Aa
Wife saw spontaneous HBeAg seroconversion in <1 month, HBsAg lowers
Guys, I hope to get some ideas from you on my wife's situation. She's not on any treatment now.
As I mentioned in an earlier post my wife was diagnosed to have activated her Hepatitis B after she gave birth to our daughter in Jan 2014. The new news is that in latest checkup we found out that she has quickly seroconverted HBeAg within one month. ALT & AST are both very close to normal ranges now but still slightly above. HBV DNA undetectable (<1,000 copies/mL).
Another thing is that her HBsAg dropped from 1128 IU/mL one month ago to 505 IU/mL. I kinda feel this is all positive movements, but not knowledgeable enough to tell:
1. Why did the HBeAg seroconversion happen so quickly in 30 days? Any chance of a bounce-back?
2. ALT/AST is still not normal yet although DNA is already und, but shall I consider this as a good sign since this might indicate a chance of a HBsAg further drop?
3. What options do I have now? to wait for another month or start interferons?
4. Am I crazy to imagine that she would clear HBsAg all by herself and develop HBsAb without any drugs/interferons? What all happened was just a bit dramatic and beyond expectation to me.
Thank you everyone for your opinions!
=====Her Data=====
On Jan 6, 2014:
HBsAg: 1128 IU/ml
HBsAb: <6.4 mIU/ml
HBeAg: 224 CI
HBeAb: <30 INH%
HBcAb: 99.9 INH%
ALT: 116 @ Jan 4; 195 @ Jan 6; 173 @ Jan 8
AST: 130 @ Jan 4; 130 @ Jan 6; 98 @ Jan 8
HBV DNA: 5.4x10^5 copies/ml
On Feb 5, 2014:
HBsAg: 505 IU/ml
HBsAb: <6.4 mIU/ml
HBeAg: <1.0 CI
HBeAb: <76.8 INH%
HBcAb: 99.2 INH%
ALT: 51 IU/L
AST: 38 IU/L
HBV DNA: <1,000 copies/ml
She's Asian, 27 years old, genotype unknown
We believe she got infected before 10 years old, but not when she's born.
My post when we first discovered her activation
http://www.medhelp.org/posts/Hepatitis-B/Need-advice-before-seeing-doctor-again/show/2078206#post_9844997
As I mentioned in an earlier post my wife was diagnosed to have activated her Hepatitis B after she gave birth to our daughter in Jan 2014. The new news is that in latest checkup we found out that she has quickly seroconverted HBeAg within one month. ALT & AST are both very close to normal ranges now but still slightly above. HBV DNA undetectable (<1,000 copies/mL).
Another thing is that her HBsAg dropped from 1128 IU/mL one month ago to 505 IU/mL. I kinda feel this is all positive movements, but not knowledgeable enough to tell:
1. Why did the HBeAg seroconversion happen so quickly in 30 days? Any chance of a bounce-back?
2. ALT/AST is still not normal yet although DNA is already und, but shall I consider this as a good sign since this might indicate a chance of a HBsAg further drop?
3. What options do I have now? to wait for another month or start interferons?
4. Am I crazy to imagine that she would clear HBsAg all by herself and develop HBsAb without any drugs/interferons? What all happened was just a bit dramatic and beyond expectation to me.
Thank you everyone for your opinions!
=====Her Data=====
On Jan 6, 2014:
HBsAg: 1128 IU/ml
HBsAb: <6.4 mIU/ml
HBeAg: 224 CI
HBeAb: <30 INH%
HBcAb: 99.9 INH%
ALT: 116 @ Jan 4; 195 @ Jan 6; 173 @ Jan 8
AST: 130 @ Jan 4; 130 @ Jan 6; 98 @ Jan 8
HBV DNA: 5.4x10^5 copies/ml
On Feb 5, 2014:
HBsAg: 505 IU/ml
HBsAb: <6.4 mIU/ml
HBeAg: <1.0 CI
HBeAb: <76.8 INH%
HBcAb: 99.2 INH%
ALT: 51 IU/L
AST: 38 IU/L
HBV DNA: <1,000 copies/ml
She's Asian, 27 years old, genotype unknown
We believe she got infected before 10 years old, but not when she's born.
