Hep B Blog

Why Won’t Doctors Treat Young Adults with High Viral Load and No Signs of Liver Damage?

Image courtesy of Graur Razvan Ionut at FreeDigitalPhotos.net.
Image courtesy of Graur Razvan Ionut at FreeDigitalPhotos.net.

If antiviral medications almost always lower viral loads, why don’t doctors treat young adults with high viral loads with this daily pill? After all, don’t high viral loads lead to liver damage and even liver cancer?

This is one of the most common questions posed to the Hepatitis B Foundation, and at first glance the decision not to treat a high viral load with antivirals seems counter-intuitive or plain wrong. If antivirals reduce the number of hepatitis B virus (HBV) in the body, won’t that give the immune system an opportunity to clear out the remaining residual HBV?

Unfortunately, it doesn’t work that way. It’s complicated, as are many aspect of hepatitis B.

It’s common for young adults (up to age 30) who live with hepatitis B to be in the “immune tolerant” stage of infection with extremely high viral load (HBV DNA) but with no signs of liver damage.

When we’re born to mothers infected with hepatitis B, unless we’re immunized at birth 90 percent of us become infected from exposure to infectious blood and body fluids during delivery. And when infants are infected, their immature immune systems don’t recognize the virus. The young immune system misses the “red flag” signature on this hepatitis B virus and “tolerates” the infection instead of attacking it.

In contrast, when we’re infected as healthy adults, our immune systems immediately detect and identify hepatitis B as a viral invader and aggressively attacks the virus and any infected liver cells. In adults, it generally can take up to six months for the immune system to eradicate the virus. When we’re infected as children, it can take up to three or even four decades for our immune systems to notice the virus and shift into “immune active” battle mode.

Until the immune systems notice the virus and begins to fight the infection, children and young adults remain in the “immune tolerant” stage, with sky high viral loads that can reach 1 billion international units per milliliter (IU/mL). Unencumbered by an immune system that’s on the offense, the virus hijacks liver cells to replicate and churn out more virus.

Because the immune system isn’t attacking and damaging the infected liver cells, liver tests (ALT or SGPT) results show no signs of damage and usually remain in the normal range (30 or less for men and 19 or less for women). And until our immune systems wake up and launches its attack, doctors say there is no reason to try to lower the viral load in these young adults because even when antivirals lower viral load, the immune system stays dormant and doesn’t go on the offensive.

Experts recently re-examined whether this hands-off approach was still valid and reviewed more than a dozen studies that examined whether antiviral treatment benefited immune-tolerant adults.

At the November 2015 AASLD Liver Conference, researchers reported, “There are no studies demonstrating that antiviral therapy is beneficial in reducing rates of liver cancer, cirrhosis, and liver-related death in persons with immune-tolerant chronic hepatitis B.”

Following their instruction to “first do no harm,” the experts recommended, “Given the lack of evidence of benefit to those with (high viral load and normal ALT levels), the potential harms of finite (or longer) antiviral therapy, including cost, antiviral drug side effects, and development of resistance, outweigh benefits.”

Let’s explore their rationale:

  • Antivirals work for only as long as you take them. Once started because of liver damage, patients can be on them for many years, and when patients go off antivirals, they often experience a “flare” with a sudden increase in viral load and ALT levels that can be dangerous.
  • The leading antivirals, including tenofovir (Viread) and entecavir (Baraclude), are not cheap, especially tenofovir which is not yet available in a generic formula.
  • And antivirals have side effects, which can include bone loss, impact on kidney function, and a risk of developing drug resistance.

So, if treatment will not yield good results, why put young adults through the cost and medical risk? In fact, experts don’t even treat immune-tolerant patients who have family members with hepatitis B-related liver cancer.

The experts did make clear that all immune-tolerant patients should have their ALT levels and viral load checked at least every six months so doctors could monitor their infection.

Still, this is challenging to hear when we are living with hepatitis B or just recently diagnosed with a chronic infection. We want to do something to fight the infection. But without an active immune system as a strategic partner in our fight against hepatitis B, we must be patient and let go of a quick-fix hope, as much as we all want a magic pill to cure our infection.

