change in HBV viral load

Question

Dear Doctor McGovern,

My doctor has been keeping track of my HBV viral load for years. I am chronically infected with HBV since birth, and I have never undergone any kind of treatment in my life. I am HBeAg negative, HBeAb positive, and my liver enzymes are normal. I do not know if I have any cirrhosis or scarring of the liver, since I never got a biopsy.

Recently, my viral load experienced a 3-fold change. Going from 6000 copies per mL to 2000 copies per mL. No elevation of liver enzymes accompanied that change.

I read that HBV viral load can vary quite a bit due to inaccuracy in the PCR assay. However, differences as great as half a log10 can be attributed to actual physiological chnages in the patient.

When viral load changes significantly, does that mean there is inflammatory activity in the liver? I am very concerned because a reactivation of Hepatitis B can lead to cirrhosis rather quickly. Should anti-viral treatment be initiated in my case?

Thank you for your time and patience. Any advice is deeply appreciated.

Answer

The viral load going down is a good thing.

Your disease status falls into a grey area. Your liver function tests are normal, your viral load is low, but we don't know how much disease you have. This is a case where I sometimes consider a biopsy to determine disease activity.

If there is moderate disease, I would consider therapy for viral suppression. This is a big decision because since your have e antigen negative infection, you will need chronic therapy. You should discuss these issues with your physician further since I do not know the details about your case.