Pls help with this findings Hepatitis B positive

[paulice]

Pls help me to understand the below findings:
I was diagnosed Hepatitis B positive 7 months ago and no medication has been given since i was pregnant that time.

Test: Hepatitis Profile
HBsAg -                            reactive - 3.373
Anti- HBs -                        Non reactive - 0.015
HBe Ag -                            Non reactive - 0.052
Anti- HBe -                         Non reactive -3.166
Anti-HBC IgG-                    Reactive - 0.012
Anti-HBc Igm                   - Non- reactive  - 0.100

Please help me to understand the result.

Thank you.
Pau

[paulice]

hi, my doctor advise me to undergone the below test. Can you please interpret the below results.

hi, can you please interpret the below results:

SGPT/ALT: 29. 57 u/l

HBsAg II Quantification 9985 IU/ml

HBsAg w/Titer (CMIA) 2866.200 --- Reactive

Anti HBs (CMIA) 0.00 mIU/ml --- Non reactive

HBeAg (CMIA) 1.612--- Grayzone

Anti Hbe (CMIA) 1.300 --- Non reactive

Anti HBC IGM (cmia) 0.050 --- Non reactive

Anti Hbc total (CMIA) 13.190 -- Reactive

HBV viral load  60 IU/Ml

Please advise what the results means.. thanks

[4est]

Test: Hepatitis Profile
HBsAg -                            reactive - 3.373  - indicate that you have a infection with hepatitis b virus (not indicate the quantum of this indicator)
Anti- HBs -                        Non reactive - 0.015 - indicate taht you don't have the anticorpi for the infection
HBe Ag -                            Non reactive - 0.052 - indicate the e Ag that can indicate that the virus is not multiply or can indicate that the virus is mutant
Anti- HBe -                         Non reactive -3.166 - curios (i was expecting + base on Anti- HBe -   )
Anti-HBC IgG-                    Reactive - 0.012 - indicate that you are in chronic phase
Anti-HBc Igm                   - Non- reactive  - 0.100 - indicate that you are not in a acute phase

as stef2011 already suggest you had to do:
- hbsag quant
- hbvdna pcr - use by doctors to specify the phase of the infection and to see if a therapy is required (some doctors use a combo of hbvdna pcr and  hbsag quant  to establish the therapy need or phase of infection )
- fibroscan - use to see the state of you liver - this answer also enter in the analyse of the therapy need

[stef2011]

Test: Hepatitis Profile
HBsAg -                            reactive - 3.373
Anti- HBs -                        Non reactive - 0.015
HBe Ag -                            Non reactive - 0.052
Anti- HBe -                         Non reactive -3.166
Anti-HBC IgG-                    Reactive - 0.012
Anti-HBc Igm                   - Non- reactive  - 0.100

all useless, as said many times these tests are too old and not good for cronic carriers, the numbers are NOT antigen quantities

UTZ: the liver is normal in size with a span of 11.7cm. Parenchyma is homogeneous with no evident mass nor abnormal calcification. Intraphetic ducts are dilated.
Impression: Normal sonogram of the liver.

this result is quite normal in early cirrhosis too, US is useless to see liver damage

hbsag quant by architect and fibroscan,hbvdna pcr.these are the main tests to know how you are doing

[paulice]

COULD ANYONE HELP ME TO UNDERSTAND THE BELOW FINDINGS?  THANKS...

what do i need to do now if the ultrasound that was requested by my doctor is not that much effective to detect liver damage? Also, what can u say about my alt result? THis is the latest findings.. pls explain.


Test: Hepatitis Profile
HBsAg -                            reactive - 3.373
Anti- HBs -                        Non reactive - 0.015
HBe Ag -                            Non reactive - 0.052
Anti- HBe -                         Non reactive -3.166
Anti-HBC IgG-                    Reactive - 0.012
Anti-HBc Igm                   - Non- reactive  - 0.100

UTZ: the liver is normal in size with a span of 11.7cm. Parenchyma is homogeneous with no evident mass nor abnormal calcification. Intraphetic ducts are dilated.

Impression: Normal sonogram of the liver.

ALT: 34.1 IU/L..

What's all about now? any other test do i need to do?
What do u mean about early cirrhosis ?
What test to i need to do to detect the liver damage?

