hepatology

we got viral serology report today for a family member today.it says hep b surface antigen is detected,hep b core antibody is detected,hep b e antibody is detected,antibody to hbv not detected.could someone inform me wether this means that my family member has got acute,chronic or dormant (non active hep b )is present?thanking you in anticipation

[stef2011]

first of all of family must check for hbv infection and if not present or cleared already get vaccine immediately

to know the state of infection and the level of liver damage the following is necessary, i see you are from UK one of the worst healthcare systems with US for hbv so pobably you will have a hard time to find tests and machines that in other countries are available in every hospital liver unit, we have seen they have them also in china and today we saw hbsag quantification in ghana

hbsag quantification by abbbot architect machine will tell you the quantity of hbsag, in case of cronic (chronic) hbv a value <500iu/ml is 100% inactive carrier in immune clearance phase

hbcab igm, possibly quantitative, if negative infection is cronic (chronic), if quantitative is less than 0.08s/co immune system is inactive at the moment the test is done, so inactive disease

hbvdna pcr sensitivity 10-20iu/ml, tells you hbv replication level, gives an idea of liver damage and liver cancer/cirrhosis risk if continuatively high

ultrasound, to check for liver cancer, this exam must be made every 6 months.it can detect only very advanced cirrhosis with nodules it cannot detect fibrosis or liver damage

fibroscan, it detects liver damage, fibrosis of the liver

precore and bcp mutants, if present hbv is very aggressive, these mutants are considered liver cancer markers, in case positive hbvdna must be kept undetactable to prevent liver cancer

alt/ast and liver pannel tests, but these say almost nothing about general disease, they only tell you damage at the moment but not damage accumulated, they can all be normal even with cirrhosis and usually get abnormal in end stage cirrhosis or very acute hbv

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

[stef2011]

forgot to say it is difficult to find good and updated liver specialist, if the infection is cronic (chronic) do check for the best ones and listen to more than 1 doc before choosing,

i do wish it is acute and in that case clearance happens in 95% cases

this is the latest research and most doctors are not aware and confuse cronic (chronic) hbv with inactive:
inactive hbv in immune clearance:hbsag<500iuml (range 0.05-1500iu/ml), hbvdna<2000iu/ml, alt1500iu/ml, hbvdna flactuates from und to thousands, alt>19
cronic (chronic) hbv active phase: hbsag>1500iu/ml, hbvdna>2000iu/ml, alt>19

the only drugs approved as firstline in order of potency:
tenofovir, entecavir, interferon, no other durg apporved or safe, truvada will be approved soon but not necessary as firstline

nitazoxanide, available as off label, active on immune system and hbsag, boosts in combo with drugs firstline but off label, only very mild sides, no resistance