antivirals work for only as long as we take them. When we stop, the virus usually reactivates although this is very rarely fatal or results in a liver transplant. Studies show that at least 78 percent of people who stop antivirals have an increase in viral load, 44 percent have a rise in ALT levels indicating liver damage, and among those who lose HBeAg during treatment, at least 9 percent experienced a return of HBeAg.

But what about individuals who take antivirals for long periods and enjoyed years of undetectable viral load, no signs of liver damage, loss of HBeAg, and development of the “e” antibody? Can they stop? After all, antivirals are expensive. Without insurance, a month’s supply of tenofovir costs about $1,000 and generic entecavir costs about $407 in the U.S., not to mention possible side effects such as bone loss or reduced kidney function with tenofovir..

Late last year, hepatitis B experts from the American Association for the Study of Liver Disease (AASLD) tackled this question and reviewed recent studies that followed patients who stopped antivirals after losing HBeAg. They found no clear answers and made clear their recommendations were “conditional” because the quality of evidence found in the studies was “low.” But here is what they recommend for patients who lost HBeAg during antiviral treatment and now have normal ALT levels:

  • Experts “suggest” that adults who don’t have cirrhosis (severe liver scarring) who lost HBeAg and developed “e” antibodies may stop treatment after a minimum of 12 months of normal ALT levels and undetectable viral load.
  • However, they recommend a longer “consolidation” treatment period might be better to reduce patients’ risk of relapse and a return of HBeAg after treatment stops. They suggested that an alternative approach would be to stay on antivirals until patients lose the hepatitis B surface antigen (HBsAg).

Decisions about how long to stay on antivirals require careful consideration of health risks and benefits, they wrote, including risks of relapse, liver damage, and liver cancer. Other considerations include the cost of treatment, the risk of developing drug resistance if people stop antivirals intermittently, and other side effects.

Anyone who stops taking antivirals, they advise, should be monitored frequently – at least every three months — for at least one year for liver damage and resurgence of viral load. Anyone with cirrhosis should continue treatment indefinitely because of their high risk of liver cancer.

For now, the message appears to error on the side of caution and continue on antivirals until you have cleared HBsAg for a prolonged period of time. Clearly this decision is one you must discuss carefully with your doctor.

In next week’s blog, we examine how long people who were HBeAg-negative when they started antivirals should remain on treatment.

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.

82 thoughts on “I’ve Lost the Hepatitis B “e” Antigen (HBeAg), So When Can I Stop Treatment?”

  1. Hi, I’ve stopped taking tenofovir for three months. Before that my hep b dna test was undetected, HBeAg was negative, and ALT, AST were normal. Unfortunately, I had my blood test results today (01-28-2016). It turned out the virus is 340 IU/mL. I am afraid of the virus is replicating. But the ALT, AST are still normal and HBeAg is negative. I am too worried about to go back to the medicine.

    1. Hello: Talk to your doctor. The increase in your viral load (340 IU/mL) is not large, and usually some rebound in viral load is to be expected after going off antivirals. Continue to get monitored every three months, as guidelines recommend, and see what happens with your viral load and ALT/AST. Good luck.

      1. Hi! I have a hepatitis B and D. I have been taking entecavir for 8 months now. Viral load of virus B is undetectable but viral load of virus D jumped and is 45,000,000 UI/ml now. Whit was 28,000 before i started taking entecavir. What should i do now? Can i stop taking entecavir? I experience tiredness, sleepiness since starting to take entecavir. I also have a liver cirrhosis.

        1. Hello: I know the only approved treatment for hepatitis D is pegylated interferon. Unfortunately, antiviral medications that work against hepatitis B are not effective against hepatitis D.
          The good news is there are five promising new drugs in development, and many more treatment options are expected in the coming years. Read more about treatments and drugs in the pipeline here: http://www.hepb.org/research-and-programs/hepdeltaconnect/treatment/
          If you want to consider joining a clinical trial for these new treatments, please visit our Clinical Trials page for more information: http://www.hepb.org/research-and-programs/hepdeltaconnect/clinical-trials/.
          For more information, resources and support, please check out our new website for hepatitis D patients: http://www.hepdconnect.org and find us on Twitter (www.twitter.com/hepdconnect), Facebook (www.facebook.com/hepdconnect) and Instagram (@hepdconnect)
          Good luck.

        2. Hello: We are not medical providers, and you should discuss all treatments and changes with a knowledgeable liver specialist. Our hepatitis D expert’s recommendation is to begin pegylated interferon weekly (90 mcg per week) and to increase this dosage if it is well tolerated. Pegylated interferon is currently the standard and only available treatment for hepatitis D. When living with an HBV/HDV coinfection, it is necessary to manage both infections. You should do your own research, and continue to consult with your doctor about the next steps. For more helpful information, please visit our website for hepatitis D patients http://www.hepdconnect.org. Good luck.

