18 month son blood test, anti-hbs 223.7, but hbsag 2.7. Is this possible?

My wife found out to be a hepatitis B carrier when pregnant. When our son was born with a c-section he took the vaccine as soon as he was born and then normally during the six months. Now at 18 months we decided to try a blood test, after he had a cold (cough, expectoration, four days of high temperature 38 C which went down after taking ibuprophen and paracetamol every eight hours). After this, until six days before the blood test, my son was taking antibiotics. three-four days before the blood test my wife was taking antibiotics too for a cold (medicine called zinnat). My son also had a rash at the butts, probably caused by the diarrhea that he had while taking the antibiotics.

The lab doctor did the test three times. The first time she said "looks slightly positive, but we can't tell for sure, so we'll will try again. She tried again and she said she'd send it to another more sophisticated lab. After the more sophisticated lab she told me that it was 2.7, which is considered positive, although the antibodies were there. Is this possible, having both antibodies and Hep B?

She said I could do another expensive blood test (molecular or sth), or just repeat the same HBSag blood test six months later.

What should I do? I was so scared when she told me. My wife is desperate. What should we do?

[stef2011]

first of all dont worry too much, hbv is a benigne virus as long as you know it is there

unfortuantely hbv vaccine is very bad designed because it uses only hbsab antibody while hbcab is the most important immunity antibody in concert with hbsab

anyway a percentage of vaccinated develops mutated hbv strains in the hbsag so the virus can still make the infection but a very mild one, with normal ast/alt, no liver damage, and very very low hbvdna

it is very important to test hbvdna with the highest sensibility pcr, limit of detection 6iu/ml, and retest often like every 6 months to see how weak the virus is

you should also test hbsag with abbott architect or roches quant, in US and UK very very old and obsolete machines are used which cannot detect the mutants but i guess in your case they used abbott because you report a 2.7 values

please confirm the machines used for the test of hbsag or the unit used, only iu/ml is a valid unit for hbsag quantification.you should see 2.7iu/ml in the report.abbott architect has sensitivity down to 0.05iu/ml and detects all mutants

again dont be worried about the word mutants or hbv, hbv is made of many viral populations called quasispieces, every carriers has these mutants

[stef2011]

it is also best to follow liver health by regular fibroscan 12 mnths and ultrasound every 6  months

if machine was not abbott architect, latest siemens models or roches elycasys, the test can well be a false positive

also get full marker panel with hbcab, hbcab igm (possibly quantitative in s/co), hbeag and hbeab

get the best liver specialist/researcher in your area to follow in case of hbsag detactable and not false positive, most of liver specialists are not updated or ignorant, so checking posts in this community you will be able to understand if currnt docotor is good enough

the best way to avoid vaccine failure is use of antivirals during pregnancy like tenofovir and vaccine at birth.the antiviral on the mother weakens hbv so much to make vaccine failure or mutants of hbsag not possible

[stef2011]

as to treatments, not needed, this type of hbv is so weak that it cannot make any damage as long as hbvdna is almost und or totally und

another possible explanation is:
she just got an hbv infection, the hbv vaccine cannot prevent infection totally but the infection will be extremely mild, short with no damage.we can see if this is the case from the full panel markers, if we find hbcab igm positive or higher than about 2s/co it menas she just got infected but the vaccine will protect her from any damage

she will have some hbsag very very low detactable, high hbsab, high hbcab, hbeab and in few weeks hbsag will be undetactable

[Nameth]

Thank you very much for the information. It was very helpful. I called last night the best infection doctor in my city and she found time for us. With your information at least I know what is going on.

[ancis]

I undergo 3 times of test for HBs Ag last Jan 16,19 and 24, 2013 using ELISA and ECLIA method for testing and all the result is reactive (cut off index is 1.0 and i have a result of 31.31).  Feb. 26, 2013, I undergo again the same test HBs Ag using ELISA method and i got a result of 0.036 non-reactive.  It is really posible that I make it down to non reactive again after almost 1 and a hallf months?  

[ancis]

I undergo 3 times of test for HBs Ag last Jan 16,19 and 24, 2013 using ELISA and ECLIA method for testing and all the result is reactive (cut off index is 1.0 and i have a result of 31.31).  Feb. 26, 2013, I undergo again the same test HBs Ag using ELISA method and i got a result of 0.036 non-reactive.  It is really posible that I make it down to non reactive again after almost 1 and a hallf months?  

[stef2011]

do not use those extremely obsolete machines for hbsag testing, they are not reliable at all, they dont detect all types of hbsag

you must use abbott architect or elysys roches or siemens latest machines, it doesn t matter if quantitative or qualitative, it only matters using these machines (which are not new architect is from 2000), these machines detect almost all hbsag types architect and siemens close to 100% of all types