So in the interim, until our immune systems wake up and starting fighting the virus in our bodies, we do what we can to protect our health, including eating healthy foods, avoiding alcohol and cigarettes, and getting monitored every six months. It may not feel like it’s enough, but for now it’s all we can do.

 

 

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57 thoughts on “Why Won’t Doctors Treat Young Adults with High Viral Load and No Signs of Liver Damage?”

  1. My HBV DNA is 38 IU/mL and ALT is 14. The HBeAg is negative. Is it wise to take tenofovir to start mediation. Please advise me.

    1. Hello: Your viral load (HBV DNA) is low and your ALT level is normal, which indicates there is no sign of liver damage. You do not need any treatment at this time. Many people live long and healthy lives with hepatitis B and never need treatment. Remember to eat healthy food, avoid alcohol and cigarettes and practice precautions. Good luck.

  2. I am a Registed Nurse and was diagnosed with reactive Hep B …my other siblings were diagnosed as well..I was devastated knowing that thos condition will affect our liver and even my job..because of this condition I quit my job and forgot that I am a health worker..I’ve been doing some reading and reaserching if there is hope on this condition..if only a person or an organization can enlighten me..and help me get rid of this …I would owe my life to them…please help us..thank you..

    1. Hello: First, just because you have hepatitis B is no reason to quit your job as a nurse! The CDC and other organizations have issued rulings and recommendations that being infected with hepatitis B does not prevent you from a career in health care. Let us know if you need documentation about this. Experts predict that they will find a cure for hepatitis B in the next several years. In the meantime, there are very effective antiviral treatments available if patients have high viral loads and signs of liver damage, indicated by elevated ALT levels. Good luck!

  3. People with chronic hepatitis b with low viral loads o undetectable but who have received a mutation, how does treatment help them since it acts by stopping viral replication

    1. Hello: I’m not sure I know how to answer your question. Generally if you have a low viral load, it means the virus are not replicating very rapidly, no matter if a mutation is identified or not. Usually, individuals do not require treatment if their viral loads are low unless they have other signs of liver damage. Please talk to your doctor. Good luck.

  4. I am 22 year old Female. What is my condition of Hepatitis B please explain. What should i do?
    HBsAg ELISA reactive
    HBsAg (Rapid) reactive
    HBeAg Rapid Non reactive
    LFT
    Billirubin T 0.6 mg% 0.3-1.4
    Billirubin D 0.3 mg% 0.0-0.4
    Alkaline Phosphatase 80 male 53 -128 U/L
    Female 42-141 U/L
    Child 54- 369 U/L
    SGPT 16 Male Upto 42 U/L
    Female Upto 32 U/L
    SGOT 22 U/L 0-37

    1. Hello: As long as you test positive for the hepatitis B surface antigen (HBsAg), you are infected with hepatitis B. I don’t know your viral load (HBV DNA) but because you test negative for the hepatitis B “e” antigen (HBeAg) the amount of virus in your body is probably low. The great news is your SGPT level is normal. SGPT (also called ALT) is a liver enzyme that liver cells release when they are damaged. Your SGPT levels are normal so it appears you are healthy and do not need treatment, though of course only your doctor can diagnose you. Keep getting monitored regularly, eat healthy foods and avoid alcohol and cigarettes. Good luck.

  5. My HBV DNA is 6.15×10*2(615) IU/mL and ALT is 13. The HBeAg is negative. Is it wise to take tenofovir to start mediation. Please advise me and my family members also have HBV but my two sister & brother take HBV vaccine when they born.can our HBV harm them ?

    1. Hello: As long as your family members do not have direct contact with your blood or body fluids, they are safe from infection, especially if they were immunized at birth. Your viral load is not high, and your ALT level of 13 shows no signs of liver damage. ALT is an enzyme released by damaged liver cells into the blood. Normal ALT levels are 30 and less for men and 19 and less for women. Talk to your doctor, however medical guidelines do not recommend treatment unless your viral load is elevated and your ALT indicates liver damage. Good luck.