  2. My 13 yr old son’s doctor recommends he start taking tenofovir – the side effects in children worry me. Is there a blog, email list, or any community of parents of children undergoing treatment?

  3. My hbeag load is 145000 IU/L..AFTER taking of tenofovir my sgpt level going to high in 6months…..any suggestions pls???

    1. Hello: I’m sorry I don’t understand your lab results. Can you write again and let us know whether that is your viral load (HBV DNA) and also what level is your SGPT? Thank you.

  4. I am a man 38 years old
    Liver Function Tests
    Total Bilirubin 0.30 mg/dL 0 – 1.2
    Direct Bilirubin 0.10 mg/dL 0 – 0.3
    Indirect Bilirubin 0.20 mg/dL 0 – 0.9
    SGPT (ALT) 27 U/L 0 – 49
    SGOT (AST) 27 U/L 0 – 34
    Kidney Function Tests
    Serum Creatinine 0.9 mg/dL 0.7 – 1.3
    Blood Urea 22 mg/dL 10 – 45
    TEST NAME RESULT UNIT
    Serum Uric Acid 4.60 mg/dL 3.0 – 7.0
    Hepatitis Markers
    Hepatitis B surface antigen Positive
    HBV DNA Quantitative by (TaqMan) 32648 IumL < 20
    FibroScan with 7.4 KPA F2 what about my liver status and when i got infected with hep b? and what the roadmap for my treatment?

    1. Hello: Your ALT of 27 is a good sign and indicates that your liver is not currently being damaged by the infection. Normal ALT levels are 30 and less for men. However, your Fibroscan score of F2 shows some fibrosis has occurred in the past. Your viral load is moderately high. What is important to know is if you have cleared the hepatitis B “e” antigen (HBeAg) and do you now test positive or reactive for the hepatitis B “e” antibody (HBeAb)? It is important to review your lab results with your doctor and review viral load, ALT levels and also HBeAg status, as well as your Fibroscan test, when making a treatment decision. And, it is important to eat healthy food and avoid alcohol and cigarettes. Good luck.

  5. January 2015
    HBsAg….. positive
    HBcAb….. positive
    HBsAb….. negative
    HBeAg….. negative
    HBeAb….. positive
    HBsAg value….. 692.07 iu/ml
    HB DNA copies 192cp
    Hb DNA 33 iu/ml
    FEBRUARY 2016
    HB DNA COPIES…. 7898 cp
    HB DNA load…. 1357 iu/ml
    LFT….
    S-ALT……. 17 IU/L
    S-AST……. 22 IU/L
    s-g-Glutaml transferase…… 24iu/l
    Above is my sister’s results. she’s not on treatment yet. she is very worried now since the viral load looks high to her. please help me educate her and what she should do next.

    1. Hello: Her viral load is moderately low, and her ALT level, a liver enzyme that rises above normal when liver cells are damaged, is healthy at 17. Normal for women is 19 and less. Usually doctors evaluate a person’s age, gender, viral load, and ALT levels, in addition to other factors, when deciding whether to treat someone. Only her doctor can determine if she needs treatment, but with low viral load and normal ALT levels, she does not appear in any danger. Good luck.

  6. I am a man 38 years old
    Liver Function Tests
    Total Bilirubin 0.30 mg/dL 0 – 1.2
    Direct Bilirubin 0.10 mg/dL 0 – 0.3
    Indirect Bilirubin 0.20 mg/dL 0 – 0.9
    SGPT (ALT) 27 U/L 0 – 49
    SGOT (AST) 27 U/L 0 – 34
    Kidney Function Tests
    Serum Creatinine 0.9 mg/dL 0.7 – 1.3
    Blood Urea 22 mg/dL 10 – 45
    TEST NAME RESULT UNIT
    Serum Uric Acid 4.60 mg/dL 3.0 – 7.0
    Hepatitis Markers
    Hepatitis B surface antigen Positive
    HBV DNA Quantitative by (TaqMan) 32648 IumL < 20
    FibroScan with 7.4 KPA F2 what about my liver status and when i got infected with hep b? and what the roadmap for my treatment?

    and i went to liver specialist yesterday and he advice me with
    check liver sample to talk the correct decision for treatment "for ever" or not "just monitor the liver "
    today i did these analysis
    Hepatitis B e antigen Negative
    Hepatitis B e antibody Positive

    can you advice me about me current status and what the correct decision and it is possible to my immune system will wake up or not?

    1. Hello: Based on your tests, today your viral load is elevated for someone with HBeAg-negative hepatitis B and your Fibroscan shows past fibrosis, even though your current ALT/SGPT test results are within the normal range at 27. 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.) As your doctor pointed out, once you start antivirals, you may have to take them for a long period of time. If I understand you post, your doctor has recommended a liver biopsy to get a better picture of your liver health before making a long-term treatment decision. Given your age and gender, your doctor has made a good recommendation. He is not rushing to treat you, he wants to make sure you need treatment, and you should follow his advice. Whatever you decide, please continue to be monitored regularly so your liver health can be carefully monitored. Good luck.

