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Long

Meet Long . . .

  • He is a young restaurant worker that immigrated from Vietnam
  • His primary language is Vietnamese, and he has been taking classes to improve his English proficiency
  • He and his roommate have been saving up to start a food truck

Patient demographics and diagnosis

Sex: Male
Age: 27 years
Race/Ethnicity: Vietnamese

Tested HBsAg (+) after screening at a community health clinic while being treated for an upper respiratory infection

Presents to gastroenterologist 4 months later

Initial visit with gastroenterologist

Past medical history: Unremarkable
Medications: None
Past surgical history: None

    • Works long hours
    • Has 1–2 servings of alcohol on weekends
    • Has never smoked tobacco products
    • Has never used recreational drugs
    • Does not understand why he needs to see a specialist if he feels fine and does not think his diagnosis is serious

  • He has not seen his immediate family since he immigrated 3 years ago, but they are healthy as far as he knows

    • Triple panel results: HBsAg (+), anti-HBs (–), and anti-HBc total (+)
    Additional tests ordered by the gastroenterologist:
    • HBeAg (+), anti-HBe (–), anti-HBc IgM (–)
    • HBV DNA: 1,000,000 IU/mL
    • ALT: 30 U/L (ULN: 35 U/L)1
    • AFP: 3.0 ng/mL (normal: <10 ng/mL)2
    1. Terrault NA, et al. Hepatology. 2018;67(4):1560-1599. 2. Ball D. et al. Am J Med Sci. 1992;303(3):157-159.

  • Liver ultrasound:

    • Normal appearing liver, no focal lesions

    Vibration-controlled transient elastography:

    • 5.5 kPa (significant fibrosis cutoff, >7.0 kPa)1
    1. European Association for the Study of the Liver. J Hepatol. 2025;83(2):502-583.

In response to his diagnosis, Long is confused and has several questions.

    • Hepatitis B is caused by a virus that spreads through body fluids1 and is relatively common in many countries around the world, including Vietnam.2 People can be infected at birth, during childhood, or as adults. It can be a lifelong, or “chronic” condition in some people3
    • People with chronic HBV (CHB) often do not feel sick. Sometimes, the only sign that something is “wrong” is abnormal liver blood tests, but some people with CHB have perfectly normal liver tests
    • Even if you do not have symptoms or do not feel like you are sick, you are still at a higher risk of liver problems,1,2 including:
      • Liver inflammation
      • Liver fibrosis and cirrhosis (scarring)
      • Liver failure
      • Liver cancer
    1. European Association for the Study of the Liver. J Hepatol. 2025;83(2):502-583. 2. World Health Organization. Global Hepatitis Report. 2024. 3. Wilkins T, et al. Am Fam Physician. 2019;99(5):314–323.
    2. European Association for the Study of the Liver. J Hepatol. 2025;83(2):502-583. 2. Terrault NA, et al. Hepatology. 2018;67(4):1560-1599.

    • The presence of hepatitis B e antigen and a large amount of HBV DNA in the blood indicates the virus is actively and rapidly multiplying
    • The normal ALT level indicates that the liver is not experiencing significant injury or inflammation. Additionally, elastography showed normal stiffness of the liver, which means the liver has little to no scarring or fibrosis, a form of liver damage
    • There are different stages of hepatitis B infection. You are in the “immune-tolerant" phase, or HBeAg-positive chronic infection.1 It means the hepatitis B virus is present in large amounts, but the immune system hasn’t started fighting it yet and the liver does not show injury or damage
    1. Terrault NA, et al. Hepatology. 2018;67(4):1560-1599.

    • In counseling Long about CHB management, you explain that he should take certain precautions to prevent the spread of HBV1
      • Avoid sharing personal hygiene items, such as toothbrushes and razors
      • Use barrier contraception with sexual partners if their HBV status is unknown. Sexual partners should be screened and receive HBV vaccination if not immune1
    • The most recent recommendations suggest treatment is reasonable if you are over 40 or if you have significant liver inflammation. You are under 40 and your tests do not indicate liver inflammation or scarring, so the decision is more individualized and depends on your preferences.2
      • A reason to consider starting treatment is reducing the amount of virus in your body to reduce the risk of spreading the virus to others
      • Reasons to consider waiting to start treatment include: your liver has no inflammation, you will likely need to take medication for years, possibly life-long, and cost.
      • If we decide to wait on treatment, we should check your blood work regularly. Hepatitis B can become active again and cause damage to the liver. Regular monitoring can help identify changes early and determine whether starting treatment should be considered.
    • Together, you decide to wait to start treatment him to come back for follow-up visits and lab testing every 3-6  months to reassess if he needs treatment.
    1. Terrault NA, et al. Hepatology. 2018;67(4):1560-1599. 2. Ghany MG, et al. Hepatology. 2026;83(4):974-997.

    • CHB can change over time from a less active stage to one that causes liver damage from inflammation1
    • Sometimes the body’s own immune system is enough to control the virus. Other times, the body needs help in the form of medicine to reduce viral levels and liver inflammation. Liver inflammation can lead to serious complications such as cirrhosis and liver cancer2
    • Regular follow-up visits and blood tests are the only way you can keep track of what stage of CHB he has2
    1. Jiang H, et al. J Gastroenterol Hepatol. 2025;40(3):720-730. 2. Terrault NA, et al. Hepatology. 2018;67(4):1560-1599.

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