Clearance and Immunity

[mark6247]

I was infected with hepatitis b in Feb or Mar of 2009. I was hospitalized in May 2009.
The first tests showed me to be positive for surface antigens, e antigens, core antibodies (both total and igm), and antibodies as well. My antibodies even tested to be at 5 times what is considered enough for immunity.
I continued to have blood test about every three weeks just monitor my liver functions. These labs showed a trend back to normal ranges over the next 4 months. I retested to see if my surface and e antigens at about six months from infection and those were still positive. At this time, however, my surface antibodies had dropped from 5 times immunity levels to half of what is considered immunity.
At about 7 months from infection and 9 months from diagnosis I retested again. All liver functions were normal. My surface antigens and e antigens were now negative and I was positive for e antibodies. My core antibodies were positive (total and igm). My surface antibodies had now dropped to less than 1 tenth of what is considered immunity. The lowest level yet and a long, long way from the first test.
My thoughts were that there must be mistakes at the lab. I decided to retest a few weeks later and got the same results again. Everything is what I wanted to see with exception of very low surface antibodies.
During much of this I came to this site to try and get some answers. Several of you told me that I had beaten the virus and that those numbers were no longer important. Negative surface antigens are the real marker of clearance. I was told something similar by the good folks at The Hepatitis B Foundation. However, there was one very knowledgeable person on this site that recommended that I continue to test for another six months just to be sure.
Last week I decided to test again. It is 14 months from diagnosis and 16-17 months from infection.
My liver functions are completely normal. AST was 22 and ALT was 28. My surface antigens were negative. My core antibodies, IGM was still positive. I kind of thought that would no longer be positive by this time but it is still positive and I have no idea what it could mean, if anything at all. My surface antibodies have now risen from their recent levels, however, I’m still only at one third of what is considered immune. So, while it has tripled over the last 6 months, it is still much lower than what is expected.
A big part of me is still very scared that I’m not immune or that I could infect someone. When this happened to me over a year ago I completed stopped having any contact with other people unless it was absolutely necessary. I couldn’t live with myself knowing I infected someone with this horrible disease. I have not even touched another human, much allow myself to have sex, since leaving the hospital over a year ago. This is getting to me mentally and emotionally.
I want to know, from all of you resident experts, what are my chances of getting this disease again? Is it possible for me to give this disease to anyone under any circumstances? Lets say for instance that I were to have unprotected sex (I won’t do that, this is purely hypothetical) with someone. Will they become infected? If the person is a known carrier of hep b will I become re-infected? Can I catch a different strain? Will the vaccine help me produce more antibodies and should I get it? Thank you very much for reading such a long post and for all responses?

[stevenNYer]

Per your message, here's my 2 cents:

I think you are fine.  You had a acute infection and your immune system cleared it, which is a very complex process.  Now everything that should be positive is positive and negative is negative.  Except your low Surface Antibody is low based on your lab assay.  The assay is looking for something very specific and may not a exact match to your true circulating anitbody, thus could registered as low.  (In the same way, my Surface Antibody is much higher than your, but I'm a chronic infection).  So I think you are fine even if you Surface Antibody register as close to zero.  Your immune system has great memory abilities for natural clearance.  Yes, there's a very very low chance that you have an occult infection via a mutation, but if that's the case, your ALT will likely be elevated.  So I don't think you are infectious. But if you are concern, just make sure your partner is immune to HepB as well.  Hope this helps.  

[stef2011]

My most recent tests for antibodies are as follows;
Result: 0.28
you must make vaccine shots absolutely, you are already negative for antibodies protection now

250miu/ml means you are superprotect, 10 is just the minimum to be considered protected when you make vaccine not when you are fighting the virus

i am sorry you don t have government free assistance in your country but vaccine is not very expensive, do the vaccine and then check if antibody has got higher after a month from first shot
you might check hbvdna when you can afford it it is not essential

[mark6247]

Thanks for the reply. My financial status is bad and getting worse daily. I do not have the funds or insurance to get any DNA testing. Treatment is also something I cannot afford.

It's very saddening to hear that I could still infect others or have the virus spring up again. I don't know how much more living in isolation I can stand.

My most recent tests for antibodies are as follows;

Result: 0.28

Status of Immunity

Inconsistent with Immunity: 0.00 - 0.99
Consistent with Immunity:  >0.99

An index value of 1.00 is equivalent to 10 mIU/mL.
However the magnitude of the Index Value is not
indicative of the total amount of antibody present.

What does that really mean? Your post says a good LOW level is 250 miu/ml and according to LabCorp (my test results above) 10 miu/ml or more is enough for immunity.

I'm very confused about antibody levels now.

[stef2011]

you must continue to check antibody titer hbsab since you have had it low, the best low level for immunity is hbsab 250miu/ml higher always better

why you have to check?

because inside the liver cells you have the cccdna which is the template of the virus, this takes decades to clear and can remake the virus again if your immune system gets suppressed and if hbsab falls low.you are no longer infectious but contact by blood can still infect others.
so now your immune system has complete control over hbv but complete eradication even if imune system gets suppressed will take about 10 years

you might also check hbvdna with very sensitive pcr that detects till 5iu/ml just to be sure you don t have occult hepatitis but this is just for a maniac since very very rare but it exists so yearly blood check wouldn t harm if you don t have financial issues

there are been study reports on hbsab antibody getting as low as 0.06miu/ml because of lamivudine mutated virus, in this case several vaccine shots got the antibody back to 250-300miu/ml