My post when we first discovered her activation
http://www.medhelp.org/posts/Hepatitis-B/Need-advice-before-seeing-doctor-again/show/2078206#post_9844997
Best Answer
Stef & Stephen,
We received the HBsAg, 329 IU/ml. declined from 1100 in Jan to 500 in early Feb and now 329 IU/ml. ALT/AST=37/30, HBV DNA=6.577 copies/ml.
The doctor made some points:
1. He agreed to have another blood test next month, before making a decision on therapy.
2. After I (again) suggested interferon because HBsAg declined, he again said HBsAg is not that useful, firstly because her viral load came back to 6,577 copies/ml,
secondly because pegsys even if successful, there is still risk of HCC or cirrhosis. However I do remember him saying in previous meeting that "If you seroconvert HBsAg before 50 then you dont have HCC risk". He's a researcher so that must be paper-supported. Not sure whether he's saying something different now because DNA is no longer und.
BTW, his attitude towards interferon is not alone in HK, the other doctor we saw also said "Pegsys is rarely recommended due to sides and low successful rate, only for those who's young and willing to put it all-in for once". I think it comes from their experience.
You guys have all given me your valuable opinions above, so I guess not much has changed here. But if I was really missing some treatment window here by waiting for another 1-3 months doing nothing, please do tell me...
I think if we do nothing here what will likely to happen is HBsAg stops declining (or even go up), viral load go up, AST/ALT back to normal (already almost normal). Can I consider that as an immune tolerance stage and thus no therapy would be needed?
Thank you guys for your opinions!
Below is a link to her complete record, easier to read.
https://docs.google.com/spreadsheet/ccc?key=0Aof1yq4cmKBmdGxNSGFtZVQ2eFNTS19BTmg4Ri0wemc&usp=sharing#gid=0
We received the HBsAg, 329 IU/ml. declined from 1100 in Jan to 500 in early Feb and now 329 IU/ml. ALT/AST=37/30, HBV DNA=6.577 copies/ml.
The doctor made some points:
1. He agreed to have another blood test next month, before making a decision on therapy.
2. After I (again) suggested interferon because HBsAg declined, he again said HBsAg is not that useful, firstly because her viral load came back to 6,577 copies/ml,
secondly because pegsys even if successful, there is still risk of HCC or cirrhosis. However I do remember him saying in previous meeting that "If you seroconvert HBsAg before 50 then you dont have HCC risk". He's a researcher so that must be paper-supported. Not sure whether he's saying something different now because DNA is no longer und.
BTW, his attitude towards interferon is not alone in HK, the other doctor we saw also said "Pegsys is rarely recommended due to sides and low successful rate, only for those who's young and willing to put it all-in for once". I think it comes from their experience.
You guys have all given me your valuable opinions above, so I guess not much has changed here. But if I was really missing some treatment window here by waiting for another 1-3 months doing nothing, please do tell me...
I think if we do nothing here what will likely to happen is HBsAg stops declining (or even go up), viral load go up, AST/ALT back to normal (already almost normal). Can I consider that as an immune tolerance stage and thus no therapy would be needed?
Thank you guys for your opinions!
Below is a link to her complete record, easier to read.
https://docs.google.com/spreadsheet/ccc?key=0Aof1yq4cmKBmdGxNSGFtZVQ2eFNTS19BTmg4Ri0wemc&usp=sharing#gid=0
Thank you Stephen and Stef,
My best hope is of course that we would see a decrease of HBsAg (result not out yet), then I can push a case for Peg (with or without TDF), though looks like I really need to persuade the doctor.
Another hope I have is that she will probably go back to immune tolerance stage. She has went through immune clearance => immune control => weak immune clearance with ALT/AST = 37/30. Maybe it's possible for her to set back to just a carrier again.
I will post her HBsAg once we got it.
Thank you guys again for following up, you guys had given me a lot of courage and I'll try to contribute to the community in my ways.
My best hope is of course that we would see a decrease of HBsAg (result not out yet), then I can push a case for Peg (with or without TDF), though looks like I really need to persuade the doctor.
Another hope I have is that she will probably go back to immune tolerance stage. She has went through immune clearance => immune control => weak immune clearance with ALT/AST = 37/30. Maybe it's possible for her to set back to just a carrier again.
I will post her HBsAg once we got it.
