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Hepatitis B

My complete history of Hepatitis B...

July 2009

Test(s)           Normal Range Unit(s)              Patient Result

ALT                   10-50   U/L                                 13
AST                   10-50   U/L                                 21


Hbsag               cut off value=1.00                    279.86
---------------------------------------------------------------------------------------------------------

Hepatitis B DNA (PCR) Qualitative                    NOT DETECTED

HBV DNA - Interpretation:

HBsAg       Anti-HBe                HBV-DNA                 Interpretation
+                      +                               +                           Acute/Chronic infection
+                      +                               -                            Chronic infection-unstable/intermittent viral load.
                                                                                       HBV-DNA absent or below detection limit.
-                        +                             +                            HBsAg mutant or HBsAg below detection limit

-------------------------------------------------------------------------------------------------------------------------------------------------------

Now after one and half year...I have the following results:

22-December-2010

ALT/AST Normal

HBsAg               reactive                                 Cutoff rate = 1.00
                                                                          Patient rate = 2734.58

Is there any problem for me? please guide me properly...
Related Discussions
24 Comments Post a Comment
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Avatar_m_tn
no you are inactive, both hbsag tests are not quantitative so the number doesn t reflect any increase or decrease of hbsag but just a different diluition with reagents of the tests.

you don t need any therapy and might have a high chance of clearing hbv, to know for sure you should make hbsag quantification by abbott architect to see if hbsag is lower than 500iu/ml in that case you are 100% inactive with a chance of clearing of 11% per year
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Avatar_m_tn
Thank u so much for ur time....

Its mean...I'm not a carrier of Hepa B...right
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Avatar_m_tn
.I'm not a carrier of Hepa B...right

you are a carrier but you have immune control of infection so the virus can make no damage to you, in the case hbsag is lower than 500iu/ml you are clearing all te hbsag

it is very difficult to explain your situation in easy words but it is close to this:
the hbv virus is made of a template, cccdna, inside liver cells, this template can remake the virions even after thay are all cleared, it also makes hbsag not only virions and hbsag is not infectious or dangerous, it just prevents immune system to control infection definitively

your situation is probably of very very low virions which are continually killed by your immune system so they can make no damage to you but at the same time the template is still there producing hbsag
the template cannot be cleared by immune system and the only way is to lower hbsag and make hbsab antibody so that cccdna cannot infect other cells and restart infection.once hbsab is zero and you have hbsab the cccdna is blocked inside the liver cells and will slowly dye with the liver cells by decades
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Avatar_m_tn
if you don tnderstand it don t worry the virus can t make damage to you now, just monitor alt/ast, hbvdna, hbsag, ultrasound every 6 months
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Avatar_m_tn
if you don tnderstand it don t worry the virus can t make damage to you now, just monitor alt/ast, hbvdna, hbsag, ultrasound every 6 months...

if i just do AL/AST every six months...is that sufficient...or do i need to do HBV-DNA, HBsAg?

By ur post I can understand...that I can transfer this disease to other people by blood transfer, or by intercourse...right
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Avatar_m_tn
or by intercourse...right

right but virus is harmless on you

it would be best to check them all but if theu cost you jsut  choose between:

if you find hbsag quantitative in iu/ml that's the best to monitor since quantitatively you understand if you are clearing, stable or increasing, remember unit is iu/ml range 0.05-250iu/ml or other tests are useles to monitor

in case no hbsag, hbvdna+alt is ok
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Avatar_m_tn
"or by intercourse...right

right but virus is harmless on you"


1. Its does not make sense that a virus is harmless for me...bt i can harm other people by this? Plz explain it? thank u 4 ur time in advance.

