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What Does Undetectable Viral Load Along With Positive HBV Tests Indicate?

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Posted on Tue, 13 Jan 2015
Question: Doc,

I am 44 years old. 1.87cm tall and weigh 95kg. Two years ago, in the course of routine medical checks, I diagnosed with HBV. Further investigation revealed that I must have picked up the virus as a kid. All my three brothers also have it. We are all married and none of our wives or kids are infected. In the past year, I have done two viral load and each Report indicate "not seen". Recently, I did an ultrasound. The result reads: slight increase in the parenchymal echo texture. Liver size is within normal with smooth capsule, span 133mm. Sonodensity is normal but echo texture is unduly fine. No focal hepatic mass legion identified. The duct and vascular system appears normal: Conclusion - Hepatic finding consistent with post hepatitis liver. No feature of active hepatobiliary disease seen. I also did a liver function test which shows that my SGPT is high at 47.0 U/L and Globulin also high at 3.82gm% as well as EARLY FATTY LIVER. The complete LFT result is: GGTP 34.0 IU/L Bilirubin (total) 0.51 mg/dl, Bilirubin (direct) 0.20 mg/dl, Bilirubin (indirect) 0.31mg/dl, SGOT 27.1U/L, SGPT 47.0U/L, Alkaline Phosphatase 95.0IU/L, Total proteins 8.7gm%, Albumins 4.25 gm%,, Globulin 3.82gm%, A/G Ratio 1.1. Biochemical. Method. PLEASE DOES THE RESULT INDCATE A DISEASED LIVER. Thank you. GOO


doctor
Answered by Dr. Muhammad Ahmad (1 hour later)
Brief Answer:
NO!! according to your history, your investigation and description you DO NOT have a diseased liver at the moment.

Detailed Answer:
Hello,

Welcome to Health Care Magic.
My name is Dr Muhammad Ahmad & I will look into your problem.

I have gone through your query and would try to help you in the best possible way.
I can well understand your concern about this issue after a positive HBV test but its good news that viral load twice came out to be not detectable.

Viral load:
Undetectable viral load with positive tests, telling you that you got it in childhood mean that your Hepatitis B virus is not in active state, it's in latent inactive phase or in chronic phase, if it stays in this stage which I expect it will, it will never cause any issues at all...and you can live a normal healthy life.

Having no infected family member specially wife also means that you don't have active virus in you...you got infected in early life then it got dormant and still its dormant.

TEST RESULTS:

FATTY LIVER:
Your only test result which has an "abnormal" finding is your ultrasound which showed fatty liver. This finding is some what normal and in 44 years of age with a heavy build as you have 90% of people will have it specially alcohol users among them, it's perfectly normal and perfectly benign and safe finding liver size is normal and echo texture just shows old change which is again very non specific, if your ultrasonographer hadn't known already, that you have positive HBV he might not have suggested that these changes were POST HEPATITIS LIVER changes because they are so non specific and subjective findings.. if you get ultrasound done by 3 consultants, two of them wont really suggest that there is an issue of echogenicity, specially if you don't tell them that you are HBV positive.

Ultrasound findings Conclusion:
Normal finding for this age and HBV positive individual and very satisfactory results.

OTHER LABS:
All you other labs are more or less perfectly normal, your liver is making proteins like albumin and globulin perfectly, your liver enzymes are in perfect range and billirubin and other things are better than many HBV negative individuals who always kept their liver with care and led a healthy life style.

My opinion:

1- Gross structure of liver on ultrasound is perfectly normal for your age and little bit HBV infection which you got early in life, your liver is in very good shape
2- Fatty liver is a normal finding, it's not pathological until your liver is normal in size and functioning well which is true in your case.
3- Your test results indicate NO ACTIVE LIVER ISSUE.
4- You don't even have to take any medications as well, because you have zero viral load, just get viral load done every year and you are good to go until it gets positive which seems to be a remote possibility in your case.
5- Increased echogenicity and fatty liver is a normal finding in your age and build, just like wrinkles are normal in a 50 years old guy and abnormal in a 17 years old lad. This also is suggested by your nearly perfect liver function tests which you have mentioned with much detail.
6- I will suggest you not to worry about it any more eat and live healthy to lead a normal life. Just get tested for viral load yearly and you are good to go for another 40-50 years and more.

