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HepB acute infection or reactivation?
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HepB acute infection or reactivation?

I contracted HIV and Hepb approx 15 years ago and was treated for HepB at that time. I started HIV HARRT 3 years ago as my CD4 count was 33 and viral load was 377,000. HAART combination was selected to also combat the low level of HepB DNA also present in my bloods. The HepB has been undectetcable for nearly 3 years now and my CD4 count rose to 370. However over the past few months I have tested positive for core antigen antibodies and neg for everything else and my CD4 count has fallen to 290. Does this mean my HepB has reactivated and my therapy is not working so well, or is it possible that I may have caught HepB again? the antibodies seem to indicate its an acute infection - !does this mean I am recently reinfected?
Thank you hope my questions make sense
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Avatar_n_tn
what are your other results ?

hep b surface antigen? hep b surface antibody?

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Avatar_m_tn
Thanks so much for looking at my question.

My other results are
HepB surface antigen negative
HepB surface antibody negative
HepB core Ab positive 2.4x10 (to the power of one)
viral loads negative

I am on atripla

I asked my consultant if my chronic HepB infection (which has had undetectable HepB DNA for nearly 3 years) had reactivated and he said its unlikely, but I have read some sources on the internet that it is possible? I really don't understand this very well so I could very well be wrong.

Thanks again and hope you can shed some light on this!
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Avatar_m_tn
Thanks so much for looking at my question.

My other results are
HepB surface antigen negative
HepB surface antibody negative
HepB core Ab positive 2.4x10 (to the power of one)
viral loads negative

I am on atripla

I asked my consultant if my chronic HepB infection (which has had undetectable HepB DNA for nearly 3 years) had reactivated and he said its unlikely, but I have read some sources on the internet that it is possible? I really don't understand this very well so I could very well be wrong.

Thanks again and hope you can shed some light on this!
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Avatar_m_tn
well the core ab will always be positive in people who have had a previous or current hep b infection. and your surface antigen is negative along with viral loads so no it has not reactivated.
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Avatar_m_tn
I should have mentioned that 3 months ago i tested positive for HepB virus DNA (PCR), very low level. For the past 3 years this had been undetectable and has now become undetectable again in this months bloods tests.So I don't know if I have been reinfected and my HAART (incudes treatment to suppress HepB DNA) has cleared this reinfection up very quickly. Or in a different scenario I am concerned that my HAART is not working effectively as HepB DNA managed to increase and worryingly my HIV CD4 count has dropped at the same time.
Thanks for your help and I would appreciate any further comments you may have.
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Avatar_m_tn
I should have mentioned that 3 months ago i tested positive for HepB virus DNA (PCR), very low level. For the past 3 years this had been undetectable and has now become undetectable again in this months bloods tests.So I don't know if I have been reinfected and my HAART (incudes treatment to suppress HepB DNA) has cleared this reinfection up very quickly. Or in a different scenario I am concerned that my HAART is not working effectively as HepB DNA managed to increase and worryingly my HIV CD4 count has dropped at the same time.
Thanks for your help and I would appreciate any further comments you may have.
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Avatar_n_tn
you're possibly in the window period where your body has not yet developed enough surface anitbodies to indicate immunity to hep b -

possibly because your body is too busy with the HIV infection at the same time which suppresses and may interfere with any immune response ?  in other words, because of HIV - it may delay the elimination of HEP B.  But then again - others on this forum can help out with this.
have you asked your doctor for vaccination at this point since your negative for both surface antigen and surface antibody?

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Avatar_m_tn
Thanks again for your further comments. I'm not sure if the window period will apply as I first contracted HepB at least 15 years ago. But HIV seems to have complicated things somewhat and my consultant couldn't explain what was going on with this and why my HepB DNA had become detectable again. I will ask about vaccination next time I see him.

Thanks so much for your helpful answers!
I will let you know if I find out for sure.
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Avatar_m_tn
Further comments would be appreciated!!
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