  7. My wife hbsAB positive greater than 1000 miu/ml
    My son 6 years old hbsAB=72 miu/ml
    My daughter 3 years old hbsAB=300 miu/ml
    They need any shots for hb

    1. Hello: I assume all three have been immunized? They are all protected against hepatitis B. You must have at least 10 mIU/mL to be protected against infection, which they all do. Good job!

  8. Dear Sir,
    I am a 53 years old male. Was diagnosed with Hepatitis B back in October 2015. After several tests it turned out that I have chronic HepB. I was vaccinated back in 2006, but it seems it did not help my too much. After finding very few HBsAntibody (not detectable), my doctor hoped that I might develop more Surface antibody and considered the stage of my disease as Semi -Chronic and prescribed me in January entecavir. After taking entecavir I developed joint pain in my legs and my doctor ordered lot of tests. The only elevated value was the Alkaline Phosphates which I tried to reduce it through a better diet and taking Vitamin D. After 5 weeks taking enytecavir and since my joint pain did not get better, my doctor switched to Tenofovir and told me I might take this for many years. Now after 10 days taking Tenovofir which was oaky at the beginning, I felt some pain again in my joint (only while I am walking).
    Now I have 2 questions for you:
    • Is there any hope that the low value of HBs Antibody improves to a higher level? I hope the memory can help and I can develop a seroclearence of HBsAG?
    • How can I deal with the joint pain, since I heard that Antivirals can cause the bone loss? Below the recent test results before and after taking entecavir (not test after taking Tenofovir)
    AST: from 50 ——-> to 41 ——-> to 39 (before talking entecavir) ——->to :43 ( After 2 weeks entecavir) and to 40 (After 4 weeks entecavir)
    ALT: from 81 ——->to 71 ——-> to 68 (before talking entecavir) ——->to :69 (After 2 weeks entecavir) and to 68 (After 4 weeks entecavir)
    Hepatitis B Viral DNA: from 3.43 ——->to 3.78 (before taking entecavir) to now 1.40 (After 2 weeks entecavir)
    Hep B Viral DNA: from 2710 ——-> to 5960 (before taking entecavir) to now 25 (After 2 weeks entecavir)
    HBsAG: Positive
    HBeAG: Negative
    IgM : Negative (in January)
    Core Antibody: Reactive (in January)
    HB s Antibody: 3.10 (non reactive)
    Alkaline Phosphatase: from 123 before entecavir to 145 (after 2 weeks taking entecavir) and to 115 (after 4 weeks entecavir and taking Vitamin D)

    1. Hello: Antivirals are effective in lowering viral load and reducing the risk of liver damage, but only in a small percentage of cases do they leave to clearing the hepatitis B surface antigen (HBsAg) and generating surface antibodies. I would follow your doctor’s instructions and take the antiviral for as long as you need it (especially until HBsAg disappears, which may take time.) Also, eat healthy foods and of course avoid alcohol and cigarettes.
      Entecavir does not cause bone loss, so your joint pain may result from another cause. I am glad your doctor recommended vitamin D. Tenofovir causes bone loss in a small percentage of people. However, your doctor can monitor for bone loss and the vitamin D will help counter-act that. Good luck.

  9. Hi,
    I see in my question I left yesterday, my photo is being displayed. Would you please make sure, that my picture is not going to be shown, once you publish my question?

    1. Hello: On the page I am viewing, your picture is not visible. Please let me know if you are able to view it. Thank you.

      1. Hello,
        I just received today the latest Hepatitis B Viral DNA results. It says hept b viral load is undetectable. It states also: “This patient had HBV viral DNA
        that was detectable, but was below the Lower Limit of Quantitation of the test (<20 IU/ml). This happens on rare occasions and is due to the presence of very low concentrations of virus that can not be precisely quantified."
        I started to take anti viral 10 weeks ago! Is there any hope of cure in this case?

        1. Hello: Congratulations, your antiviral medication has successfully reduced your viral load (HBV DNA) down to undetectable levels, which is good news. Most labs consider a person to have “undetectable” viral load if his or her viral load is 20 IU/mL or lower.
          Experts predict a cure for hepatitis B will be developed in the next few years, we hope it is too and are trying our best to help find a cure. Good luck.