  6. HBcAb… positive
    HBsAg….. positive
    HBeAb…. positive
    HBeAg…. Negative
    HBsAb….. negative

    January 2015
    Hbv DNA copies….. 192 cp/ml
    hbv DNA………. 33 iu/ml

    February 2016
    hbv DNA copies…… 7898 cp/ml
    hbv DNA…………….. 1357 iu/ml
    that is my sister’s results. please help me educate her and what she should do. she is very devastated. 29 years.

    1. Hello: I believe you are asking about the increase in her viral load (HBV DNA) over the past year. Viral loads can vary over time, and the increase is not alarming — though of course only her doctor can tell for sure. One lab test you did not include is her ALT level. ALT (also called SGPT) is an enzyme released by damaged liver cells into the blood. Normal ALT levels for women is 19 and under. Doctors generally look at a person’s viral load and ALT level, among other factors, when evaluating a patient. It would be good to know if her ALT level has stayed steady over the past year, or if it has changed along with her viral load. Your sister may want to monitor both her viral load and ALT regularly too look for any change. Thank you.

  7. Hello sir
    During pregnancy check up my wife diagnosed positive for hep b
    In the mnth of sept she is done with the test
    Hbsag positive
    Hbeag positive
    Anti hbc igm result was 0.18
    Hbv viral load >170000000

    Without taking any antiviral she again did some test in the mnth of Feb 2016
    Here are the results
    Lft was nrml
    Rft nrml
    Hbv viral load >10000000
    Plzz guide she has acute or chronic hep b liver is nrml found by sonography

    1. Hello: It appears the two tests were six months apartment, and because she tested positive for the hepatitis B surface antigen (HBsAg) both times, it probably means she has a chronic infection. What is very important is that her viral load is quite high, and therefore she is at high risk of infecting her baby when it is born. Please make sure when she gives birth, that the baby is immediately immunized with the first hepatitis B vaccine dose within 12 hours, and is also given a dose of HBIG (hepatitis B antibodies). Also, if she is still pregnant, she should be given antivirals to lower her viral load before delivery. This also reduces the risk that the baby will be infected. Please contact her doctor as soon as possible about this. You can refer her doctor to new medical guidelines at http://onlinelibrary.wiley.com/doi/10.1002/hep.28302/full this explains the need for antiviral treatment in pregnant women with high viral loads. Good luck.

  8. Hello,
    This is my result as Feb 2016
    HBs Ag= +ve
    ant-HBs= -ve
    HBe Ag =-ve
    Anti-HBe=+ve
    Anti-HBc=+ve
    HBV DNA= 1.16 x 10^10
    ALP=51
    ALT=16
    AST=28
    Bilirubin:
    Total=18
    Direct=7
    SERUM PROTEIN:
    T/Protein=64
    Albumin=45
    Globulin=19

    1. Hello: Because you have tested positive for the hepatitis B surface antigen (HBsAg), it means you are currently infected. The good news is you have developed the hepatitis B “e” antibody and your ALT level is low. (Healthy ALT levels, which mean you have NO liver damage, are 30 and under for men and 19 and under for women. I’m not sure I understand your viral load (HBV DNA) so I cannot comment on it. Please continue to get monitored regularly, eat healthy foods, and avoid alcohol and cigarettes. Good luck.

  9. I was born in Korea in the 60’s where Hepatitis B was a common diagnosis. My mother was infected when I was born, infecting me during the process. I really didn’t know I was infected until I got really sick in 2011. Went through interferon treatment for 48 weeks where my viral load lowered from 55 million to under 10 thousand. Doctor said my treatment failed since the virus was still present and my body never developed antibodies. I believe it has flared up recently as I’m feeling the similar symptoms as before. Your explanation abt why they don’t treat young adults made more sense than anything anyone’s ever said to me. I would love to hear your thoughts on what options there are for someone like me (reaching 50) with the previous “failed” treatment. Thanks!!

