Strange Results

[mark6247]

Hi, I just joined this site. Hoping to gain some knowledge regarding my results and prognosis.

These tests were ordered on 5/28/09.

Hep B Surface Ab -  4.94 (index value of 1.00 is equivalent to 10 mIU/mL)
Hep B Surface Ag - Confirmation Positive
Hep B Core Ab, Total - Positive
Hep B Core Ab, IgM - Positive

These tests were ordered on 06/01/09
Hep B E Ag - Positive
HBV DNA -  17400000 IU/mL 66600000 copies/mL

The really confusing part is that the lab report's antibody reference indicates "consistent with immunity"

As I understand it now I have an acute infection. Has anyone here seen these weird results where antibodies and antigens are simultaneously present? Does it indicate that my immune system is already fighting the infection?

Also, at it's peak on 06/02/09 my ALT was 2147 and my AST was 1134 and Bilirubin total was 11.7.

My latest liver functions, taken on 08/06/09 were; ALT 26, AST 23, Bilirubin Total 0.6, Albumin 4.6

My liver functions have returned to normal. I still experience some fatigue. I get sleepy easily, even after plenty of sleep. I have had palmar erythema since the end of May and it's only shown moderate improvement.

Hep B Foundation advised me that I should retest for hep b on Nov 28, 2009 using the standard three panel.

Can anyone add any addition information or give me an encouraging prognosis? Any specific foods I should avoid? I quit smoking and drinking alcohol and I'm not working so I get plenty of rest. I take no meds and I even stopped eating red meat for 8 weeks and limited other meats.

Any help is greatly appreciated!

[Sharp7]

If you look around on this forum, you will come across a few others who tested positive for both HBsAg and HBsAb. It is not common, but yes, I have come across such people here.

You seem to be doing all the right things, as far as I can tell. Do let us know how your HBV DNA VL and ALT progress.
Do you have HBeAb also?

Oily food makes several people with HepB uncomfortable. If you feel this way too, it is best you avoid it.
66.6E6 copies/ml is not a good sign if it stays that way for a long time.

[mark6247]

Thanks for the reply. I haven't had the test for HBeAb. I have been getting a hepatic functions panel every 3-4 weeks. Is it possible to still have the E antigen present if the surface antigen has cleared?
I ask because my next tests are HBcAb total, HBsAg, HBsAb. The HBV DNA test is quite expense so I thought I should see if the antigens clear first. If I clear the surface antigen shouldn't that signal no real need to retest for the HBeAg or HBeAb or even another DNA?

I don't have employment or insurance so I'm not under that care of a doctor. The initial diagnosis was through hospital (ER entrance). Unfortunately for me, it was a non-profit hospital and they took complete advantage of my situation. They kept denying the hep b diagnosis and kept me there trying to say I had pancreatic cancer. I began to feel like I was being financially raped after 6 days so I damanded to be released. They managed to get the bill to more than $22K while only giving me the diagnosis of hep b after I demanded to be released. The first 4 test results were in their hands on the second day and the last two weren't even ordered until I started making waves. I'm fighting this injustice.

So, that's why I'm doing it all myself now. I now order the tests I need online and interpret the results myself. So far I have only been getting a hepatic functions panel. If I get to a stage that I need prescription drugs I will obviously need a doctor to write the prescription but I will cross that bridge when I get to it.

Thanks for sharing your knowledge.

[Sharp7]

Well... you are eAg positive... so I think it is a good idea to see if you have eAb as well. This is not an expensive test -- in India it costs less than a tenth of what the DNA viral load test costs here.

"Is it possible to still have the E antigen present if the surface antigen has cleared?" There is such a thing as "occult hepatitis b" where sAg is not detected, but there is still a good amount of HBV DNA. I don't know about E antigen status in such cases. Anyway, I don't know why you ask about that. This is clearly not your situation.

Tests like HBsAg, HBsAb, HBeAb, etc. are "qualitative" tests: their numbers do not have much meaning... the only thing that you will get out of this test is whether you are positive for something or not. This is not a good way to monitor the progress, especially in a case such as yours: with sAg and sAb both positive. When both these are positive, I expect a lot of transient behaviour (but I'm not a doctor), and the only tests that can help you keep track of transient behaviour are ALT (when a lot of liver damage may be underway) and HBV DNA VL (monitoring would be especially important when ALT levels are low). I agree that HBV DNA VL tests are expensive... perhaps you can contact one of the drug manufacturers? In quite a few countries, these drug manufacturers help out when people can't afford meds.

I am sorry to hear about your ER experience. A lot of companies (medicine or not) are run by a** h***s. You must have felt terrible about hearing about pancreatic cancer! That is a particularly painful way to die.

Just a thought, but if you find my questions to be in bad taste, please disregard it. What happens if you default on your bill of $22K? Will they put you in jail? If so, will you get better medical attention in jail?

Please read http://www.medhelp.org/health_pages/Hepatitis/HepB-Introduction--Welcome-Page/show/34?cid=153 first. But I guess you would already know most of the stuff there by now. Still, it is good to see if you have missed something.

Then, you can go through http://www.medhelp.org/health_pages/Hepatitis/HepB-Research-Info/show/939?cid=153 ; The first link there is particularly helpful. It is a good textbook of Hepatology.

Some forums on MedHelp are run by doctors... Hep C, Liver Transplant, etc. Perhaps you can post your questions there too... I don't know if they would reply, because your questions would not be directly related to that particular forum, but it does not hurt to try...

[Sharp7]

Pegasys, Baraclude and Viread are good choices of medications to begin with. (One of them at a time, not all of them at once!)
Perhaps you can visit
http://www.pegasys.com/
http://www.bms.com/pages/default.aspx (Baraclude)
http://www.viread.com/en/index.cfm

and find out which ones are willing to help you with medication and tests.
Though I paid for medication entirely, Roche and BMS helped to fully and partially (respectively) finance my HBV DNA VL tests. Not because I asked them for it, but it is part of their standard sales package here!