I badly need ur comment pls..

To my fellow filipino: any good/specialist doctor that u could recommend?

[4est]

I will look also on this option but i don't know if it is availbel for me. Italy will be a good option, I can afford to came to italy every couple of mounts, but I don't know if they will revive me or if I'm entitle to go to Itally for tratament. Until now I had all the analyses including fibroscan, only one that i don't have it is the hbsag quant, but i will do it in the next period (I will aspect until 6 mounth pass and i had to made all analyses again - or you suggest that will be better to rush it ?)

for hbsquant I will open a new thread and we can discuss on it. I found a publication that claim that a correlation of quantitative assay of HBsAg and HBV DNA exist and I'm curios that this is verify it. (corelation was measured  during chronic HBV treatment.)

[stef2011]

if you can afford move to italy, france or germany, i suppose that as a EC citizen healthcare is free for you.
in these country both fibroscan and hbsag quant is routine and in italy available in every city hospital

[4est]

anyway, i hope not to angry you with my questions.
I still have a lot to look into this problems and i hope to found a good medic / research center for a better monitoring or tratament if will be the case,

[4est]

you haven t heard about hbsag quant because no available in east europe - it is available, I've jsut check and we have at least one laboratory (I only check one) that provide this. I say that I was not heard, from the doctor perspective.
I spoke also on some other forums (from my country) and nobody heard from his doctor something regarding hbsag quantitative and they are some doctors that made research or clinical trials or go to hepatology / gastroenterology seminars .... and this was the point that i try to show.

I'm sorry to hear about your cirrhosis, but I read in your journal that is going well, you manage to reduce the fibrosis  ant this is a good thing.

[stef2011]

no it is not personal for you, i get angree at these guidelines because ignorance of these guidelines made my cirrhosis and my doctor wasn t a researcher at that time so he followed guidelines mistakenly

so whenver possible it is better to find researchers/doctors or doctors that updates yearly or more at these conferences

you haven t heard about hbsag quant because no available in east europe

[4est]

the new ones are from 2011, europe updates every 6-12 months according to new discoveries - maybe you are correct, but I only found on the internet this and this was posted like the official ones.
If you have the new ones, I will be more than happy to read it and to discuss it with my doctor and to post all the comets on this topic.
I can say that in Romania the official guideline  look like the one that I presented above (they are looking for HVBDNA, AST, ALT and fibrose level (fibroscan or biopsy))

[4est]

hi,

don't take this personal, I'm not a lawyer and I don't try to enforce the guidelines. I just say that I never saw the hbvag quantitative in a guideline and all are referring to the hbvdna.

Discution, I was not meant to be personal, i was only a to chalange some information taht was new for me.

I'm from Romania and in my case, fibroscan is recomandaate to be made each year, HVB DNA each 6 mouth and ALT, AST each 3 mouth (I've done also fibromax and i probably done it each year), but no doctor sad anything about the HVBAG quantitative and that is my dilema.  

[stef2011]

as regards europe they are all expired, those you posted are not valid, just for the safety of readers...2008 was like another century.

the new ones are from 2011, europe updates every 6-12 months according to new discoveries

[stef2011]

go with the guidelines, especially the US ones, and very easily end up with advanced cirrhosis while they monitor according to those guidelines....in US you have double risk since they have no fibroscans so it is impossible to monitor liver damage (biopsy can be made every 5 year and some cases might develop cirrhosis as early as 1 year!)

[stef2011]

thoose are the guidelines are talked about made for the ignorants....treatment must be personalized according to tests results, this is why i got to cirrhosis level because of these extremely "STUPID" guidelines which are wrong for many although they might fit for the most

and this is why researchers in pisa said "going to a normal hospital is just like going to a fast food" while here you have a single chef cooking just for you

[4est]