    1. Hello: Is interferon the only treatment you’ve received? The other very effective treatment is an antiviral, which is a daily pill that prevents the virus from replicating in the liver. Medical guidelines recommend two antivirals: tenofovir (Viread) or entecavir. Antivirals will quickly lower your viral load, which is important for someone like you who has had a detectable/high viral load for many years. Are your ALT/SGPT (liver enzymes) normal or above average, indicating liver damage? If you have elevated ALT/SGPT levels (more than 19 in women, and above 30 in men) and a viral load above 2,000 IU/mL, then you may have HBeAg-negative hepatitis B. This results from a mutation in the hepatitis B virus and can lead to accelerated liver damage, so it’s important to get treatment if you are in that situation.
      Is your doctor experienced in treating hepatitis B? If you feel you want to consult with a hepatitis B expert, we have a list of liver specialists familiar with hepatitis B at http://www.hepb.org/resources/liver_specialist_directory.htm
      Good luck.

  10. Yes, interferon is the only treatment I had. The gastroenterologist who was treating me wouldn’t let me take the antiiviral pills…I didn’t like him but didn’t have a choice at the time (2011). Had a liver biopsy then and the damage was minimal. I’ve not checked my ALT for awhile as I’ve had no insurance coverage for last few years. I’m hoping that situation will change soon. Thanks for your advice!!

  11. Hello, I am 34 years old male.
    This is my result:
    9/2010: GOT 35, GPT 41, HBsAg-pos; HBeAg-neg, AFP- neg, untrasound: normal
    9/2011: GOT 20, GPT 27, GGT 19; HBsAg-pos; HBeAg-neg; Anti-HBe neg
    4/2012: GOT 18, GPT 28, GGT 18; HBsAg-pos; HBeAg-neg; Anti-HBe neg; HBV-DNA 1240 copies/mL; untrasound:normal
    10/2012: GOT 22, GPT 24, GGT 19; HBsAg-pos; HBV-DNA neg; AFP 4.76
    1/2013: GOT 21.6, GPT 23.4, GGT 17
    6/2013: GOT 19.4, GPT 25.6, GGT 14.2
    12/2014: GOT 23.4, GPT 39.2, GGT 17
    1/2015: GOT 25.8, GPT 38.5, GGT 20.8; HBsAg-pos; HBeAg-neg; Anti-HBe pos, AFP 6.27; untrasound: normal
    9/2015: GOT 29.0, GPT 35.4; HBsAg-pos; Anti-HBs neg; HBeAg-neg; Anti-HBe pos (0.074); HBV-DNA 5790 copies/mL; AFP: 5.3
    5/2016: GOT 27.7, GPT 30.4; qHBsAg: 382.3; HBeAg-neg; Anti-HBe pos (0.069); HBV-DNA 52200 copies/mL; AFP: 4.83
    The recent result in 5/2016 with high level HBV-DNA; due to the uper limit for GPT of the Lab is <41 UI/ml; GOT < 40 UI/ml; my result was concluded with normal GPT (or ALT), and not to treat now.
    Please help me to explain; should I start NA treatment
    thank you

    1. Hello:
      According to medical guidelines, anyone who is HBeAg-negative and has a viral load exceeding 2,000 IU/mL (equal to about 3,400 copies/mL) and an elevated SGPT/ALT level should be treated.
      Many people infected at birth and who remain infected into their 30s, 40s or 50s, 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.
      Your rising viral load, from 5,790 to 52,200 copies/mL suggests you may be developing HBeAg-negative hepatitis B. However, your ALT/SGPT has remained normal. Do you know if you are at high risk of liver cancer? Have any of your immediate family members had liver cancer that you know of? If you are at high risk of cancer, medical guidelines recommend frequent screening and starting treatment.
      Talk to your doctor. If you live outside of the U.S., the World Health Organization has published hepatitis B treatment guidelines at http://www.who.int/hiv/pub/hepatitis/hepatitis-b-guidelines/en/ that you may want to review with your doctor. Good luck.