[mark6247]

They cannot put me in jail. Worst case scenario I will have to file for bankruptcy and that will eliminate the debt. No matter what happens, as a non-profit hospital, they will benefit. The system provides incentive to fleech the uninsured. Frankly speaking, I think they should pay me for scaring me with the whole pancreatic cancer thing just to make more money.

Thanks for the links. I will look into them. I have just taken more tests to see if I've cleared the virus. Waiting on results now. If the surface antigen is negative and the anitbodies come back greater than 10, should I still get another HBV DNA and also test for e antibodies?

Just thinking from a logical perspective it seems like the e antigen would be negative if the surface antigen is negative. Forgive me if that's a naive question I'm still learning about this virus.

Thanks.

[Sharp7]

no no... I meant, would it be in your best interest to end up in jail :-).

"Just thinking from a logical perspective it seems like the e antigen would be negative if the surface antigen is negative."

HBsAg+ with HBeAg+ is common, and there is usually a detectable viral load (DNA).
HBsAg+ with HBeAg- is common, and there is usually a detectable viral load (DNA).

HBsAg- with a detectable viral load is very uncommon (occult HepB). I do not have info on whether HBeAg would be positive or negative in such a case. I won't be surprised to see HBsAg- with HBeAg+ because these two proteins are created by entirely different sections of the HBV DNA. Again, all this clearly does not apply to you: you are HBsAg+.

[stevenNYer]

Sharp7 wrote me about your thread.  First a disclaimer: I am NOT a doctor.  I am just a regular person with chronic HepB.

There is good news on based on your posted labs.  Sharp7 already pointed alot of it out.  The best thing is that your "Hep B Core Ab, IgM" is Positive.  Together with a large initial DNA and very elevated ALT (2147), AST (1134), Bilirubin (11.7) are classic markers for an acute infection.  Acute infection is a good thing.  And since your labs are trending back down, it a sign that you are clearing the virus.  If you are an adult, you are very likely (90%) to clear the virus and develop immunity naturally.  Also for acute infections, there is a period where both HBsAg and HBsAb could both positive.  Again, this is also sign that you are clearing the virus.

No need to do anything now but to rest and wait for your HBsAg and HBsAb results.  If they are HBsAg - and HBsAb + and your ALT are back to normal, there is no need for DNA test since you need to consider lab expenses.  Again, everything is looking to be in your favor.  Good luck.  Keep us informed.

[britgirl477]

Yeah i agree with Steven. When I read thro your results I immediately thought acute infection. I have just cleared an acute infection mark6247, and so know that the IgM antibody as Steven has already pointed out is a clear sign of being in an acute stage of the virus. You just gotta love that IgM antibody eh???? It was my best pal for almost 8 months.
Brit

[mark6247]

Thanks alot for sharing your knowledge. I hope to get results in the next few days. I know it's not November (six months from symptoms) but I just couldn't wait to see if I'm clear of this virus. It's really got me in a state of limbo and knowing that I'm cleared will be like getting out of jail. I will keep you posted. Thanks again!!!

[britgirl477]

Totally understand how you are feeling right now. I had about 8 months of waiting for it to go. After I passed the 6 month mark I was in a frantic state, but then I began to get used to the idea that I may have it for life and just decided to find out as much as I could about it and battle it that way. If you had symptoms in May then yeah NOvember is the official cut off date but you could take a wee bit longer as there have been a couple of folks on this site like me who have cleared it around 8 months or so. You need to stay calm and get lots of rest to have best chance of clearing it and whatever you do DO NOT drink alcohol. As Steven said, you have good chance of clearing and your bloods seem to indicate that your body is fighting it off well. I will keep you in my thoughts and you will get rid of the wee blighter soon. Keep us all posted.
Brit

[mark6247]

Thanks for the encouragement and congrats on clearing the virus!

I'm glad I found this site. There are lots of places on the net to get support for hep c, but hep b hasn't been so easy. I have done and incredible amount of research on this virus and it seems like it can be a little different for each person that gets it. This site has been great and it's only my second day here.

Thanks so much to everyone. The time you give to share your knowledge doesn't go unappreciated!

[mark6247]

Hi, hope all is well with those battling this virus.

I received the results of my latest tests. As I had stated in my previous post I couldn't wait the full six months to see if I had beaten this virus yet. Unfortunately I have not.

My original tests from 5/28/09 had shown that my antibodies were at 4.94, which I'm now thinking must have been an error of some sort. Reference: 0.00-0.99

This test result, taken on 09/08/09, was as follows:

HBsAB   0.5
HBcAB   Positive
HBsAG   Positive

The IGM test was not performed, however, it was positive on the 5/28 test.

I don't know what happened with the 4.94 vs 0.5 thing. My only guess is that perhaps it should have read 0.494?

I also checked my liver functions again and those numbers were even lower than last time.

ALT dropped from 26 to 21
AST dropped from 23 to 20
Alk Phosphatase dropped from 66 to 64
Bilirubin, Total dropped from 0.6 to 0.4
Bilirubin, Direct dropped from 0.30 to 0.10
Albumin, Serum stayed the same at 4.6
Protein, Total, Serum rose from 6.9 to 7.2

I think my course of action now is to wait until November, 28 2009 and take these tests again. I suppose I could take the HBV DNA test and learn if the viral load is dropping but it's just too expensive. I've searched for it online but $650 is the cheapest I have found. I have no insurance. Does anyone know of a way the get this test done for less? Should I just wait til November and see what I know then?

Thanks for all the help and support!