Am i considered chronically infected with Hepatitis B?

[seekinghelp90]

hello everyone.

i was diagnosed with hepatitis b in february this year.

my lab results were extremely high, alt/ast hovering around 3000 hence my doctor prescribed me tenofovir.

in the span of 9 months, i went down for blood tests in 3 occasion.

Here are my blood test results :

March 2017 : ALT/AST are still slightly elevated, but only in the range of 100s compared to the 3000 i had back in February.

May 2017 : ALT/AST has became normal(17 for ALT/19 for AST) , DNA viral load came back with the result of "This assay cannot accurately quantify HBV DNA below this level". Hepatitis B surface antibody NEGATIVE. Hepatitis B e surface antigen NEGATIVE/Hepatitis B e surface antibody POSITIVE

August 2017 : ALT/AST normal, Hepatitis B surface antigen Negative;Hepatitis B antibody Negative; DNA Viral Load - UNDETACTABLE . Hepatitis B e surface antigen NEGATIVE/Hepatitis B e surface antibody POSITIVE

I am still on medication and i will have another blood test in December. Im puzzled, what stage am i at ? Am i considered chronically infected as i did not develop hepatitis b surface antibody over 6months?

[ajnasution]

I think I should congratulate you that you have cleared the HEP B virus as this was proved by your HBsAg result ~ Negative. Please discuss with your Physician in considering to stop the medication.  

[seekinghelp90]

Hello,

Thank you for your response, but im still not sure if im completely okay now since i still dont have HBsAB yet(just got my test results today). But however, im off medication.

Update on my situation:
HBsAB negative, HBeAB positive, HBeAG negative, HBsAG quantitative test got cancelled(I don't know why, only realised that after i requested for hardcopy for my test results, didnt manage to ask my doctor)

However, according to my doctor, he said that there is no virus in my body(not sure if its purely based on HBeAb and HBeAG test) and im off medication right now, but will have a followup test next month.

[Bm2016]

i don't know if there is any medical guideline,

from my personal experience, i was a chronically infected with hbv, i went from detectable hbv dna 1800 ui/ml to to hbv dna undetectable, hbsab reactive, hbsag non-reactive over a span of 2 months, i DID continued to follow up with my every 6 months GI appointments and bloodwork and my GI doctor kept me on  viread for another 12 months even after hbsag sero-conversion, and then took me off the pill, and then followed up one last blood work and GI dr office visit after 6 months taken off pill to make sure hbsab is still reactive, immuned to to hbv, and my GI doctor sent me home for good.

now i am following up with my family doctor every 6 months at the request of my GI doctor, no longer on any drug, doing bloodwork on lipid panel, as well as qualitatively test hbsag, hbsab, so far it has been almost 3 years, my hbsag has been non-reactive, and hbsab reactive (more than 10 ui/ml).


my GI doctor told me,  the hbv virus still remained in my body permanently until death, even when i am hbsag negative, hbsab positive, and hbv dna undetectable.  the remnants of the hbv/cccDNA is rooted deep in liver cell, luckily my immune system is keep the hbv at bay, therefore, no hbv virus is flowing in my bloodstream.  Quality of life should be as good as someone who is vaccinated for hbv.

[seekinghelp90]

Hello Bm2016,

Congratulations for developing HBsAB!!

My question is that, how are you chronically infected for just 2months? Or is that 2months ontop of the 6months acute phase? And during the days when you have not develop HBsAB, were your LFT(ALT/AST) well?

Its kinda odd that you were on medication for 12months even after you had seroconversion, but its all good now since you developed the antibodies, every patient's dream. Hope i get it too.. :D

[Bm2016]

i was chronically infected with hbv for decades, (way passed acute).

according to my bloodwork report, the one last time i saw my hbv dna detected 1800 ui/ml to hbv dna undetectable, and then 2 months later HBsAB reactive, and been reactive since then.

my liver function test, alt was high for the past decade, mostly like 80 to 90 range, did went to triple digits once or twice.
even right after seroconversion, my alt was in 50s, and then 6 month or a year later, lowered to 20 and 30s.


as safety precaution, my GI doctor extended my viread for 12 months after seroconversion to make sure my immune system able to generate enough HBsAB to suppress the remnants of hbsag/cccDNA, and after i was taken off viread for 6 months, make sure hbv won't flare back without the suppression assistance from viread.

[seekinghelp90]

Were you on medication for decades? Im still waiting for my HBsAB, has been 3 months since my viral load test being undetectable, but still no luck.

Will be going back for another test just next month, since i just got off medication. Hope it all goes well!

[Bm2016]

initially I was under GI doctor monitoring every 6 months, then all the sudden my dna viral count started spike exponentially around age 30, GI doctor put me on viread for close to a decade.

[ajnasution]

As along as your HBsAg is non-reactive or undetected, you are in good condition like other normal person. I would say you have cleared the virus from your body. Do not think much on your HBsAb too much as this will later on develop by itself.

[seekinghelp90]

Hello,

I just had another round of tests last week.. results are still the same.

HBsAB - negative
HBsAG - negative
ALT/AST - 12/16

Would it be useful if i go for the 3 dose hepatitis b vaccination jab so that my HBsAB will show quickly??

[StephenCastlecrag]

As an adult, you are expected to recover without treatment from your Hepatitis B infection(over 95% chance). But because of your very high ALT, your doctor prescribed you Tenofovir , as a precaution. In my opinion, I am not a doctor, you will recover from your acute HBV infection and will not become chronic Hepatitis B carrier. This is confirmed by your HBsAg negative and hbvdna undetectable.
The serum HBsAg is a quantative measure of the amount of HBsAg in your serum. I expect that it will be less 0.05 iu/ml and be classified as HBsAg negative.

You should discuss with your doctor about stopping TDF if your HBsAg remains negative. Don't be too concerned about HBsAb not being positive yet, it will come.

[seekinghelp90]

Hi Stephen, really appreciate for your reply!

For the previous tests i had was HBsAG qualitative, the upcoming one will be HBsAG quantitative, so that has to come in negative in order for me to be considered as "cleared infection"?

[StephenCastlecrag]

Good question, I don't know. Personally I think both tests should reflect the same result. A quantitative test has some value for treatment purpose. But if you are HBsAg negative, the test will show that too.

[seekinghelp90]

I have another question, if Hepatitis B DNA Viral Load is undetectable, does it equates to HBsAG negative too? Or you can actually be positive for HBsAG but undetectable for viral load?

[StephenCastlecrag]

Yes, it is certainly possible that HBsAg remains positive even when hbvdna is undetectable. This is the case for patients under oral antiviral treatment, as only production of hbvdna is suppressed by the medication but not production of HbsAg by cccDNA. In the case of those not under treatment, HBsAg can be produced from integrated hbvdna.

[seekinghelp90]

Hello Stephen, i just came back with my new test results.

HBsAB negative, HBeAB positive, HBeAG negative, HBsAG quantitative test got cancelled(I don't know why, only realised that after i requested for hardcopy for my test results, didnt manage to ask my doctor)

However, according to my doctor, he said that there is no virus in my body(not sure if its purely based on HBeAb and HBeAG test) and im off medication right now, but will have a followup test next month.

Any idea why will my doctor cancel that test?

Thank you!!

[seekinghelp90]

Hi, also would like to ask the following:

I am being scheduled for another round of blood tests, which comprises of the normal liver function tests(ALT/AST/ALP), i also realised theres AFP(some test for cancer marker..? ) and HBsAG Quantitative.

Can someone explain on the HBsAG Quantitative test? What kind of result should i expect for this?