AASLD • Consider treatment:
(Lok 2007; 2009)
• HBeAg(+): HBV DNA >20,000 IU/ml + ALT ≤2x ULN + biopsy shows moderate/severe inflammation or significant fibrosis.
• HBeAg(+): HBV DNA >20,000 IU/ml + ALT >2x ULN Observe for 3-6
months and treat if no spontaneous HBeAg loss.
• HBeAg(-): HBV DNA >20,000 IU/ml + ALT >2x ULN
• Consider biopsy:
• HBeAg(+): HBV DNA >20,000 IU/ml + ALT >2x ULN + compensated
• HBeAg(+): HBV DNA >20,000 IU/ml + ALT 1-2x ULN + age >40 years or family history of HCC
• HBeAg(-): HBV DNA >2,000-20,000 IU/ml + ALT 1-2x ULN

APASL • Consider treatment:
(Liaw 2008)
• All patients: HBV DNA detectable + advanced fibrosis/cirrhosis
• HBeAg(+): HBV DNA >20,000 IU/ml + ALT >2x ULN + impending/overt
decompensation
• HBeAg(-): HBV DNA > 2,000 + ALT >2x ULN + impending/overt
decompensation
EASL • Consider treatment:
• HBV DNA >20,000 IU/ml + ALT >2x ULN + moderate to severe
necroinflammation

Belgian • Consider treatment:
(Colle 2007) • HBeAg(+): HBV DNA >20,000 IU/ml + ALT >2x ULN (or moderate/severe
hepatitis on biopsy)
• HBeAg(-): HBV DNA ≥2,000 IU/ml and elevated ALT
• Consider biopsy:
• Fluctuating or minimally elevated ALT (especially in those older
than 35-40 years)

Dutch • Consider treatment:
(Janssen 2008)
• HBeAg(+) and HBeAg(-): HBV DNA ≥20,000 IU/ml and ALT ≥2x ULN
or active necrotic inflammation
• HBeAg(-): HBV DNA ≥2,000–20,000 IU/ml and ALT ≥2x ULN (and absence
of any other cause of hepatitis)

German • Consider treatment:
(Cornberg 2007)
• HBV DNA >2,000 IU/ml + minimal inflammation/low fibrosis or ALT ≥2x ULN

Italian • Consider treatment:
(Carosi 2008)
• HBeAg(+): HBV DNA >20,000 IU/ml + ALT >2x ULN
• HBeAg(-): HBV DNA >2,000 IU/ml + abnormal ALT and or fibrosis (Ishak ≥S2)
• Consider biopsy:
• HBeAg(-): HBV DNA >2,000 IU/ml + borderline ALT, or if DNA 2,000–20,000 IU/ml + high ALT

Polish • Consider treatment:
(Juszczyk 2008)
• HBeAg(+): HBV DNA ≥20,000 IU/ml + raised ALT; biopsy not required
• HBeAg(-): HBV DNA ≥2,000 IU/ml + raised ALT; biopsy not required
• Biopsy required:
• Normal ALT

Turkish VHSD • Consider treatment:
(Balik 2008)
• HBeAg(+): HBV DNA >20,000 IU/ml + ALT >ULN or age >40 years
(ALT 1-2x ULN) + histological indication
• HBeAg(-): HBV DNA >2,000 IU/ml + histological indication

Turkish TASL • Consider treatment:
(Akarca 2007)
• HBV DNA >2,000 IU/ml + histological fibrosis >2
• HBV DNA >20,000 IU/ml + any histological finding + ALT >2x ULN

[4est]

"The general book of ingnorance about hbv" - I've read this and I can say that teh conclusion from thsi book is apply in europe. and in this book (presentation) I've not see a indication to use the hbvag quantitative to determine the virus acivity, but I've see that hbvdna pcr is indicated to be used. in the presentation hbvag quanitatiive is presente to be a indicator if a person will respond more or less to interferon.

" hbsag can be used instead of hbvdna pcr or in combo" - I've read a study and the result was that no relation between hbvag quantitative and hbvdna pcr was found, so in this case we can not use hbvag quantitative instead of hbvdna pcr, maybe we can used it only in combo.

as far as I know HBV DNA carries the genetic blueprint of the virus - how many HBV DNA “copies” are found in your blood indicates how rapidly the virus is reproducing in your liver.

I had a look on the clinical guide line from europe and I don't found any country that use hbvag quantitative for tratament indication, all country use ALT / AST levels, fibrose level and hvbdna level.

so for me is still unclear what is hvbag quantitative and what is stand for.