Hope I have answered your query. If you have any further questions, I will be happy to help if not then don't forget to close the discussion and rate it.
Wishing you good health !!
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. Muhammad Ahmad (24 hours later)
Dr. XXXXXXX

Many thanks for your detailed response which is quite illuminating.

I have a related question.

Last year I was diagnosed with gastric erosion. I also tested positive for H.pylori infection. Since then, I have done four endoscopies because of the almost permanent pain I feel in my upper right abdomen. Three of the endoscopy results indicated mild go moderate gastric erosion. I was placed on treatment and the latest endoscopy did not not the gastric erosion bug showed mild hiatus hernia. Further blood tests shows that I was no longer positive for H. Pylori. Nevertheless, the pain in my upper right abdomen persists. My endoscopist examined me clinically and recommended an ultrasound to exclude gall stones. His findings are as follows: "Conclusion: Patient has a mild hiatus hernia with resulting reflux. I examined him clinically and he was tender in the upper right quadrant with equivocal Murphy's sign. I have recommended an abdominal ultrasound scan to exclude gall stones".

I did two ultrasound recently and all showed my gall stone bladder to be in perfect condition. I am confused and don't know what else to do. I thought the pain had to do with my liver but since you have excluded that, I am really at a loss as to the cause of the persistent pain which seems like I have a sore in my stomach. My stomach is always bloated and I have this feeling of fulness with pain in my upper back radiating to my hip. I don't eat spicy or hot foods, don't take fizzy drinks and avoid eating after 7 pm at night. Yet no relief.

Please not that both my ultrasound test shows that my kidneys and other organs are normal.
Doc, Just a minor correction in the second paragraph of my last question.

The statement should read: " I was placed on treatment. The latest endoscopy did not show the gastric erosion but showed mild hiatus hernia".

XXXXXXXX
doctor
Answered by Dr. Muhammad Ahmad (1 hour later)
Brief Answer:
Lets consider other possible causes then.

Detailed Answer:
Thanks for writing back me to, its a pleasure that you showed trust and ease in sharing the other issue with me.

I read your post in detail twice and I congratulate you on getting rid of H.Pylori. I can't see any way of your liver causing the pain neither it is inflamed nor did it show any signs of disease and tests are also good, before reaching the end of your post I too had this opinion that this must be gall bladder then because right sided or mid abdomen pain is usually gall bladder specially if it is radiating to the back which is true in your case. Plus stomach ulcer usually presents as left sided pain or middle abdomen pain...it seldom presents as right sided pain.

Possibilities:

Now I can tell you other possibilities of pain which should be ruled out.

1- Hiatus hernia:

Hiatus hernia is a big cause of acid regurge and dyspepsia, you can just relieve symptoms a bit by using antacids and PPI's, that's a great thing that you avoid fizzy drinks and spices but I want to point out here is that in many cases hiatus hernia and symptoms caused by it can only be treated surgically, diet, lifestyle changes and medications actually save you from worsening of symptoms.

2- Gall bladder:

It's a good news that there are no gall stones found in gall bladder but some times there is bladder infection or inflammation which causes its pain and tenderness, this doesn't show on ultrasound but in many cases gastroentrologists prefer giving 5-7 days prophylactic antibiotic course because sometimes a minor antibiotic trials corrects underlying infection or inflammation and patient's symptoms are dramatically relieved.

3- A single small peptic ulcer:

There can be a single small peptic ulcer instead of a large gastritis which didn't show on endoscopy.