2. someone told me that HBsAg will remain =ve through out ur life...u don't need to check it again? is that true...
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Avatar_m_tn

1
hbv is never really cleared when enters a body like most of the viruses, so you just achive a balance between this cccdna and your hbsab antibodies blocking entrance to liver cells for virions, so the infection in your body is blocked at the moment by the balance, when hbsab appears the balance is complete and hbv can never return unless you take immune suppressive drugs.in your case you are close to balance but hbsag is still too much for your hbsab antibodies

in this kind of balance is obvious that you don t get any damage but other people without hbsab will

2
no there is a balance between immune system and hbsag as i said above, very few clear when it is high, about 3% per year,  while those, probably like you, with hbsag between 500 and 1500iu/ml have higher chances at about 11% per year
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Avatar_m_tn
waooo...

Thank u so much...

U hv really all the info about Hepatitis B...I thank to God that u r here to answer all my questions...

1. Now one question is there? How can I get balance? as u told me that my HBsAg is high.

2.Wt kind of drugs, which harm ur immune system...

3. One thing more...My ALT and AST never go high from the past 20 months...

4.Most important...can I get back Hepatitis B in life. Or it will never come back. I hope and pray to god that It wont come back.

5. Plz tell me is there any problm for me...I mean any precautions...or just enjoy the life without fear...I hope u understand.

thank u so much for ur precious time.
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Avatar_m_tn
1. Now one question is there? How can I get balance? as u told me that my HBsAg is high.

you are probably close in the range of 500-1500iu/ml but only test can tell.there is no therapy necessary just monitor but if you find the test and the result is lower than 1500iu/ml you might try to make it negative by ntz or interferon

2.Wt kind of drugs, which harm ur immune system...

many all the immune suppressive ones, there are indications on the drugs and antivirals are given to patients before use because hbv reactivates with high number of deaths,steroids, chemiotherapy for cancer and many other impair immune system.but this is a well known fact

3. One thing more...My ALT and AST never go high from the past 20 months...

doesn t help to say your hbsag level or immunity state 100%, they don t correlate much with hbsag and hbvdna

4.Most important...can I get back Hepatitis B in life. Or it will never come back. I hope and pray to god that It wont come back.
until there is no hbsab detactable hepatitis can come back, but in the cases of hbsag<500iu/ml no, it is very very rare

5. Plz tell me is there any problm for me...I mean any precautions...or just enjoy the life without fear...I hope u understand.
no problems at all, just monitor in case hepatitis comes back, live a healthy life, do avoid alcool and drugs because they both suppress immune system and damage the liver more than viruses
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Avatar_m_tn
hank u so much for such detailed guidance.

One last question...

HBsAg<iu/ml

Plz explain this test...as i did this test already but the laboratory did not mention any units on the test....Its just stated that Cutoff Value is this and Patient Rate is this...
Plz explain wt kind of test I need to do...which eplain the 500-1500 iu/ml results.

thnx again  
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Avatar_m_tn

it was the old type of qualitative test where the number is the reagent not hbsag quantity so there is no unit or sometimes they indicate the method like s/co or s/n, they usually have a bad sensibility at 1 and cant detect most of hbsag mutants

the assay i am talking about is abbott architect hbsag quantification in iu/ml with diluition 1:1000 for values higher than 250iu/ml
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Avatar_m_tn
these are some articles of my doctor brunetto and others researchers, the first to study and discover the meaning of hbsag quantification

http://www.multiwebcast.com/easl/2010/International_Liver_Congress_2010/4755/maurizia.brunetto.hbs.antigen.quantification.in.clinical.practice.html

http://www.natap.org/2010/APASL/APASL_06.htm

http://www.natap.org/2009/APASL/APASL_02.htm
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Avatar_m_tn
okay thank u so much for ur help and pieces of advice.


Now...wt r my chances to pass this disease to others? Plz explain?
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Avatar_m_tn
1. Is my Hepatitis is acute or chronic?

2. someone told me that if ur Anti-HBs is =ve then u r completely cure...

3. can I get Vaccine right now at this stage?

4. Abbott architect HBsAg is not available in my country.


plz explain  them...these realy strange tests...
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Avatar_m_tn
one question...


What is the hepatitis B surface antibody (HBsAb or
anti-HBs)?