  10. I am a man 38 years old
    Liver Function Tests
    Total Bilirubin 0.30 mg/dL 0 – 1.2
    Direct Bilirubin 0.10 mg/dL 0 – 0.3
    Indirect Bilirubin 0.20 mg/dL 0 – 0.9
    SGPT (ALT) 27 U/L 0 – 49
    SGOT (AST) 27 U/L 0 – 34
    Kidney Function Tests
    Serum Creatinine 0.9 mg/dL 0.7 – 1.3
    Blood Urea 22 mg/dL 10 – 45
    TEST NAME RESULT UNIT
    Serum Uric Acid 4.60 mg/dL 3.0 – 7.0
    Hepatitis Markers
    Hepatitis B surface antigen Positive
    Hepatitis B e antigen Negative
    Hepatitis B e antibody Positive
    HBV DNA Quantitative by (TaqMan) 32648 IumL < 20
    FibroScan with 7.4 KPA F2

    and i went to liver specialist yesterday and he advice me with
    check liver biopsy to talk the correct decision for treatment "for ever" or not "just monitor the liver "
    today i get Live pathology report

    liver Pathology report

    Description
    Length of the core : 2 CM
    Number of portal tracts : 9
    Degree on interface hepatitis : Mild
    Degree lobular necrosis : Mild
    Degree of portal inflammation : Mild
    Stage of fibrosis : Mild
    Degree steatosis : No
    presence of cirrhosis : –
    Presence of dysplasia : –
    Presence of malignancy : –

    Diagnosis
    Mild chronic Hepatotos B
    Mild Fibrosous portal expansion without septa
    No Steatosis
    ISHAK Score : 4/18 Stage 1/6
    Metavir score : A1,F1

    can you advice me about me about my liver current status and what the correct decision take treatment or just monitoring?
    and it is possible to my immune system will wake up or not?

    1. Hello: You ask a very good question, for which there is no easy answer. You have 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 can put you at a 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.) You clearly qualify for treatment because of your elevated viral load and moderately elevated ALT levels. As your doctor explained, once you start antiviral treatment, it’s a long-term commitment. It’s difficult to know when you can go off antivirals (see http://hepbblog.org/2016/02/03/can-people-with-hbeag-negative-hepatitis-b-ever-stop-taking-antivirals/ for a blog on this topic.) It appears you have a good doctor, and you can continue to be monitored every three to six months to see what happens and make a treatment decision if anything changes. I also have no easy answer for you, but you are doing all the right things by getting informed, getting monitored and no doubt you have a healthy diet without alcohol or cigarettes. Good luck.

  11. I went to my doctor and his device to monintor every six months with these alt,ast,pcr,alfa fetoprotien and HBsag this advice match with you words last reply to me what your comments now and why he need this HBsag after Six month

    1. Hello: When you have a chronic infection and are monitored, usually a doctor routinely checks your liver enzymes (to see if your liver is damaged by the infection) and also your hepatitis B surface antigen (HBsAg) to see if you are still infected. Good luck.

  12. I am a man 38 years
    Liver Function Tests
    Total Bilirubin 0.30 mg/dL 0 – 1.2
    Direct Bilirubin 0.10 mg/dL 0 – 0.3
    Indirect Bilirubin 0.20 mg/dL 0 – 0.9
    SGPT (ALT) 27 U/L 0 – 49
    SGOT (AST) 27 U/L 0 – 34
    Kidney Function Tests
    Serum Creatinine 0.9 mg/dL 0.7 – 1.3
    Blood Urea 22 mg/dL 10 – 45
    TEST NAME RESULT UNIT
    Serum Uric Acid 4.60 mg/dL 3.0 – 7.0
    Hepatitis Markers
    Hepatitis B surface antigen Positive
    Hepatitis B e antigen Negative
    Hepatitis B e antibody Positive
    HBV DNA Quantitative by (TaqMan) 32648 IumL < 20
    FibroScan with 7.4 KPA F2

    and i went to liver specialist yesterday and he advice me with
    check liver biopsy to talk the correct decision for treatment "for ever" or not "just monitor the liver "
    today i get Live pathology report

    liver Pathology report

    Description
    Length of the core : 2 CM
    Number of portal tracts : 9
    Degree on interface hepatitis : Mild
    Degree lobular necrosis : Mild
    Degree of portal inflammation : Mild
    Stage of fibrosis : Mild
    Degree steatosis : No
    presence of cirrhosis : –
    Presence of dysplasia : –
    Presence of malignancy : –

    Diagnosis
    Mild chronic Hepatotos B
    Mild Fibrosous portal expansion without septa
    No Steatosis
    ISHAK Score : 4/18 Stage 1/6
    Metavir score : A1,F1

    I went to my doctor and his device to monintor every six months with these alt,ast,pcr,alfa fetoprotien and HBsag this advice match with you words last reply to me what your comments now and why he need this HBsag after Six month

    I did not know when i infected just when i checked to travel 10 Feb 2016 i found i had infection with Hbv please reply about my case

    1. Hello: Your doctor has made a good recommendation to continue to monitor your condition every six months because there is no current indication of liver damage (your ALT levels are normal) and the liver biopsy showed only mild fibrosis. (Please see my earlier reply to you.) Your doctor will continue to monitor your viral load and ALT levels. Treatment will be prescribed if signs of liver damage develop. Good luck.

