HBV Tests - Need Clarification....

Doctor:

My wife and I recently found out we are having a baby. After taking prenatal blood work they found that she tested positive for HBsAg. All other tests were fine including her liver test. The doctor was pretty confident it was a false positive, due to her not falling into one of the high risk categories as well as the fact that I have been vaccinated.

So, she immediately took another test. (In the meantime, I took blood work to make sure I was properly vaccinated and immune. My results came back fine as all my titers are where they are supposed to be.) Her results came back as follows: HBsAg Non reactive Anti-Hbs Non reactive IgM Non reactive HBeAg Non reactive Anti-HBe Non reactive Viral DNA 9,321 Liver test Normal

Our doctor was completely baffled and suggested we see a liver specialist. We went to the liver specialist and he retook her blood work (this being her THIRD test in five weeks) and everything came back clear. All of the above was retaken and there were no signs anywhere. Five weeks later we retook her blood work again (this being her FOURTH test) and everything came back clear AGAIN. She also just had her second round of prenatal testing (mandatory in the state for CT and this being her FIFTH test) and the HBsAg test came back non reactive no other HBV tests retaken this time though.

I have done a tremendous amount of research and have found that surface antigens dont come and go. Plus, PCR testing is subject a lot of times to false positive readings.  These results don't make sense... specifically because they don't correlate together.

What would you conclude? Remember the catch here is, her first two tests showed signs (first test = hbsAg positive; second test hbsAg turned negative, but small amounts in her DNA) and the last three tests were absolutely clear.

Obviously, we are struggling with this situation. If you can shed light on this situation we would be very grateful.  

We would just love finality with this situation and to hear your expert opinion now that we have taken FIVE tests (remember the fifth only tested for hbsag).

Thank you.

[Kevin Pho, MD]

This is certainly a confusing set of results.

A viral DNA of less than 10,000 in the face of a normal HbsAg can suggest a non-active carrier state of the virus.  The other normal antibody tests would support this hypothesis.

Repeating the serologic markers periodically can be considered to cement the diagnosis.  With the last 2 hepatitis B tests being non-revealing, the chance of an acute infection is low.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

[72Kent]

Thank you for your response.  

I am a bit confused by your answer though.  You said... "A viral DNA of less than 10,000 in the face of a normal HbsAg can suggest a non-active carrier state of the virus. The other normal antibody tests would support this hypothesis."

What do you mean "in the face of a normal HbsAg?"  Are you saying a REACTIVE HbsAg?  If so, I understand your answer.  

If not, can you explain...

Thank you.  

PS -- Remember my wife didn't have a reactive core antibody.