[paulice]

what do i need to do now if the ultrasound that was requested by my doctor is not that much effective to detect liver damage? Also, what can u say about my alt result? THis is the latest findings.. pls explain.


Test: Hepatitis Profile
HBsAg -                            reactive - 3.373
Anti- HBs -                        Non reactive - 0.015
HBe Ag -                            Non reactive - 0.052
Anti- HBe -                         Non reactive -3.166
Anti-HBC IgG-                    Reactive - 0.012
Anti-HBc Igm                   - Non- reactive  - 0.100

UTZ: the liver is normal in size with a span of 11.7cm. Parenchyma is homogeneous with no evident mass nor abnormal calcification. Intraphetic ducts are dilated.

Impression: Normal sonogram of the liver.

ALT: 34.1 IU/L..

What's all about now? any other test do i need to do?
What do u mean about early cirrhosis ?
What test to i need to do to detect the liver damage?

I badly need ur comment pls..

To my fellow filipino: any good/specialist doctor that u could recommend?

thanks..

[stef2011]

hbsag quant and fibroscan are used since 2005 in advanced countries with good healthcare and good doctors...that is germany, italy, france, belgium, holland, norway

[stef2011]

you just met ignorants, not doctors, see also this, a liver specialist prepared this book for his collegues and presented at a conference years ago since there are too many ignorants that understand nothing about hbv and make more damage than good:

"The general book of ingnorance about hbv"
http://www.medhelp.org/health_pages/Hepatitis/the-general-book-of-ignorance-about-hepatitis-B/show/1152?cid=153

hbsag is available since hbsag itself is known, from 2000-2005 abbott made a good commercial assay.
since hbvdna pcr is very expensive and hbsag is extremely cheap (7euro in italy), there is a tendency to hide hbsag quant (US, canada dont use it yet whie even third world countries have it), hbsag can be used instead of hbvdna pcr or in combo

hbsag quant shows also that antivirals like tenofovir and entecavir, quite expensive, increase its quantity making hbvdna undetactabel.....and many might think they are useless on hbv, which is not quite wrong

hbsag reflects cccdna which are the infected cells in the liver, i have yet to understand what exactly is the use of hbvdna really apart the use for monitoring nucs response and resistance development.
to me hbvdna is totally useless to monitor infection, infected cells increase when hbvnda pcr is und by antivirals, infact if you stop antivirals you get an acute hbv that might be even dangerous for life

[judas13]

WHEN IT COMES THAT YOU ARE RIGHT.....!!!!  I REALLY REALLY REALLY HATE MY GOVERMENT.....many of us lost our jobs that needs for our family income because of misunderstanding about the result. many of us lost thier dreams and future. Even in our own country they prohibit us to work.
                        i regret i was born in my country ,why not in europe...!!!!????????

[4est]

I've just read some news regarding the hbsag in quantity and I've see that is use for monitoring the tratament and I've see that no relation between hbsag and hbsdna was found, so what exactly is hbsdna (virus numbers) and hbsag ?  

[4est]

from when the hbsag is important as in quantity?

doctors that I spoke (all form Europe) said nothing about the hbsag, they only specify that the other criteria hbvdna pcr<2000iu/ml, ast and alt normal value.
Also specify that the results from fibroscan and fibromax should count for liver damage.  

[stef2011]

what is the difference if you have HbsAg alone without HbeAg ?

almost none, hbeag cant be used to define active or inactive hbv, they are very old studies and wrong

inactive hbv is defined by:
hbsag<500iu/ml geno D
hbsag<....something between 100-300iu/ml i dont remember because we dont have these genotypes in europe
hbvdna pcr<2000iu/ml
alt/ast<30men nd 19 women

phillipines has no doctors, no tests...no nothing.i think they are just in a mess as regards hbv until somebody wakes goverment up on the mess they are doing

i read there is a movment making tests like vaccines at birth, hbsag quant and fibroscan available to the population but i dont know which hospital will ahve these available.

hbeag has no meanining here in europe, we check hbvdna pcr and hbsag quant for infectvity

[stef2011]

normal ultrasound but this happens also in early cirrhosis so ultrasound is uselful only to detect liver cancer or fatty liver, abslutley useless for liver damage since when it detects damage is so advanced that it cant be regressed