  13. Thanks for your replys and from my above data can we determine the time of this HBV infection

    1. Hello: Lab tests over time can reveal if you have an acute or chronic infection, but they cannot pinpoint exactly when you became infected. Also, it can take up to nine weeks after exposure to the virus for lab tests to identify the presence of the virus’ antigens. Thank you.

  14. On 8 Mar 2016 i did absag is positive and hbs AB negative with 2 miu/ml whats are these means

    1. Hello: That means you are still infected, however you also have low levels of hepatitis B surface antibodies. You need enough surface antibodies to bind to and destroy the HBsAg in your body, so keep up your healthy lifestyle and get monitored. Good luck.

  15. Hi, I am hep b patient,with hbvdna undetectable or neg for the last 8years(from 2008),I am on tenofovir and my sgpt is normal as well as my other LFT results,my AFP is 1.5ng/ml and my fibrosis is 8.5kpa,my platelets are adequate and my creatinine is 0.9..My question is fibrosis reversable,as per my fibroscan I am at which stage of fibrosis(f3 or f4)??if reversible then how??

    1. Hello: Only your doctor can answer the question about the range and change in your fibrosis results. However in general, fibrosis can be reduced with effective treatment, which you have clearly received given your undetectable viral load and normal liver enzymes (SGPT/ALT). Keep up the good work! Thank you.

  16. Hello Doc,

    I’m going to start taking baraclude. My HBV DNA is >110 000 000 (both last year and this year) but my SGPT is not so high.Also I have positive IGM for 12 months already. What do you thing the best option for me?

    1. Hello: Medical guidelines generally do not recommend treatment unless you have signs of liver damage — which is a liver enzyme (ALT or SGPT) reading exceeding 30 for men and 19 for women.
      Generally, if you are in the “immune tolerant” phase of hepatitis B, which is common in younger adults with high viral loads (HBV DNA) who are still hepatitis B “e” antigen (HBeAg) positive, treatment will not help. You need to wait until your immune system starts to fight the infection for treatment to be effective. That is why monitoring is so important to identify when you move into the “immune active” stage when treatment might be advantageous.
      If you live outside of the U.S. and Europe (which have their own treatment guidelines), you want want to review the World Health Organization’s hepatitis B treatment guidelines with your doctor and discuss if you require treatment. They are found at: http://www.who.int/hiv/pub/hepatitis/hepatitis-b-guidelines/en/
      Good luck.

  17. My 21 year old daughter has been on Tenofovir for 3 years now after being diagnosed with F3 fibrosis secondary to HBV acquired at birth. Her ALT numbers have been rising lately to 41 IU/ml and she has not consistently achieved undetectable viral load of less than 20 IU/ml. She has hovered around 25-31 IU/ml in her last two tests. Her liver function tests are normal and her last Fibroscan in April showed less scarring but I am very worried even though her specialist says she’s fine. As a side note, she had a viral rebound on ETV and was switched to Tenofovir 3 years ago. What do you think?

    1. Hello: Having a viral load of 25 to 41 IU/mL is extremely low, and some labs would classify it as undetectable. Her healthy liver function test results and ultrasound also confirm she is doing fine and is not experiencing any liver damage. Her doctor is clearly following guidelines and switching from entecavir to tenofovir is also recommended when patients don’t respond to entecavir. It sounds like she’s getting good care, make sure she is monitored regularly, and of course eats healthy food and avoids alcohol and cigarettes. Good luck!

  18. Hi! Is it advisable to stop taking antivirals if you are Hep B e antigen negative, with the hope of losing Hep B surface antigen. If yes, after how long must the antiviral be stopped? Thank Yu.

  19. Dear Sir/Madame,

    I was infected with Hepatitis B. I was positive with HbeAg and have high ALT level: 120 and high copy of viral load.I have been placed under treatment treatment with Tenofovir for 40 Weeks now. Now my ALT level is 44 and HbeAg is negative, HBeAb is positive and viral load is undetected. Is it possible for me to stop taking Tenofovir? Is it possible that HBeAb will disappear immediately after stopping taking Tenofovir?

    One more important question is what kind exercise is recommended for me. I like going to gym to lift heavy equipment. I heard heavy exercise can make ALT increase? Is it true?

    I’m looking forward to hearing from you soon.

    Best regards

    1. Hello: I’m glad to hear tenofovir has been effective for you in lowering your viral load and reducing your liver damage (ALT level.) Unfortunately, antivirals work for only as long as you take them. Researchers are trying to determine when it is safe to go off antivirals. Some research shows that if people lose the hepatitis B surface antigen (HBsAg) while on antivirals for six months or longer, it might be safe, but this whole question is under study now. For more information on this please see: http://www.hepb.org/blog/can-people-with-hbeag-negative-hepatitis-b-ever-stop-taking-antivirals/
      Exercise is very good for all of us. ALT (liver enzymes) can rise when we’re sick from other illnesses other than hepatitis B, or if we are obese or drink alcohol and smoke cigarettes. Keep up the good work, get monitored regularly, and keep talking to your doctor about your treatment. Good luck.

