New here, newly diagnosed

[MB707]

Hi All,
I've been reading your stories and have found some useful information from the members here. I'd like to thank each of you for sharing your knowledge and experiences -- its all helped me a great deal. Here's my story: I got diagnosed with Hep B 2 years ago by accident. My initial test results were as follows:

HbSag: Reactive
HBSab: Nonreactive *
HB Core AB total: Reactive
HB Core AB IGM: Nonreactive
HBEag: Nonreactive
HBEab: Reactive
HBV DNA: 110 iu
Genotype A
Mutations: BCP Detected
Alt and Ast: under 19


*In the following 2 months after initial diagnosis I did additional blood tests with other labs that showed exactly as above, but my HepB SAB Qual kept showing up as "Indeterminate" instead of nonreactive (this was with two other labs, twice each lab -- showiing up as "Indeterminate".)

I tested HB Sab Quantitative earlier this year (2016) at my family doctor and it came back as 18/Immune. I thought I had cleared, but after 6 months when I tested again with a different lab it came back as Nonreactive on HB Sab Qualitiative. However throughout all this I still test SAG positive.

My questions are: Why the differences in antibody results? Is that my immune system or is that just mistakes in the lab readings?

Is this a recent infection or an old one? My parents test negative, and I don't know how I got infected. No drug use, no tattoos, my husband was/is my only sexual partner, and he doesn't have it so I didn't get it from him. (His HB Core AB is nonreactive and it was determined that he was not vaccinated and subsequently got vaccinated after my diagnosis.)

Am I HB Eag negative because of the mutations or because I naturally seroconverted?

My most recent HBV DNA result is 80iu. Its never been over 120iu. With such low levels is it necessary that I go on treatment if I were to try to become pregnant?  

[StephenCastlecrag]

I am not a doctor. You asked some interesting questions, I will reply with my opinions, not necessary correct.

In the serological test for HBsAb, some labs will just report positive(reactive) or negative(non-reactive). But some labs will report with a quantity, e.g., x IU/L. If x is less than 10 iu/l, the labs mayl comment "negative" or "non-protective".
In general, my opinion is that HBsAb, whether it is "positive" or "x iu/l" is not important AS LONG AS HBsAg is positive.  The reason is that even though you have s-antibodies, they are not the right types for your s-antigen. Why do you have these variant types of s-antibodies is a moot point in the scientific circle.

There is no sure way to find out how long you have been infected. Vertical transmission is the first thing to consider. However, you did say your parents tested HBsAg negative, but was your Mum infected in the past and since then had recovered? One way to check is to test your Mum's HBcAb. Or did you have any medical procedures in the past?

The fact that BCP(Basal Core Promotor) mutation is detected, may or may not indicate how long you had been infected, but in my opinion, it is most likely have to do with the fact that your are HBeAg negative. The theory is that HBeAg seroconversion always involve some mutations in precore/BCP that lead to reduction of serum HBeAg (another contentious issue).

Finally, you do not require treatment now. But if you do consider treatment, please consider  PegIFN as you are genotype A and female, very favorable factors for a cure with PegIFN. Check with your doctor.(no PegIFN at least 6 months before falling pregnant).

[Bm2016]

while I was at the dr. office last month,  the dr. also told me there was a case where one of the patient got the hbsab, then lost HBsAB 6 months later. normally if HBV DNA is undetectable, HBsAG non-reactive, and HBSAB reactive at the same time, then it is a very good indication the immune system is responding and should  be able to suppress hbv on its own, and produce HB surface anti-body for life.

[MB707]

Thanks for the reply. I haven't come across any literature on people developing antibodies in such a rollercoaster way. The doctors couldn't give me a straight answer concerning wether I was long time chronic or recently infected and went chronic because I wasn't able to develop enough of an antibody response. Another doctor says that the Basal Core promoter mutations point to a longtime infection, possibly from childhood. But I have yet to receive a definitive answer from them.