  12. Thank you for your prompt response, I’m so sad to know my situation. There was none of my immediate family members who had liver cancer. I’m not sure if I am at risk of liver cancer or not. Should I take Fibrotest, Actitest, untrasound (or liver biopsy?) immediately? After that deciding to start treatment regardness of ALT?
    I’m living in Vietnam

    1. Hello: In the U.S., medical guidelines recommend being more aggressive with treatment if there is a family member with liver cancer, which is why I asked about your family history. An ultrasound or Fibrotest would be helpful to your doctor in deciding whether to start treatment soon, or wait for your next round of lab tests. Your normal ALT/SGPT levels means you don’t have to rush into treatment. Review the WHO guidelines with your doctor and at the very least continue to get monitored every six months or whatever your doctor recommends for ALT/SGPT and viral load so you and your doctor can make an informed decision. Good luck.

  13. I’m sorry, I have just got the information that my grandmother died by liver cancer so I am so confured. Please instruct me

    1. Hello: Assuming she died from hepatitis B-related liver cancer, it means you may be at high risk of liver cancer yourself. Please share that information with your doctor when you discuss your treatment options. And, make sure you are tested for alpha fetaprotin (AFP) and do get a liver ultrasound test so you and your doctor can make informed treatment decisions. Good luck.

    1. Hello: SGPT (also called ALT) is a liver enzyme that liver cells release into the bloodstream when they are damaged. Healthy SGPT levels for men are up to 30, and for women they are up to 19. Keep in mind each lab has its own “healthy” ranges, and some call 40 or 50 healthy. Please consult with your doctor about your SGPT levels to determine if you require treatment. The doctor will take into consideration your overall health, age, gender, and family history of liver cancer when making a treatment recommendation. Have you had a viral load (HBV DNA) test? This can provide additional information about your hepatitis B status. Good luck.

  14. hello sir,
    am 34years. Am a lab technician am working in lab.
    2012 feb
    hbsag positive.
    hbeag positive.
    lft normal.
    hbv viral load 21000 iu/ml.
    anti hbs non reactive.
    2014 aug
    hnsag positive.
    hbeag negative.
    lft normal.
    hbv viral load 4100 iu/ml.
    anti hbs. not done.
    2015 oct
    hbsag weakly positive.
    hbeag negative.
    lft normal.
    hbv viral load 219 iu/ml.
    anti hbs not done. what is my condition. I have 2 yrs old baby he had immunisation immune globulin & hep b vacc 3 doses completed. is he safe from hep b sir. pls help and guide me. also I can’t continue tablet.

    1. Hello: It appears over the years your hepatitis B infection has become less active. Your viral load (HBV DNA) has declined markedly to almost undetectable levels, and you’ve lost the hepatitis B “e” antigen (HBeAg), which shows your immune system and its antibodies are trying to get rid of the hepatitis B antigens. Also, your liver is healthy.
      Are you taking an antiviral or under any treatment at this time? Are you saying you can no longer continue treatment (tablet)?
      I’m happy to hear your child was vaccinated and received immune globulin. The only way to confirm that he is not infected is to get him tested for the hepatitis B surface antigen (HBsAg) and antibody (HBsAb). That’s important to know, so you don’t have to worry. Good luck.

  15. hello sir. thank u so much and happy to your positive replay. in one year old my son’s blood checked hbsag negative. again may I check his blood sir? sorry to say I discontinued my tablet 1 year back sir. what will I do?

  16. hello sir
    13/2017
    hbsag elisa-3080 reactive.
    lft normal.
    is this very high sir?
    will check hbv viral load sir?
    Please guide me. thank you.

    1. Hello: The key things to get tested is your viral load (HBV DNA), that will give you a sense of what stage of hepatitis B you are in, and how often you should be monitored. Have you been tested for the hepatitis B “e” antigen (HBeAg) or “e” antibody (HBeAb) yet? That is another valuable tool for your doctor to know what stage you are in. Good luck, I am glad you liver is healthy.

  17. Hbv viral load is 110,000,000 sgpt/alt norml ultra sound in the liver normal does it need treatment for viral load hope for your reply good bless.

