HbeAg negative and DNA Hbsag quant question

[twinboys1girl4me]

I'm hoping to get some help understanding something that totally confuses me.  For those of us that are HbeAg negative and NOT on antivirals.....why do some have high DNA but very low hbsag and others have low/undetectable DNA but high hbsag?  

[Ram1982]

My HBsAg is 4400 iu/ml. Undetectable viral load..no treatment.Does this quantity is higher or its in medium limit or lower?

[Ram1982]

Thanks studyforhope. HBsAg 4400 iu/ml, is it like it will never decrease and seroconverted or there are certain chances that it will be serovonverted without any treatment? I am sure that I got this virus 4-5 years back and wondering why HBsag is so high for HBsAg negative with undetectable viral load.

[needadvicewithhep]

Thanks I appreciate the answer

[studyforhope]

Mutations effecting intensity of hbsag or virion production can be numerous, the standard bcp and pc mutations are involved also but not at the center of this effect.

In most Hbeag pos patients the linear relationship should hold reasonable well, on the way to long standing e neg infection integration and adaptive mutation will get more prevalent.

It is a better situation to have a lower hbsag level, since the chance to seroconvert to hbsag neg and hbsag antibody positive are obviously better.
if you can't have an antibody, it is h ARD to prevent reinfection, no matter what you did to reduce cccDNA.

[mike9111]

So in my So in my situation with high dna but low hbsag. Is it considered better than having low dna and high hbsag? Which one is more likely to mutate and harm your liver etc....situation with high dna but low hbsag. Is it considered better than having low dna and high hbsag? Which one is more likely to mutate and harm your liver etc....

[twinboys1girl4me]

Studyforhope.....Thanks Studyforhope so much.  So, if someone has high hbsag but low DNA this could be either from integrated DNA and/or mutations?  Are these mutations the typical precore, core promoter that are commonly tested or other mutations that are not available in commercial labs?

For most of us, do DNA and hbsag usually parallel each other fairly well, or is this inverse relationship quite common for HbeAg negative?

I know we can't pick but if we do have that inverse relationship is it a better situation to have high hbsag/low DNA or better to have low hbsag/high DNA?  The reason I ask is because everything in the US revolves around DNA but here on medhelp we know low hbsag is key to immune control and possible hbsag loss, correct?

[studyforhope]

Treatment with antivirals will reduce inflammation and have a positive influence on hcc development. HBsAg production from integrated  dna will not be affected by that.
Naps will have some effect on integration by increasing immune efficacy, possibly eliminating some cells with hbsag production only by class I tcell action on hbsag epitopes. But the efficacy of this is likely fairly low.
once naps are stopped the integrated hbsag gene will be able to secret particles again, removing the antibody excess by complexing.

birinapant seemed to be ideally positioned to eliminate those cells, but it's development is quite in doubt.

Peg ifn or Zadaxin in combo with naps will work much bette than naps alone, but results after ending treatment long term remain to be seen.

Ultrasound monitoring for hcc is always important, single cancers can be curative removed if detected early.

[studyforhope]

I am not aware of such a study, but it might well exist. There is little doubt, that a high degree of integration is a risk factor for hcc, but it might be an early one and correlations are hard to assess due to all the additional factoes that  are needed to actually promote a cancer development.