hbeag negative means virus is less aggressive and immune response is less suppressed by hbv, it doesn t mean anything in terms of illness hbv is always there but less aggressive.hbe negative has lower hbvdna, lower hbsag, lower cccdna
it is very important to check for virus mutants precore bcp promoter, this tests were not available once but since now they are available it is very important to check, this mutants are more present in hbe nagative but can also be present in hbe positive, they are more aggressive promoting liver cancer and cirrhosis so when present therapy must be started if hbvdna is detactable to prevent liver cancer
the only thin that can tell severity of disease is fibroscan which measure liver damage, all other tests are useless for this, unfortunately we have seen that our members from US and UK are like a very poor third world country since fibroscan machines are very rare in thoses states, only biopsy can help in that case
the other important test is hbvdna that reflects virus replication, not virus quantity, and alt which reflects damage in the moment you make test but not total damage accumulated day by day
if hbvdna is low, liver damage low, alt almost normal there is no need to start therapy because you are already where therapy can take you
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