A "positive" or "reactive" HBsAb (or anti-HBs) test result indicates that a person has successfully responded to the hepatitis B vaccine or has recovered from an acute hepatitis B infection.  This result means that you are immune to future hepatitis B infection and you are not contagious. This test is not routinely included in blood bank screenings.


NB: as in my case anti-HBs is reactive that mean recovered from the virus. And there is point that "you are not contagious"? As u said I'm carrier...bt this test is explaining that i'm not contagious.

if u say, I can repeat this test again for the updates.
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Avatar_m_tn
Now...wt r my chances to pass this disease to others? Plz explain?

not possible to have exact numbers, when hbvdna lower than 6iu/ml or even lower, the virus is also undetactable in the sperm but still present in the blood, so sex should be low/moderate risk
the key is always avoiding micro blood contacts by micro open wounds sometimes not visible by the eyes

so there is no escape from this question, as long as hbsg is positive you can pass disease to others by sex and blood

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Avatar_m_tn
1 if hbcab igm negative cronic (chronic)

2 someone who??complitely wrong, it is the opposite

3. can I get Vaccine right now at this stage?
no, you are already infected, all vaccines must be made before getting infection and for diseases like hbv at birth to all population this way there will be no hbv anymore in 1-2 generations

4. Abbott architect HBsAg is not available in my country.
which country are you?we have seen vietnam, china, europe, south africa have

.these realy strange tests.
everything you don tknow might sound strange, they are routine in many countries best hospitals now
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Avatar_m_tn
in the first post you wrote
HBsAg               reactive

check  medhelp healthpages you will find everything you need to know in first link and more if you are willing to read all hbv pages in scnd link

http://www.medhelp.org/health_pages/Hepatitis/HepB-Introduction--Welcome-Page/show/34?cid=153

http://www.medhelp.org/health_pages/list?cid=153
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Avatar_m_tn
What is the hepatitis B surface antibody (HBsAb or
anti-HBs)?
I got this from the website:

"A "positive" or "reactive" HBsAb (or anti-HBs) test result indicates that a person has successfully responded to the hepatitis B vaccine or has recovered from an acute hepatitis B infection.  This result means that you are immune to future hepatitis B infection and you are not contagious. This test is not routinely included in blood bank screenings."


NB: Here in the above Paragraph is clearly written that "You are bot contagious". Plz read the 2nd last line of the above paragraph. Can I do Anti-HBs test?
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Avatar_m_tn
what they say about hbsab is correct and they say not contagious as a general thing but you will not be able to donate blood and organs because cccdna is not cleared complitely from liver cells and minimum quantities of virus can be present but of course only in big quatities of blood not from a small cut.
and you also cannot take immune suppressive drugs or steriods without taking hbv antivirals because in this case hbv can come back

some clear also cccdna decades after clearance of hbsag, this process is very slow because hbsab blocks entrance to other liver cells so that hbv cannot start an infection and the cccdna is blocked in the cells.it is slowly destroyed when liver cells with cccdna dye but it is also persistent for long times because when the liver cells with cccdna duplicates also cccdna duplicates



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Avatar_m_tn
there are also rare forms of cronic (chronic) hbv with both hbsag reactive and hbsab reactive, this cronic (chronic) hbv is due to a mutant in the a determinantof hbsag (an hbsag mutant), so the infection is not cleared by hbsab.they are rare infact there are only a few members of the community with this form

when you see something online check the source, scientific journals or pubmed are very good sources, and especially dates.
knowledge of hbv improves year by year, few things back from 5-10years ago might be even incorrect today
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Avatar_m_tn
Can you explain me what is ment by cronic (chronic) and how I cna find out that the patient is cronic (chronic)
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Avatar_m_tn

cronic (chronic)

hbsag positive test for more than 6-12months or hbcab igm test negative

what is ment by cronic (chronic)
info on link below
http://www.medhelp.org/health_pages/list?cid=153
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