  20. Dear sir ,

    My mother of 52 years have Hepatis B in 2013 September when she have 209 copies /ml.,HBeAg non reactive value is 0.109, HBsAg Réactive value is 2.75 , anti HDV positive value of 2.016 and Anti HCV non reactive.since then she is taking Tenofoiv B .

    Result 2015 Dec
    DNA below detection point
    ALT 50 U/L
    AST 117 U/L
    ALBUMIN 3.2 g/dL
    Globulin 4.41 g/dL
    Alkaline Phosphatase 174 U/L
    GGT 70 U/L
    HBeAg Negative
    Anti HBe Positive (value 0.01)
    PLT 42*10.e 3/ul
    MPV 13 fl

    2016 December

    Moderate Ascites
    Ch.Parenchymal liver diisease with moderate
    Serum Albumin 2.5 g/dl

    My concern is that doctors has advised to stop Tenofoivr B and advising these medicines Aldactone (100mg),VEDICAR (Carvedilol) 6.25mg.amd polymalt and Cefim(cefixime)400mg..
    As she is so weak now ..and doctor said we need to monitor and changed her all medicine now..
    Any suggestion you recommend now

    1. Hello: Your mother is suffering serious liver damage, is she seeing a liver specialist who has experience with hepatitis B?
      There is a possibility she is coinfected with hepatitis B and D, which can accelerate liver damage. Continuing her tenofovir treatment may keep her hepatitis B viral load undetectable, which is helpful.
      Where do you live? We have a list of hepatitis B experts at http://www.hepb.org/treatment-and-management/physician-directory/
      Please review the list and see if there is someone near you. Good luck.

  21. Hi, i have just started taking enticavir a month back. My SGOT and SGPT went very high, ( 80 and 112). I started taking the medicin every night , 2 hours after dinner,the reason being i take my Thyroid tablet in the morning. since both have to be taken on an empty stomach, it is becoming very difficult to take the enticavir at night on the days i go out for a dinner, as it usually gets late for eating. can i take the enticavir with my thyroid tablet, or is it ok to take withih 30mins of eating food.

    1. Hello: You will have to talk to your doctor to see if it’s safe to take entecavir and your thyroid medication at the same time. Here is a webpage that examines drug interactions with entecavir: https://www.drugs.com/drug-interactions/entecavir.html
      Entecavir is usually taken at least two hours after a meal or at least two hours before the next meal. If you find you cannot take entecavir and the thyroid drug at the same time, perhaps you could start taking entecavir two hours before you eat, so dining out will not affect your schedule?
      Good luck.

  22. Sir, I am recently diagnosed HBsAg +ve.
    My test results are as below:
    SGOT 24, SGPT 34
    HBeAg Negative, Anti HBE +ve
    Liver scan (ARFI) Normal
    PCR 1790 IU/ml.
    Father is also HbsAg +ve but his latest viral load is NIL.
    Kindly guide me.

    1. Hello: It appears that you have “inactive” hepatitis B. Your liver enzymes (SGPT) are not elevated, and your viral load (HBV DNA or PCR) is quite low. You do not need treatment at this time, however it is very important that you continue to be monitored at least once a year. Hopefully your father is also monitored regularly. Also, avoid alcohol and cigarettes, practice safe sex, and make sure all of your family members are tested and vaccinated if needed. Good luck.

      1. Thanks for feedback.

        I have come across one lab from South Africa who provide herbal medicine and they are claiming to completely eliminate HbsAg within two months. The are charging USD 450 for medicine.
        What is your advice in this regard.
        Thanks.

      2. Sir, recently I went through one research article where it was stated that doctors consider treatment for HbeAg -ve patients even when there viral load is slightly elevated (> 10^4 copies) and SGPT/ ALT> 30 IU/ml.
        My test results also show I am exceeding these limits (PCR 1790 with multiplying factor 5.82 = 10417 copies/ml and SGPT 34) but my doctor has not recommended treatment (ARFI normal. However, he has recommended liver biopsy if viral load increases. I am worried if I am fit candidate for treatment. You also have stated that I seem to have “inactive” hepatitis B.
        I am confused how they differentiate between “inactive” hepatitis B and person suffering active liver disease.
        Is there any benchmark to confirm the status.
        Thanks and regards.

        1. Hello: Your viral load (HBV DNA) is moderate at 1,790 IU/mL and your liver enzyme test (SGPT) result of 34 indicates your liver is healthy. Medical guidelines recommend treatment only if your liver enzymes are above normal (or an ultrasound shows liver damage) and your viral load exceeds 2,000 IU/mL (or 11,200 copies/mL). Your doctor will continue to monitor you carefully in the event your hepatitis B becomes “active” and you have signs of liver damage. Good luck.

