I'm so confused with my HBV DNA results

[confuseguy]

Can you guys tell me what #s am I suppose to look at?
Here is what the results report look like.

                                                   Value                Flag                Reference Range
HEPATITIS B DNA QNT PCT         4.0                    H                    < 1.6 log IU

**** Viral load result for HBV DNA is 9,450 IU/ML***        

1 IU/ML is 5 copies/mL.

My question is what does the 4.0 stand for? Is it the same as 9,450 IU/ML? so i have 47,250 copies/mL?

I quote, "The National Institutes of Health have suggested that viral loads that exceed 100,000 copies/mL are “clinically significant.” and "If the HBV DNA level remains below 200 IU/mL, that indicates an "inactive" carrier state of the infection."

So am I borderline for treatment?

It will probably be another month before I get to see a hepatologist. Is there anything I can do now to decrease my DNA level? exercise ? Can stress increase DNA level? Thanks.

[zellyf]

Its confusing, isn't it, with the switching from copies/ml to IU/ml?

There is no straight conversion from copies to IU or vice versa.  It varies from lab to lab and even at the same lab the conversion isn't straight.  It seems that 1 IU is equivalent to 2 - 5 copies.  You can ask your lab to convert it for you.

The guideline is like this:

For e-antigen+ CHB, consider treatment when viral load is: >100,000 copies/ml OR >20,000 IU/ml

For e-antigen- CHB, consider treatment when viral load is: >10,000 copies/ml or >2,000 IU/ml

You can't do much about your viral level.  You should try to have a healthy lifestyle.  No smoking. Probably no alcohol at least until you get your situation figured out and maybe longer.  I would not advise supplements at this time while trying to get some baseline labs.  No extra iron.  Exercise is good for the body in general and will support digestion which is good for the liver.  Stress probably has no direct impact on the virus but is not good for the body or immune system so is not at all helpful.

[zellyf]

Oh, let's consolidate all your questions/comments to this thread.  Everytime you start a new thread it bumps down someone else's question/concerns.  As you can see your question will get a response from one of us even if its within an existing thread.  Thanks.

[confuseguy]

I just read a research paper and it scare me very much. I thought that e negative is good but only if you have low or undetectable viral load. in my case, i am e negative but still have high viral load. they say my scenario have higher correlation with cirrohsis and liver cancer.

i thought that if there is serconversion, the virus replicate less, so what cause my viral load to still be high?

is it true that e negative and high viral load means i fall into the group of needing drug therapy for life?

[zellyf]

About 50% of CHBs end up with one of the muations in which case they will still have active replication but the virus cannot produce e-antigen.  Drug therapy for life is a possibility.  You need to do more reading about mutations.  Search the boards.

[confuseguy]

what does e-antigen do? how crucial is it to the virus's life?

[confuseguy]

is it possible that since i'm 27, i may have the blood test done at a time when seroconversion just happen to be finish and my viral load is still a little high. If i re-test in a year, the viral load will be low?

[zellyf]

You know I thought about that...I don't think its completely out of the question.

e-antigen is a protein attached to the virus.  It does help the virus replicate.  You typically don't get really high viral loads without it but you can get enough virus to do damage over a long period of time.  That's why docs like to control it.

Remember, Hep B is typically a slow moving disease...you have time to do some good research before taking any drastic steps.

[confuseguy]

thanks zelly,

i'm so depressed right now. i took a sick day off today.

i'm done alot of reading the whole day and it seems that there is 2 types. e antigen - (wild type) and e antigen - (mutant, pre/post core mutation).

i asked myself, gosh dang it, why do i fall into the mutation category. so i've been trying to fight off that anger the whole day, why me?

the e antigen - mutation patients have high viral load and require life time therapy with relapse of viral load up again if off therapy. this group of patients have a higher chance of cirrohsis and cancer. depressing...

my life just ***** so bad. i just want someone to come and tell me there's nothing wrong with me. go live life and don't worry, everything will be ok.

[zellyf]

Believe me, I know how you feel.  But I also belong to a HepB email list where many of the members have the precore or basal core promoter mutation...I think I probably have it too.  It doesn't change things that much, though, to tell you the truth.  50% of CHB end up with the mutation.  One guy has precore chronic Hep B and has 3 different kinds of cancers and he is still very active and upbeat.  When I think about him I have to say, "Dang, and here I just have CHB...I am so lucky."

[confuseguy]

I read your profile. Have you ever had any high viral load like mine? There's so many conflicting recommendations for treatment. Some recommend if it's > 100,000 copies/ml. others recommend if > 2,000 IU/mL along with confirmation of liver damage with biopsy and elevated ATL.