    1. Hello: It sounds like you are in the immune-tolerant stage of hepatitis B.
      When we are first infected, we often have lots of hepatitis B virus (HBV) in our bodies that are rapidly replicating in our liver. When we’re infected as newborns or children, our immature immune systems don’t recognize or fight HBV, instead it “tolerates” the infection. During this immune-tolerant phase with rapid HBV replication, we usually test positive for the hepatitis B “e” antigen. (I didn’t see that listed in your report.) This stage can last a few years or even into our 30s or 40s. Eventually, our immune system notices the infection and starts generating “e” antibodies (HBeAb) to eradicate the “e” antigen, and we move out of the immune-tolerant stage.
      We can transmit hepatitis B through our blood and body fluids as long as we test positive for the hepatitis B surface antigen (HBsAg). Our chance of spreading it is higher when we’re HBeAg-positive and have lots of HBV in our blood, as you do.
      One more note, the reason your liver enzymes (SGPT/ALT) are normal despite all of the virus in your body is that your immune system hasn’t noticed the virus and begun attacking the infected liver cells. Over time, that will happen.
      So eat healthy foods, avoid alcohol and cigarettes, and make sure you practice safe sex so you do not infect your sexual partners.
      Also, please make sure your family members have all been tested for hepatitis B and vaccinated if needed. Good luck.

      1. Thank you for ur response this are my hep profile. Anti-hbc igg 0.008/1.0 reactive. Hbeag 2520/1.0 reactive anti-hbc igm 0.116/1.0 non reactive anti hbe 7.17/1.0 non reactive my doctor said that i have to take my viral load test so and i need to take treatmnt to slow down my viral load and become not infectious with the others for wht i understnd in ur page if should start my treatment but my sgpt/alt is normal and i will stop it my liver become damage i want to know if i need treatment because im going to see my doctor nextweek for my viral result and what is the explanation of my hep profile please help me godbless

        1. Hello: I have little knowledge about hepatitis C, but there is a chance you are newly infected with hepatitis C, and could be coinfected with hepatitis C and B. You need to see your doctor and get retested for hepatitis C in a few weeks or months to know for sure.
          Sometimes, when people have both viruses, it is the hepatitis C virus that becomes the dominant virus, reducing hepatitis B levels to almost undetectable. (See: http://www.hepb.org/what-is-hepatitis-b/hepatitis-c-co-infection/)
          Please consult with your doctor, and understand that treatment against hepatitis B will not be effective against hepatitis C. There is now a cure available for hepatitis C. Please talk to your doctor about what the next steps should be, and of course avoid alcohol and cigarettes.
          Good luck.

  18. Thank you for your answers!

    My dad and more are over 80 years of age.I am 30 and I was recently diagnosed with hepatitis B. Here is the break down of the lab test. some are still underway.

    -Unspecified viral hepatitis B without hepatic coma

    -Chronic viral hepatitis B without delta-agent.

    -Ultra sound: normal.

    -AST 65H

    -ALT 130H

    -HEPATITIS B SURFACE ANTIGEN: REACTIVE

    -Hepatitis be antigen: non reactive

    If I was infected by my parent as an infant, how have my parents lived so long without any

    liver disease? I don’t know yet whether they have virus or not, but if they do how is it possible to make it to 80 with that. I have a pretty healthy life and still don’t know how that happened and what step should be taken.

    I will see the doctor in 3 weeks to discuss what should be the best course of action.

    What is your take on this please.

    Than you so much again.

    1. Hello: Many people who have chronic hepatitis B live long and healthy lives, and your father is an example of this. He probably did not drink alcohol or smoke and led a healthy lifestyle.
      I am glad you are getting monitored regularly, and no doubt are taking good care of yourself. Also, congratulations on getting your family members tested and vaccinated, if needed.
      Your father’s ALT, at 130, is high (healthy levels for men range up to 30 to 40.) As people age, and their immune systems weaken, it’s not unusual to see viral load (HBV DNA) increase, along with signs of liver damage.
      You did not report his viral load, you may want to get that tested, and your doctor may recommend treatment. Current guidelines recommend either tenofovir or entecavir. I don’t know where you live or whether it’s available, but there is a new formulation of tenofovir on the market called Vemlidy or TAF. It reaches liver cells more efficiently, so requires a lower dose of tenofovir. This drug is recommended if people have experienced bone loss or any kidney issues, so if your father has osteoporosis (bone density loss) because of age, this might be a better option for him.
      I’m also glad he was tested for hepatitis D (delta agent), his doctor clearly is very knowledgeable about viral hepatitis.
      Good luck to you both.