          1. Sir,

            Two more questions:
            1. Can hepatitis B be transmitted through mosquito bite?
            2. Is there any way out that Hep-B +ve patient can have children without transmitting virus to partner.

            Regards.

          2. Hello:
            There is no scientific proof that mosquitoes can transmit hepatitis B.
            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 (HBsAb) 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 antibody 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.
            Good luck.

  23. Hi,
    I’m Male, 27 years old. I have been diagnosed with HBS Antigen – Reactive last March 4 during blood screening before donating blood. I’m really shocked because I don’t feel anything wrong with my health no any symptoms at all, after some research I justified that I have chronic Hep B. My first lab test was

    SGPT= 38
    HBV DNA = 12414 IU/ML
    Ultrasound shows fatty infiltration of the liver

    no other tests done yet..Do I need treatment with these values? My doctors’ first impression before those test was I’m healthy carrier ( I really wish I am). I haven’t talk to him yet, perhaps this afternoon.

    1. Hello: I assume you have tested positive for the hepatitis B surface antigen (HBsAg) for more than six months now. Your liver enzyme test (SGPT) is 38, which is in the normal, healthy range. When our liver cells are damaged by fatty liver or hepatitis B, they release SGPT into the blood stream.
      Your viral load is rather high, but does not require treatment because you have no signs of liver damage.
      Continue to be monitored, eat healthy foods and try to lose some weight, and of course avoid alcohol and cigarettes.
      A combination of both fatty liver and hepatitis B can accelerate liver damage. You are right, you are healthy now and you want to stay that way! Good luck.

      1. Hi, thanks so much for the reply, with my HBV DNA being high should I expect it to be lower next time (with hopes on my antibodies work their way against viruses). With these HBV values am I too infectious to transmit HVB to my family? I’m quite not satisfied with my doctor because he didn’t advise me to take full HBV panel thing or even test if I have HBeAg. What do makes HBV DNA being high / low? I’m not really into smoking (never smoke once in my life) and drinking alcoholic beverages.

        1. Hello: It is impossible to predict what will happen to your viral load (HBV DNA).
          Your family should be tested and vaccinated against hepatitis B, and you should be careful not to share anything that has contact with blood and body fluids, such as toothbrush, nail clippers, or personal jewelry.
          Please continue to lead a healthy lifestyle and getting monitored regularly. Good luck.

          1. thanks again, by the way..I read back your first reply that you assumed i’m tested for HbsAg reactive for more than 6 months..it’s not, I’m just tested positive just last March 4, 2017 then I’m tested for SGPT/ALT and HBV DNA last March 6, 2017..I’m not tested yet for other markers like HBeAg etc (I thinks its because my doctor assumed I’m healthy carrier, tho I want more test to make it sure). . so should I still hope that I would get cleared of the virus after 6 months? or If I got this since birth does my initial results looks good (for having the virus for more than 20yrs)

          2. Hello: Unfortunately, you will have to wait the six months to find out if it’s chronic or acute. If your viral load is low and your liver tests are normal, and it turns out that you have chronic hepatitis B, then yes it is good to have “inactive” hepatitis B that is not harming your liver. Good luck.

  24. Hello i have my result of HBV DNA 35 copies/ml (5.9IU/ml) the liver is normal and the ALT is slightly elevated to 79. I want to lower my viral load or undetectable now i take viread tenofovir for two weeks. It is possible to lower in two weeks?

    1. Hello: Medical guidelines recommend treatment ONLY if you have signs of liver damage (such as elevated ALT, which you have) and a high viral load, which you do not have. Your viral load, at 5.9 IU/mL is already close to undetectable. There is no reason to take antivirals to further reduce it. Is there another reason why your ALT levels are slightly elevated? Do you drink, have fatty liver or take over-the-counter painkillers such as acetaminophen?
      Please talk to your doctor to see if treatment is warranted at this time. Good luck.

      1. Hello,

        My liver is normal and i don’t have a fatty liver i’m done my test of my(Liver CC 11.4cm, AP 9.7cm. also i don’t drink anykind of alcohol and i don’t take any painkillers. What should i need to do with my result 5.9 IU/mL to be undetectable? ALT/SGPT 74. my company doctor like this result to be undetectable so i can work again. need your further advice. thank you

        1. Hello: There is no drug or cure that will make your hepatitis B surface antigen (HBsAg) disappear. You can have a healthy liver with low viral load, and still be HBsAg-positive.
          Your ALT/SGPT is 74 which is a little above normal and does indicate some liver damage. Please keep getting monitored and lead a healthy lifestyle. Good luck.

  25. Hi,
    My father has 48 years old and have hbsag-postive
    Hbeag – non reactive
    Shot – 38
    Sgpt – 22
    Hbv DNA viral load – 4711 iu ml
    When I consult my doctor,he replied no need further treatment now after 3 months need to test liver function test..
    So kindly reply me..