Thank you guys again for following up, you guys had given me a lot of courage and I'll try to contribute to the community in my ways.
We have not received quantitative HBsAg yet, but the doctor kept emphasizing that it is "not very useful".
on the contrary this is the most important test because if this increases to higher than 1000iu/ml you lose all possibilities to clear by peg.i d go for peg or tdf and then peg as soon as possible before the chance is lost
tenofovir will make hbvdna undetectable but hbsag may continue to rise despite tdf
is genotype B or C?
of corse the goal here is hbv cure, if we mean to manage the infection only there is no rush at all and the rush of the doctor to start antivirals is not justified becuase there wont be liver damage so fast and fibroscan can track when this will happen and then tdf is needed
on the contrary this is the most important test because if this increases to higher than 1000iu/ml you lose all possibilities to clear by peg.i d go for peg or tdf and then peg as soon as possible before the chance is lost
tenofovir will make hbvdna undetectable but hbsag may continue to rise despite tdf
is genotype B or C?
of corse the goal here is hbv cure, if we mean to manage the infection only there is no rush at all and the rush of the doctor to start antivirals is not justified becuase there wont be liver damage so fast and fibroscan can track when this will happen and then tdf is needed
I would wait to see if the viral load comes back down again and the e-antigen turns negative again. There is no rush to start medication, in my opinion.
We got an update on data. We havn't got the whole thing but looks like:
1. HBVDNA bounced back to 6,576 copies/ml, from previous <1,000 copies/ml
2. HBeAg re-appeared reactive. She had seroconverted HBeAg before during 2014-Jan~2014-Feb short period of time.
Doctor said in the phone that the DNA suppression and e-seroconversion we saw before were just a temprary immune responce after She delivered the baby. When that stage ends DNA and HBeAg will bounce back like what we are seeing now. He suggested us to start TDF. Her ALT/AST is 37/30, while the lab's high-end reference is 36/30.
We have not received quantitative HBsAg yet, but the doctor kept emphasizing that it is "not very useful".
We didn't immediately agree on taking the meds, but suggested repeating a blood test after one month. Because my thinking is, since she's getting to the end of the "immune flare" stage, will she set back to a immune tolerence stage again?
I will post full result after we got all reports. Thank you guys for your opinions!
1. HBVDNA bounced back to 6,576 copies/ml, from previous <1,000 copies/ml
2. HBeAg re-appeared reactive. She had seroconverted HBeAg before during 2014-Jan~2014-Feb short period of time.
Doctor said in the phone that the DNA suppression and e-seroconversion we saw before were just a temprary immune responce after She delivered the baby. When that stage ends DNA and HBeAg will bounce back like what we are seeing now. He suggested us to start TDF. Her ALT/AST is 37/30, while the lab's high-end reference is 36/30.
We have not received quantitative HBsAg yet, but the doctor kept emphasizing that it is "not very useful".
We didn't immediately agree on taking the meds, but suggested repeating a blood test after one month. Because my thinking is, since she's getting to the end of the "immune flare" stage, will she set back to a immune tolerence stage again?
I will post full result after we got all reports. Thank you guys for your opinions!
Have an Answer?
You are reading content posted in the Hepatitis B Community
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
1 Obviously, your wife has seroconvverted her e- antigen naturally. During pregnancy, the immune system is naturally suppressed because of the fetus. So there is a rebounce in the immune system after birth. I think you will find what happened to your wife is not rare. The e-seroconversion is always a bit of a mystery. It heralds the end of immune clearance and transition to the immune control (inactive) phase. There is a chance of going back to e-antigen positive, but unlikely in my opinion because she did it naturally.
2. The qHBSAg may drop further, but unlikely because her ALT is really not that elevated, but that is just a guess.
3. I have no idea whether she should start IFN to see if it will help her to clear the virus. You may like to ask her doctor.
4. In the natural history of HBV, your wife may stay in this phase for a very long time with some chances of eventually losing her HBsAg altogether. However, in a percentage of patients, they will transition to the immune escape (re-active) phase due to mutation of the virus. If your wife' qHBSAg drops below 100 iu/ml, this would indicate she is in a truely inactive state. So an annual check-up is important.
Finally, did you find out anything about arc520 clinical trial?