[confuseguy]

Is it possible to reacquire HBV even though I'm already infected but in a silent stage. For example, if I'm already e negative with undetectable viral load but then have unprotected sex with someone who also HBV. Since i'm not immune, she gave it to me and then now, I carry two strain of the virus, wild type which is already seroconverted, now another wild that has not?

[stevenNYer]

I think you should stop reading and take a break.  Your status won't change when you come back tomorrow or in a few days.  HepB is a complex disease and you won't understand it all in a few days.  Once you understand the concepts (not the specifics), it will make sense.  I've been where you are and it's no fun.

If you are 31 and your labs are accurate, it's likely you are in pretty good shape.  Your viral load and "e" status looks good.  I'm taking treatment trying to get to where you are now.  And who said you have a mutant strain?  Anxiety makes you jump to wrong or incomplete conclusions.  The only things you should do is tell your girlfriend via Meki's suggestion.  Let her in, especially when she's asking you to let her in.

And having HepB doesn't have to change your plans.  I have a good freind with is a doctor.  He also have HepB.  So HepB doesn't have to own you.

[zellyf]

No. That could not have happened.  The mutation is a not a strain.  Its the wild type that has mutated.  

Lots of other stuff you could have gotten from her though.  

[cajim]

http://www.medhelp.org/posts/show/458687

Hope this comparison calms you:  I am like you only a lot more than you.  Do what you need to take care of your liver and continue enjoying life.

Best wishes.

[confuseguy]

Thanks guys. It's just too much for me to absorb right now. It feels like a busy office of life. I missed the good times not so long ago :(

I'll see the hepatologist when they called me to make an appointment and we will go from there.

[confuseguy]

I read that the mean age for e coversion to negative status is 45 years in men. I'm only 27 , is that unusual? My viral load is 45,000 copies/mL right now, 1st ever test so I don't know what it was 1 year ago.

I'm really hoping that I don't have a pre-core mutation and fall into the e negative chronic stage where there is still high dna.

Is it possible that I have contracted another HBV variant (pre-core mutant) from another person after I already e converted and in inactive phase? Aren't we not immune so we can potentially be infected with another HBV genotype?

Or is it possible that I have just finish e seroconversion and the blood test just happen to catch it, that's why my viral load is still high. If I take another test 6 months later, maybe viral load will go down?

[cajim]

My doctor said the disease goes its course whether we worry or not.  As long as you are doing all that are sensible, logical, and reasonable, let your doctor, your lab tests, and your treatment deal with the HBV.  And you go find something enjoyable to do.

Best wishes.

[confuseguy]

Question about what I should expect to happen next. My primary already referred to a hepatologist. I'm just waiting for them to call me. That's how the health care system work. From experience, it usually takes at least a month to be seen.

A few questions:

1) So far, I have not had ALT, AST, biopsy, ultrasound measured for baseline. Is this something that the hepatologist might do first for me? Remember, I just got tested and I'm e ag-, anti-e ag +, ~45,000 copies/ml.

2) My primary said interferon is recommended but I'm already seroconverted so isn't the goal now anti-viral?

4) Does heavy strenuous weighlifting and exercise elevate AST? i read that ALT is primarily from liver whereas  AST is also secreted by other organs (heart, kidney, muscle). So I guess my AST level should be high which may not be attributed to Hep B but exercise alone?

[cajim]

Your lab results:

Hep B surface Ag= Reactive  =You carry HBV.
Hep B surface Ab = Neg =You are not immune.
Hep B core ab= reactive =You have previous or ongoing infection with HBV
Hep B core Ab, IgM = Negative =You do not have acute infection now.
Hep Be Antigen = Negative =You are not very infectious now
Hep Be Ab = positive =present temporarily during acute HBV infection or consistently during or after a burst in viral replication.
Hep B DNA QNT PCR 4.0 log IU or same as 9,450 IU/mL. =You have viral replication now.

1) ALT,AST, ultrasound for regular monitoring, maybe not biopsy.  

2) "I'm already seroconverted."  Consult your doctor to make sure.

3) Don't go to extremes is being friendly to your body and your liver.

4) See 3)

[confuseguy]

My primary doc order a liver panel today.

I know I need to establish a baseline and need to know what's going on. I haven't had a liver panel in my life.

[cajim]

>>>Should I wait at least 1 or more weeks before I take the blood test for liver enzymes (AST, ALT)?

Don't think so.

[confuseguy]

I did a comprehensive blood panel (CBC) and a liver panel yesterday. The results came back today.

My doctor said everything was normal except my BUN was a little high. BUN is use to measure kidney function.

What do you guys think, treat or not treat with the summary below:

1) Eg negative, Eab positive.
2) Viral count as of last week is ~45,000 ml/copies.
3) liver panel (AST,ALT) normal
4) I'm 27 y.o.

