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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
To add one point:
For the past 10 days my wife has again started to feel the symptoms, mainly nausea, is this normal given her only slightly alleviated ALT/AST? how should I interpret this phenomenon?
For the past 10 days my wife has again started to feel the symptoms, mainly nausea, is this normal given her only slightly alleviated ALT/AST? how should I interpret this phenomenon?
Stephen,
Thanks a lot for your opinions. Maybe to stay at status-quo would be the best scenario for her at this moment.
As of ARC 520, we are seeing the doctor on Feb 14th (the coming Friday), The hospital is one of the two hospitals where the trials will be taking place.
The doctor we are seeing is not the one conducting the study, but he's the best they have, he's a professor. I'll try to ask him. It looks like the enrollment has finished, so maybe ask him about efficacy if the test has started. It's just a single-shot trial so it should be fairly quick.
Thanks a lot for your opinions. Maybe to stay at status-quo would be the best scenario for her at this moment.
As of ARC 520, we are seeing the doctor on Feb 14th (the coming Friday), The hospital is one of the two hospitals where the trials will be taking place.
The doctor we are seeing is not the one conducting the study, but he's the best they have, he's a professor. I'll try to ask him. It looks like the enrollment has finished, so maybe ask him about efficacy if the test has started. It's just a single-shot trial so it should be fairly quick.
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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?