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HBsAB+ along with HBsAG+ ??
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HBsAB+ along with HBsAG+ ??

I was diagnosed with recent infection of HBV in June 2004.  By Dec 2004 it had not cleared and I was diagnosed as chronic.  Doctor put me on Lamivudine, I developed resistance after 1 year (Dec 2005).  Jan 2006 I was started on Pegasys, did that for 8 months until Sep 2006, then switched to new test antivirals - tenofovir and emtractibine <sp?>  

In Nov 2006 I sero-converted to HBeAG -, HBeAB+ with undetectable HBV DNA.  
In Jan 2007, still HBeAG-, HBeAB+, undetectable HBV DNA, and now had HBsAB+ along with HBsAG+.  I understand that it is rare to have both sAG+ and sAB+ at the same time.  We retested in March 2007, and everything still the same, with HBsAB+ titres well above 10,000 units - enough to confer protection normally.  Normal ultrasound at that time also.  HBV DNA undetectable.  However, HBsAG was still reactive.   My last lab work (July 2007 before a hernia operation) showed normal ALT, normal AST.  Doctor decided we should retest all the HBV markers in Sept. to see where I am at nine months after the "e" seroconversion.

Any ideas on what it means to have both surface AB and surface AG at the same time?  Should I ask for titre levels on the AG as well as the AB?  What about genotype testing?  All the literature I read says sAG and sAB should not co-exist at the same time.
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12 Comments Post a Comment
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217229_tn?1192766004
StevenNY is our Resident HepB god of knowledge. LOL!

He'll be along sometime in the next 2 days. Hang in there.

Meki
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181575_tn?1250202386
While rare it could happen (being both positive).  If your HBsAg stays positive with undectable DNA it could that your treatment helped you reached an inactive carrier status.  But as long as your HBsAg is positive, there is a chance to reactivation to an active disease.  It would be interesting to see if you sustain your status without the meds.  At any rate, your treatment seem to be going well.  Congrats!

When they test your for HBsAb, they are testing for a specific protein.  Sometimes a protein with a very similiar characteristic to HBsAb register this marker to be positive but it is not the exact antibody to the HBsAg.  In this case, you still have HepB.  It's kinda like the key to your expensive and sensitive lock.  When you make a copy of the key.  Although the key looks the same, it may not open the lock due to a very slight difference to one of the teeths not visible to the naked eye.  I know of a person who also tested positive for both and this was how his doctor explained it to him.  Share this with your doctor and see what your doctor say.  Actually let me know what your doctor say.

Also how did you do on Pegasys?  How did you tolerate it?  
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181575_tn?1250202386
Okay...okay...we will revisit that commission issue...LOL.

Seriously, thanks for helping to bump up the HepB post.  HepB needs community support too :)

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Avatar_n_tn
Thanks Steven.  

I wonder if it's worth asking for a biopsy, a genotype, or any other kind of tests; I want to rule out a mutant.

I did fine on the Peg actually; first two weeks were kind of rough - flu like symptoms, exhausted, headaches, etc - but after that, I seemed to get used to it and eventually didn't really notice it other than injection site soreness.  All the time I was on it, my DNA was dropping gradually - about a log every three months - but not fast enough for the insurance company, who eventually stopped approving it.  That's when my doc switched me to anti-virals.  
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181575_tn?1250202386
My doctor didn't order biopsy or other tests because he said it won't chance course of treatment.  I will consider additonal test if there is a new reason for it.  

Insurance companies could be such bastards sometimes.  Sorry that you had to stop PEG especially if you tolerated it well.  I hope you do well with the antivirals.  I have a feeling PEG abd tenofovir will be in my future.  We'll see.  Good luck to us HepB people.
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Avatar_n_tn
My doc thought last spring that it might have been the combination of being loaded full of interferon for 8 moths and then slamming my system with tenofovir that caused the "e" seroconversion, and the subsequent chain of events (loss of DNA, first appearance of sAb).  He was only expecting the peg to drop the DNA - was very surprised to see the "e" conversion and the rest happen so quickly.  I guess we'll know more about my status in a couple of weeks.
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181575_tn?1250202386
keep us informed.
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Avatar_n_tn
Got my latest lab results today.   This is eleven months after stopping Peg, and ten  months being on Tenofovir.

Liver panel, all competely normal and in range, including ALT and AST.
ALT   44  range 9-60  
AST  26  range 10-40


HBV DNA PCR quant  <100 (aka undetectable, says the doc)

HBeAg     non-reactive
HBeAb     reactive

HBsAg     reactive (still)
HBsAb     also reactive

So it looks like I am doing just fine, although I sure would like to see that HBsAg go non-reactive (wouldn't we all?).  Unfortunately we didn't do titers on the HBsAb this time, I wish we had.

Back to "wait and see" mode for another six months.


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181575_tn?1250202386
D'oh...I was pulling for you to the the lucky few who seroconvert to HBsAb positive and HBsAg negative.  But least your ALT and DNA looks good.  Good luck!
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Avatar_n_tn
Thanks Steven.  I was hoping the same thing...  oh well, what's another six month wait?  I am used to it by now... NOT.    :-)

Dave
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Avatar_n_tn
Hi-
Your serology is consistent with a carrier known as a heterotypic state. Often times when people develop HepB S Ab in response to an infection it is protective. About 10% of the time, someone will develop an Surface Ab and have surface Ag persist. Some hypothesize that this may represent an antibody response that is ineffective in clearing the infection.

However, the good news is that you are completely undetectable in terms of DNA and also have a negative e ag which are both good prognostic indicators. Best of luck!
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Avatar_m_tn
Hi, any news? Did your HBsAg turned to negative?
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