If I fall into the e- negative group, I read that treatment is only recommended if the high viral load is couple with high ALT,AST.

Should I wait and get retested for viral load at 3 months and 6 months and re-evaluate treatment?

In the back of my mind, I keep thinking that I may have just ended serconversion,hence, the e neg status but still elevation in viral load. If I wait at 3 months, maybe my viral load will go down to UND and I'll be inactive?

What is the next step, ultrasound? Biopsy?

[zellyf]

What are the AST, ALT numbers?

Get hard copies of your labs and keep them.

I would get another round of labs in three months, and three months after that...if stuff holds or drops then I'd go bto twice a year with a yearly ultrasound.  Get an ultrasound no matter what...yearly. This all looks good.

[cajim]

Did your doctor recommend no treatment yet?  I would think that is logical.  I am sure he will also keep you monitored.

As zellyf said, you look pretty good.

[confuseguy]

My primary doctor will send me the hard copies results. I will know my AST and ALT #s when I get them. According to him, all liver panel enzymes are normal.

He referred me to a hepatolgist but I have not receive any call from hepatology regarding my referral. I expect an appointment with them within the next month or so. I don't have a recommendation to treat or not by a hepatologist because I have not seen one yet.

Is it true that even though you have high viral load, it doesn't necessary mean you have liver damage unless high levels of ALT?

Zelly, I asked you the question before of the half-life of HBV. Well I researched it and it's ~1 day. The paper indicate that a full equiped virus will circulate in your blood and be gone within a day. I don't know what happen to it, either they get kill or they get incorporated into hepatocyte.

[zellyf]

The only real way to know what is going on in the liver is to biopsy and even that is somewhat suspect.  A lot depends up on the sample size/quantity/location.  There are other markers that may give some indication but are not reliable on their own (bilirubin, AST/ALT ration, platelets etc).  I think you can get the most complete picture with the labs,imaging and biopsy but of course, that is costly and not everyone will get that.

I ask about the ALT b/c "normal" doesn't always mean "healthy".  Some labs set normal at <60 but a healthy liver function for men is 30 at the upper limit and for women is 19 (upper limit).  The lab values are somewhat skewed by the population sample.  

My own doctor told me my labs were normal for 8 years...welll, they weren't.  They were high for a woman...still are.  But they were normal by lab values (and even by what was understood at that time).  

[confuseguy]

Zelly,

I found out my ALT is 27 but the normal range is 6-23. I don't know whta that means? My doc said it's normal though.

[zellyf]

27 is good.  I'd be happy with a 27.  Your lab's normal range is much lower than mine.

[stevenNYer]

Firstly, don't let this become an obsession.  It's a quick road to depression.

Just learn the concepts needed to monitor your condition.

You are 31 and for most that's early for the eSeroconversion.  Maybe you are still in the process of that and the e's are still dancing a bit and fluctuating your DNA.  If your ALT remains solid in the 20's and 30's, you're in good shape.  

[confuseguy]

Thanks Steve. I got away from it for a few days and life seems to be back to normal again.

Do you think it's possible to test negative for e and still have high DNA during seroconversion?

I think I got the big picture. An analogy I came up with is that the liver is a kingdom with many people (hepatocytes). HBV are foreign invaders that can come into the kingdom and wants to take over. They infiltrate and blend in nicely with the locals (again, hepatocytes) who doesn't know and can't differentiate themselves from HBV. Hence, the local (hepatocytes) got marry with the foreigners (HBV) and reproduce kids (more HBV). The only problem here is that the kid's genetic makeup is 100% HBV. As time goes on, HBV can become widespread within the kingdom.

Here's the twist. The immune system cells are suppose to protect the world (our body) by patrolling areas outside of the kingdom as well as in the kingdom. They are smart CIAs, FBIs, Army, etc. They can recognize invaders (HBV) and will kill them at all cost. In our case, killing the hepatocytes along with HBV.

The moral of the story is that each and everyday, remember to live and eat healthy. Nourish your body so that you can maintain or even ugrade your army against these invaders! Maybe one day, you'll be strong enough so that you can fall within the <1% that clearn the big boss (HB sAg) !!! Good luck to everyone!

[cajim]

Great analogy!

[Clod123]

Guyz dont read internet to much and get crazy if u have seroconverted and ast alt are normal  dont worry about dna an vireal load they need time time years to b normal again so pls have a life and chekevery 4 months ur ast alt for now. Exercise eat well Get ur multivitamins daily and liver protectet tabs, one beer per day or glass wine get laid , stress dont efects hbv but efect any one   So less the better.