    1. Hello: Medical guidelines do not recommend any treatment unless you have liver damage, and your father’s liver enzyme (SGPT) of 22 is within the healthy range.
      As your doctor recommends, make sure your father continues to be monitored, and that he avoid alcohol and cigarettes, and leads a healthy lifestyle.
      Good luck.

  26. Please help, my test result:25/2/17
    HBD-DNA 700000 cops/ml
    PCR hep b quant 2318 iu/ml
    pCR HEP B VIRUS QUANT LOG 12.1 log, prothrombim time 17, pTK 47, TOTAL BILIRUM 16, conj bilirubin 5, alkaline phosphate 72, sgot 17, sgpt 14, Tsh 6, total protein 70, albumin 35,
    my doctor recommended tenofovir and heptovit. Iv been on it for 2months now. Sometimes i feel dizzy, mild abdominal pain & tiredness. Pls advise me, tnx

    1. Hello: Current medical guidelines recommend treatment with antivirals, such as tenofovir, ONLY if you have a high viral load and signs of liver damage, indicated by above normal liver enzymes (SGPT) or signs of liver damage identified in an ultrasound of the liver.
      You have a moderate viral load and NO signs of liver damage, based on what you indicated. Did your doctor want you to start treat because of some other medical condition, or because you have a history of liver cancer in your family?
      Also, be aware that there is no clinical evidence that herbal supplements (such as the heptovit recommended by your doctor) cures hepatitis B or protects your liver.
      Please talk to your doctor about whether you should continue treatment. You could review the World Health Organization’s guidelines for hepatitis B monitoring and treatment at: http://www.who.int/hiv/pub/hepatitis/hepatitis-b-guidelines/en/
      Lastly, it is unusual to experience abdominal pain from hepatitis B because there are very few sensory nerves around the liver, and those symptoms are not commonly associated with antiviral treatment. Make sure you discuss those symptoms with your doctor in the event they are the result of stress or a different medical condition. Good luck.

  27. Thanks, I’ll discuss this with my doctor but pls, i been on these pills for 2mnths now, what are the likely consequence if i stop d anti-viral pill, knowing fully well that once u start you cannot stop.? I hav no history of liver cancer or undoing treatment for any ailment, I am really confused and troubled

  28. Initially i wasn’t having any pain in my abdomen or dizziness or tiredness not until i began takin d drugs ,…pls i’ll be grateful with ur professional advise

  29. Hi. Please help my cuurrent HBV DNA is 295 IU/ml. My ASAT is 19 u/l, ALAT – 12 u/l, GGT – 13, Alk Phosphatase – 98 u/l. E antigen is negative,hep B surface Ag S/Co – 4767, Core IgG antibody -11,anti-HBs-0.74,
    My DNA previous times was under 10 but now is 295. My fibroscan result is normal 3,3-0.8; CAP- 287.
    What do you think anout this result?

    1. Hello: Viral load (HBV DNA) needs to increase substantially, such as 100-fold, to be clinically significant. An increase from 10 to 295 is not large.
      Please continue to be monitored regularly. I’m glad your liver shows no damage. Good luck.

  30. Hi. Before getting intimate with my boyfriend we tested for many things all results came back negative except positive for hbv on his side. He paid for me to get vaccinated against Hbv however after completing my third dose I took an immunity test and my results are 1000u/l. Dr said I was safe but if I engage sexually with him how is my safety guaranteed. Since every time he does a viral load it shows replication of the virus?

    1. Hello: As long as your hepatitis B surface antibody (HBsAb) level is higher than 10 mIU/mL, it means you are permanently protected against hepatitis B. You are protected against infection. However, if you have concerns, you should practice safe sex (use a condom), which protects you against a variety of sexually transmitted diseases.
      Eventually, if you choose to marry and want to have children and have unprotected sex, you will be protected against infection.
      Good luck.

  31. Hi,
    My doctor put me on Truvada in November 2014 when my HBV DNA was 434,000,000 IU/ML and my HBSAg was 5,000 IU/ML. In 2016 my HBV DNA was <20 IU/ML and HBSAg was 500. I did a lab test again last week and saw that my ALT is gone up to 87 from the previous 52. HBV DNA is now 130 IU/ML while the HBSAg has risen to a whopping 13780 IU/ML.

    What is happening? Is a viral remission occuring? Is truvada (which contains tenofovir) no longer works against HBV? Please help!

    1. Hello: That is unusual. I recommend that you get tested for hepatitis D, which is a coinfection with hepatitis B and D. The hepatitis D virus needs the hepatitis B surface antigen (HBsAg) to replicate. Unfortunately, antivirals used to treat hepatitis B are not effective against hepatitis D.
      For more information about hepatitis D, please visit: http://www.hepb.org/research-and-programs/hepdeltaconnect/
      Also, Truvada is effective against hepatitis B, but the two leading antivirals recommended for hepatitis B is tenofovir and entecavir. However, neither of those drugs are effective against hepatitis D.
      Good luck.

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