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Diagnosed with HBV

Hello,

I was recently tested for HBV and it came out positive.But the doctors say that the virus is inactive and asked me to get vaccinated immediately.

HbsAb (+) --- 0.08 (weakly reactive)
HBsAb (-)
HBeAg(+) --- 2.615
HBeAb(+)--- 0.33
HbcAb-IgC (+) ---7.75

Virus replication is very less at the moment, less than 1000 copies/ml. ALT levels are around 50 which a bit elevated considering the normal range is between 0-40.CT scan and ultrasound came our normal.Had a flare of jaundice about a 15 days back but subsided in 3-4 days.

Should I be concerned and force my doctor to me up on some kind of medications ? He is insisting that getting vaccinated would be enough at this stage.
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Avatar universal
Thanks for the information. Your first item now has a unit, so it is quantitative and I can understand the comment "weakly reactive" as I believe Less than 0.05 is considered negative. I can only speculate that you had an acute infection (the jaundice) and is now on your way to a full recovery. Or if you were chronic, you are still on the way to losing your HBsAg. Do check again your HBsAg, HBeAg, ALT, hbvdna in a few months time. No need for the vaccine or medication, just wait and see. Good luck.
Helpful - 1
2 Comments
Thank you very much Stephen.Your  reply is indeed very encouraging and has given me a ray of hope.

If you don't mind can you please clarify briefly to what those units iu/ml and s/co mean and how to decipher them ?

And I will definitely follow your advice and retest after 6-8 months.
iu/ml is a standard International Unit - no matter what the methods they use to measure, you should get the same result.
s/co, signal to cut-off ratio is just a ratio, results in s/co can vary from lab to lab, depending on the methods and assays used.
Avatar universal
//According to your results, you are HBeAg positive, yet you claim your hbvdna (virus replication) is less than 1000 copies/ml. //

Doing further research and talking to my doctor it seems I am in the Immune clearance state in which the HbeAg stays positive and DNA levels becomes less.
Helpful - 0
10 Comments
Please anyone ?? I am sure the doctor is playing guess games and is not ready to put me on medications.

Please help me understand why am I positive for both for HBeAg and HbeAb at the same time. It is just that HBeAg  is what worries me.Looking for an expert opinion here.
After looking at your clinical data, i understand that you are HBV positive. Now, the next question is whether you are infectious and whether the virus is replicating ? Since your HBeAg is positive and HBV DNA is < 1000 iu/ml, you are infectious but virus replication is within range. i would suggest, you may check HBV DNA every half-yearly so that you will know the virus replication is active or not. Generally it is said that if HBV DNA is < 1000 iu/ml then HBV is inactive and hence medicines are prescribed. So you should not not worry about. But since HbeAg is postive, it is always better to check the HBV DNA quite regularly. I have seen many HBV infected people  non-transmitting whose HBV DNA is < 1000 iu/ml.  
Generally it is said that if HBV DNA is < 1000 iu/ml then HBV is inactive and hence medicines are **NOT** prescribed
Thank you kaatot. Greatly appreciate your reply.

Just a correction.The standard used was copies/ml and not ui/ml for HBV DNA.So I guess in my case it is less than 200 ui/ml.

But can you please comment why is HbeAg and HBeAb both are positive even though the virus replication is so low ?HbeAg positive is the most worrying part for me.
oops...sorry....anyway, then you should be more happy now than earlier. Since both your HBeAg & HBeAb are positive, you look insignificantly infectious. But, you should not worry about. HBV look inactive. I would suggest, you may check HBeAg after couple of months to confirm if it still remains positive. Also, check HBV DNA at that time.
Thank you kaatoot. Would a recheck after 6 months be fine ?
Hello Kaatoot,

Just needed classification to make sure there is no typo error.

//Since both your HBeAg & HBeAb are positive, you look insignificantly infectious. But, you should not worry about.//

Do you mean significantly or insignificantly ?
It is insignificant since your HBV DNA is < 1000 iu/ml
Thank You Kaatot..But I am still not very convinced.

Please take a look here : -

http://www.medscape.com/viewarticle/747559_4

//All patients studied were in the immune active phase of chronic hepatitis B, and consistent with earlier observations on the concurrence of hepatitis B surface antigen and antibody,[11,12] this study indicated that the concurrence of HBeAg and anti-HBe was also correlated with pronounced liver disease. First, higher ALT levels were found in the concurrent patients compared with HBeAg-positive or anti-HBe-positive patients, which usually indicates extensive hepatocyte damage.[1] Second, higher inflammation grades in concurrent patients also suggested severe immune-mediated liver injury,[13,14] which in turn might result in a reduction in viral replication//

I just don't know what to think.My doctor is adamant that there is no need for medication.

My ALT levels hover around the 50-55 mark.

Whatever i know...i have shared with you. It is better for you to consult with another doctor who can cross check your status.
Avatar universal
Thank you very much Stephen.One last query before I stop bugging you.

In my report of all the markers HbcAb-IgG shows the highest value which is 7.75 s/co.Can you please let me know how to interpret it ?

Also in the report HBsAb shows a value of 10 mIU/ml but is not marked as positive but instead marked as negative.
Helpful - 0
3 Comments
The 7.75 s/co will be interpreted by the Lab according to the assay kit used. In this case, they reported it as (+).
It seems most Labs will report HBsAb greater than 10 miu/ml as positive, but you should take heart that it is 10 miu/ml, almost there.
Thanks Stephen.So does the presence of HbcAb-IgG say anything about the infection being chronic or acute ? I promise I won't bug you anymore after this .
The presence of HBcAb-IGG indicates you were infected with HBV (acute or chronic).
Avatar universal
My apologies for the not posting information properly earlier.Yes it is HBsAg as the first item and the last item is
HbcAb-IgG.

HbsAg (+) --- 0.08 (weakly reactive)  IU/ml
HBsAb (-)
HBeAg(+) --- 2.615 S/CO
HBeAb(+)--- 0.33  S/CO
HbcAb-IgG (+) ---7.75  S/CO

Yes the viral load is quite low, less than 1000 copies/ml.

I had a jaundice flare up about 15 days back and was hospitalized and it was there during the tests I tested positive for HBV

Kindly advice.
Helpful - 0
Avatar universal
The first item of your result should be HBsAg, not HBsAb. The meaning of 0.08 (weakly reactive) is not clear, as this seems to be a qualitative test, since no unit is given.
According to your results, you are HBeAg positive, yet you claim your hbvdna (virus replication) is less than 1000 copies/ml. Normally, if you are HBeAg positive, your hbvdna would be very much higher. And also when and why did you have a flare of jaundice? Not knowing your full history of infection, it is difficult to interpret your results.
Also, please check your spelling: HBcAb-IgC? Should it be HBcAb igg?
Helpful - 0
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