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HBeAg and HBeAb
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HBeAg and HBeAb

Hi. I am 28 year old, male, known to have chronic hep B for ten years( familial). i have blood check 3 months ago, HBeAg positive, anti HBeAb negative, HBV viral load 9506710IU/ml, ALT 200. My family doctor advice me to obersve for 3-6 months for spontaneous seroconversion if other liver function normal. 3 months later, my HBeag positive, but anti HBeAb became positive, HBV viral load increases  to 26455620 IU/ml, ALT 330.

Should i start treatment now?
8 Comments Post a Comment
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Avatar_m_tn
You have asked a difficult question. There are two schools of thought. One would say, as you are still young, wait for spontaneous seroconversion so that you will go into immune inactive phase and hopefully stay there for a long time. The downside is there is on-going liver damage. The other school would say, treat now, especially with Interferon, and you may have a chance (however small) to clear the virus or you may be a responder and lose your e-antigen after treatment. To be optimal for Interferon, it is better if you have Genotype A and lower hbvdna. Of you have genotype A, then it is definitely worthwhile to treat with Interferon.

Just my opinion.
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Avatar_m_tn
Thank you for your opinion. I am worried because despite i am starting to have anti HBeab, my HBV viral load is increasing. I am worried that i might start to develop precore mutant or chronic HBeag negative hepatitis which confers a poorer diagnosis...
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Avatar_m_tn
I think you are jumping ahead. HBeAg negative chronic hepatitis usually develops AFTER you seroconvert your e-Antigen. In any case, HBeAg negative hepatitis can be treated by all the antivirals and interferon. So it confers a poor diagnosis in the past because it was then wrongly assumed HBeAg negative means inactive disease.

Your fluctuating ALT and hbddna may be just the usual pattern during the immune clearance phase.

Just my opinion.
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Avatar_m_tn
Thank you.

I read several literatures, precore mutant usually develop during the immune clearance phase and also during the inactive phase. Pls correct me.

I am confused, because as i am now in immune clearance phase, my body is trying to clear up hepatitis B virus, at the same time, my liver cells will be damaged evidenced by high ALT, as these liver cells are infected by the virus. I expect my HBV DNA viral load will be coming down trend during the clearance phase, but it is not.
And my Anti HBeAb is detected now, which was not previously. Is it a good news? or just a false alarm??
Thanks.
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Avatar_m_tn
"I read several literatures, precore mutant usually develop during the immune clearance phase and also during the inactive phase." I am not an expert, just like you, I read up on the subject. I will give you my understanding.

During the immune tolerance phase, as the patients get older, "viral mutants not capable of secreting HBeAg are then slowly selected (pre-core mutants are detected in 89% of HbeAg-positive patients)" according to a paper I just read. Here you must be careful. The hbv virus in our liver consists of a population of quasispecies, so what is meant when doctors say we have the wild type or precore mutant virus? Clearly, they have their own definition. So you are right, there are precore mutants during the immune clearance phase, but at which percentage of the whole population? Actually, it is because of the presence of these mutants, less tolerogenic HBeAg is secreted, that makes the immune system becomes intolerant and start attempting to clear the virus. This is the current theory. The exact mechanism is not known.

As your immune system attempts to clear the virus, the battle is fought, sometimes won, sometimes lost, and that is why the fluctuations in ALT and hbvdna. Eventually the war is won but with some damage in the form of fibrosis. Again this is the theory at the moment.
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Avatar_m_tn

you can check for precore and bcp much longer before hbeag gets negative, this mutant is the most widespread today, so the best thing is check for it

my suggestion is treat anyway since hbv wont clear by itself, start with tdf so you make hbvdna und and increase response to intf and then add on intf

you have to balance pros and cons, one waiting has one sure con once you are hbeag neg it will be much more difficult to clear hbv
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Avatar_m_tn
Thanks everyone for the info.

I just hope that by the end of 6 months, i will enter the inactive phase. Or else if my ALT is persistent;y high or my HBeag still postive, i will start treatment.
what i follow is the AASLD 2009 guideline.
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Avatar_m_tn

refer to guidelines 2012 or at worst 2011, everything changes year after year you cant refer to something in 2009, too many things different today
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