hbsag quantity and hbv DNA

Hi, Stefano 170669
I am chronic hbsag positive carrier (alt/ast normal). My hbv DNA is 72,000 copies/ml. Does that mean I have high hbsag quantities?

[stef2011]

hbsag quantities are not correlated with all other parameters, they have correlation with cccdna which is the only real test to show how many infected liver cells we have (cccdna is the virus tempates).unfortunately no direct test for cccdna are available, but hbsag yes

if hbvdna is equal or less than 2000iu/ml you have high probability to be a heathy carrier with about 11% probability per year to clear hbsag...

you ave the old unit for hbvdna.
hbvdna 72000c/ml/5.8= about 12413iu/ml

so you look like a cronic (chronic) carrier with inactive replication phase, you should check liver damage by fibroscan and if there is damage consider therapy by:

interferon+antiviral+nitazoxanide, interferon for a minimum of 2 years and see if hbsag gets low/negative
this combo therapy has the highest eradication rates

start therapy when you get abnormal alt, because it means your immune system has become active and therapy has the higest rate of response.it doesn t make sense to start a therapy during inactive phase unless you have very severe damage like cirrhosis

[stef2011]

hbsag quantities are not correlated with all other parameters, they have correlation with cccdna which is the only real test to show how many infected liver cells we have (cccdna is the virus tempates).unfortunately no direct test for cccdna are available, but hbsag yes

if hbvdna is equal or less than 2000iu/ml you have high probability to be a heathy carrier with about 11% probability per year to clear hbsag...

you ave the old unit for hbvdna.
hbvdna 72000c/ml/5.8= about 12413iu/ml

so you look like a cronic (chronic) carrier with inactive replication phase, you should check liver damage by fibroscan and if there is damage consider therapy by:

interferon+antiviral+nitazoxanide, interferon for a minimum of 2 years and see if hbsag gets low/negative
this combo therapy has the highest eradication rates

start therapy when you get abnormal alt, because it means your immune system has become active and therapy has the higest rate of response.it doesn t make sense to start a therapy during inactive phase unless you have very severe damage like cirrhosis

[stef2011]

i forgot, you might also monitor hbcab igM, now you have it lower than 0.2s/co and it means immune system is not active
when immune system will become active hbcab igM will rise before alt and hbvdna to values higher than 0.2s/co, that is the best moment to start terapy and eradicate hbv

[lzhmsa]

Thanks for your reply. Happy New Year!

[lzhmsa]

Sorry, I forgot to mention that the following is my test result.
Hepatitis B e-antigen: negative,
Anti-hepatitis B e-antibody: positive,
Anti-hepatitis B core: positive,

Does it mean I am still in an inactive replication phase? Am i infectious now?

[stef2011]

Hepatitis B e-antigen: negative,
Anti-hepatitis B e-antibody: positive,
Anti-hepatitis B core: positive,

hbeag and hbeab antibody were thought to put the carrier in inactive state and to be positive but this was a very old view when little was known about hbv and most tests were not available.

hbeag is not needed by virus (only needed to infect babies getting trhu placenta) so the virus just abolish hbe production to escape immune system pressure

the only good thing about hbe negative is that response to drugs is faster, in particular nitazoxanide is more potent to make hbsag lowering and negative

on the contrary hbe positives have better response on tnf and interferon but these are still very low percentages like 16 to 30% hbsag eradication on combos and longer interferon use.actually the virus might be considered weaker to the immune system when hbeag is ppositive but more aggressive on replication

[stef2011]

Does it mean I am still in an inactive replication phase? Am i infectious now?

replication is always active although and you are always infectious as long as hbsag is positive

to know if you are inactive and that you have about 11% probability of hbsag negative per year you neeed:
hbsag<500iu/ml
hbvdna<2000iu/ml
this has more than 90% sensibility on what i said above

but also:
hbsag<1500iu/ml
hbvdna<2000iu/ml
can confirm both inactive and higher eradication rates but sensibility is about 80% with this higher hbsag

active hbe negative carriers have usually hbsag from 3000 to 10000iu/ml and sometimes even higher

hbe pos have hbsag from 10000iu/ml up

[lzhmsa]

thank you, stefano 170669