      1. Thank for your response! I leave in the US, and the test result and description I presented earlier is not for my father but me. It was a misunderstanding. I brought up my parents in the comment to say that if I was infected during birth by my mom, she would be also infected, since 30 years and has never presented any sign of cancer. The only medication I have taken in my life is for stomachache since I was kid. I do take them very rarely. So I am scared that the new treatment (Vemlidy) may have side effects on my body since I am not used to medication. On over 30 test done for the checkup, only that one turned bad. It was a choc for me who has always taken care of my body. Isn’t it better to go do another test in 6 months to see if it has gotten better?

        1. Hello: I’m sorry I misunderstood. You could wait another six months. While your ultrasound of your liver showed no damage, according to your earlier post, your ALT is 130, which is high. Our liver cells release the enzyme ALT when they are damaged. Normal ALT levels range from 30 to 40. You can certainly wait another six months to see if your ALT level changes or improves. Also, have you had a viral load (HBV DNA) test? Antiviral treatment, which your doctor would probably recommend, lowers viral load. So, it’s an important piece of information to have when making a decision whether to treat. Keep up the good healthy lifestyle, and take care. Good luck.

          1. Thanks! my HBV DNA was very high 38,000,000H.
            That is probably why I was recommended to see a specialist. One think I am trying to figure out is whether I got it from birth or thru other means. by the way what is “Hepatitis be antigen”? Is it different from HEPATITIS B SURFACE ANTIGEN? I got those separated on the result test as listed above.

  19. Hi! My result are as follow. Hbv viral load is 88m my hbesag is positive my ast is 59 my alt is 64 and my Dr said I don’t need to take medication! Pls advice

    1. Hello: Your viral load (HBV DNA) is quite low, however your liver enzyme level at 64 is a little above normal, though not enough to require medication at this time. Do you drink alcohol or smoke? Please continue to be monitored and be careful about what you eat and drink. Good luck.

  20. Hello,I’m 25 years,a male and was diagnosed for HBsag for the first time on 23rd of Feb. 2017. Based on the following result,I was made to understand that my liver function is perfect. Please advice and interpret on the following result;
    Liver function test
    AST- 41 IU/I
    ALT- 17 IU/I
    Alkaline phos- 203
    Total bilirubin- <17
    FBC- normal level

    HBsag Profile
    1.HBsag- positive
    2.HBeab- negative
    3.Anti HBc- positive
    4.Anti HBsag- 5mill/ml
    5.HBeag- negative

    Viral Load-1687 IU/ml

    Pls,What's Anti HBsag-5ml/ml?

    1. Hello: When healthy adults are infected with hepatitis B, it takes about six months for their immune system to fight the infection. This is called an acute infection. The indication that you have cleared the infection is the disappearance of the hepatitis B surface antigen (HBsAg) and appearance of the hepatitis B surface antibody (Anti HBsAg). You must have at least 10 mIU/mL of the anti HBsAg to have successfully cleared the infection. So get tested again six months after your first test to find out if you have had an acute infection, and if you have cleared it. Good luck.

  21. Hello,I’m 37 years,a male and was diagnosed for HBsag for the first time on 15th June 2017 and HbsAg is positive. my liver function is perfect. And HBV DNA IS NO DETECTED. PLEASE ADVISE ME THIS IS CURABLE OR NOT

    Reply

    1. Hello: You may currently have “inactive” hepatitis B. This means your immune system is working hard to eradicate and contain the viral infection, to the point that you have very few hepatitis B virus in your body, and they are not hurting your liver.
      You must get tested again in six months to find out if this is an acute infection, or if you were infected during early childhood and have a chronic or long-term infection. If you continue to test positive for HBsAg, you should also get a test to see if you have experienced any liver damage regularly. Also, avoid alcohol and cigarettes, and eat a low-fat, well-balanced diet, and make sure your family is tested and vaccinated against hepatitis B.
      There is no cure for hepatitis B currently, however there are effective antivirals that lower viral load and reduce the risk of liver damage, if you ever experience liver damage.
      Researchers predict a cure should be developed in the next few years. Good luck.