Suggestion:

All three possibilities I have mentioned above can be worked up by a single specialist, a General surgeon, he can deal with all three issues I have mentioned above, so I would suggest you to visit a general/ abdominal surgeon with all your medical records and reports. He might like to run some tests to determine the severity of hiatal hernia, this will help him to rule out or rule in the causes of your abdominal pain.

I would ask you to keep avoiding foods which worsen you symptoms, and visit a general surgeon as soon as possible, even if he can't find anything atleast he would tell you that your hiatus hernia is not something to cause symptoms and its really an insignificant defect. This itself would be a relieving news for you that hernia isn't causing any symptoms and it isn't significant, on the other hand if he finds a possibility that symptoms are caused by it, he will come up with options to treat it and this again will be helpful for you so it's a win-win situation for you either ways.

Thanks for showing your trust. I hope I answered comprehensive and clearly enough, if you have further questions I am happy to help. You can also ask direct question to me even after you have visited the surgeon, if the answer satisfies you rate and close the conversation.

Wish you best of health.
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
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Answered by
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Dr. Muhammad Ahmad

General & Family Physician

Practicing since :2012

Answered : 1308 Questions

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What Does Undetectable Viral Load Along With Positive HBV Tests Indicate?

Brief Answer: NO!! according to your history, your investigation and description you DO NOT have a diseased liver at the moment. Detailed Answer: Hello, Welcome to Health Care Magic. My name is Dr Muhammad Ahmad & I will look into your problem. I have gone through your query and would try to help you in the best possible way. I can well understand your concern about this issue after a positive HBV test but its good news that viral load twice came out to be not detectable. Viral load: Undetectable viral load with positive tests, telling you that you got it in childhood mean that your Hepatitis B virus is not in active state, it's in latent inactive phase or in chronic phase, if it stays in this stage which I expect it will, it will never cause any issues at all...and you can live a normal healthy life. Having no infected family member specially wife also means that you don't have active virus in you...you got infected in early life then it got dormant and still its dormant. TEST RESULTS: FATTY LIVER: Your only test result which has an "abnormal" finding is your ultrasound which showed fatty liver. This finding is some what normal and in 44 years of age with a heavy build as you have 90% of people will have it specially alcohol users among them, it's perfectly normal and perfectly benign and safe finding liver size is normal and echo texture just shows old change which is again very non specific, if your ultrasonographer hadn't known already, that you have positive HBV he might not have suggested that these changes were POST HEPATITIS LIVER changes because they are so non specific and subjective findings.. if you get ultrasound done by 3 consultants, two of them wont really suggest that there is an issue of echogenicity, specially if you don't tell them that you are HBV positive. Ultrasound findings Conclusion: Normal finding for this age and HBV positive individual and very satisfactory results. OTHER LABS: All you other labs are more or less perfectly normal, your liver is making proteins like albumin and globulin perfectly, your liver enzymes are in perfect range and billirubin and other things are better than many HBV negative individuals who always kept their liver with care and led a healthy life style. My opinion: 1- Gross structure of liver on ultrasound is perfectly normal for your age and little bit HBV infection which you got early in life, your liver is in very good shape 2- Fatty liver is a normal finding, it's not pathological until your liver is normal in size and functioning well which is true in your case. 3- Your test results indicate NO ACTIVE LIVER ISSUE. 4- You don't even have to take any medications as well, because you have zero viral load, just get viral load done every year and you are good to go until it gets positive which seems to be a remote possibility in your case. 5- Increased echogenicity and fatty liver is a normal finding in your age and build, just like wrinkles are normal in a 50 years old guy and abnormal in a 17 years old lad. This also is suggested by your nearly perfect liver function tests which you have mentioned with much detail. 6- I will suggest you not to worry about it any more eat and live healthy to lead a normal life. Just get tested for viral load yearly and you are good to go for another 40-50 years and more. Hope I have answered your query. If you have any further questions, I will be happy to help if not then don't forget to close the discussion and rate it. Wishing you good health !!