  22. Hello, I am 35 male. I just checked my health and found that I am having:
    1. HBsAg: Positive (Index<1;S/Co<1;S/N<2;[<0.05UI/mL])
    I understand that I am having Hepatitis B. But I am not sure how serious it is. The docture said the liver is still good because of the below level of others:
    2. Anti HBs: Negative (<=10mUI/mL)
    3. SGOT (AST): 29
    4. SGPT (ATL): 36
    5. GGT: 30
    6. Bilirubin T: 3.4
    7. Bilirubin D: 0.6
    8. Bilirubin I: 2.8
    9. Albumin: 45

    The doctor here said it's just virus and the liver is not yet inflamed. Could you advice and give me some idea of the above result.

    Thanks.

    1. Hello: When you test positive for the hepatitis B surface antigen (HBsAG), it means you are currently infected with hepatitis B. Most healthy adults who are infected are able to get rid of the virus on their own within six months. This is called an acute infection.
      However, if you continue to test positive for HBsAg for longer than six months, it is considered a chronic infection. It means you were probably infected at birth or during early childhood, when your immature immune system could not fight it.
      Knowing whether your hepatitis B is acute or chronic will help you and your doctor determine your next steps. Please get tested again in six months to find out if it’s chronic or acute. If you are unsure of what your blood test results mean, please visit: http://www.hepb.org/prevention-and-diagnosis/diagnosis/hbv-blood-tests/
      Your liver enzyme SGPT/ALT at 36 is at the upper ranges of healthy. Healthy for men ranges up to 30.
      It is very important that you eat healthy foods, and avoid alcohol and cigarettes, which can contribute to additional liver damage.
      Please continue to be monitored regularly, and practice safe sex as you can spread hepatitis B. Good luck.

  23. Hello,
    I just had my health check and found that I have a positive Hepatitis B with the following information:
    1. HBsAg: Positive (Index<1;S/Co<1;S/N<2;[<0.05UI/mL])
    2. Anti HBs: Negative (<=10mUl/mL)
    3. SGOT (AST): 29
    4. SGPT (ALT): 36
    5. GGT: 30
    6. Bilirubin T: 3.4
    7. Bilirubin D: 0.6
    8. Bilirubin l: 2.8
    9. Albumin: 45
    I talked with the doctor and he said that I am having Hepatitis B virus. But my liver is not yet inflaming.
    Could you explain abit more how this result really is? What should I do next? The doctor made appointment again to check in September 2017. Your advice will be very much appreciated.

    1. Hello: When you test positive for the hepatitis B surface antigen (HBsAG), it means you are currently infected with hepatitis B. Most healthy adults who are infected are able to get rid of the virus on their own within six months. This is called an acute infection.
      However, if you continue to test positive for HBsAg for longer than six months, it is considered a chronic infection. It means you were probably infected at birth or during early childhood, when your immature immune system could not fight it.
      Knowing whether your hepatitis B is acute or chronic will help you and your doctor determine your next steps. Please get tested again in six months to find out if it’s chronic or acute. If you are unsure of what your blood test results mean, please visit: http://www.hepb.org/prevention-and-diagnosis/diagnosis/hbv-blood-tests/
      The results you provided indicate you are not experiencing any severe liver damage. When liver cells are damaged, they release the liver enzyme SGPT/ALT into the bloodstream. Healthy ALT/SGPT levels range up to abour 19 for women and 30 for men. Yours is 36, which could be within a normal range for labs (whose measurement of healthy can vary.)
      It is important for you to avoid alcohol and cigarettes, and eat healthy foods. Also, please continue to be monitored regularly.
      Good luck.

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