my wife tested positive for HBV, 15 weeks pregnant

[Mustafa_Iqbal]

Hi Steven,

Firstly, congratulations on getting this forum set up... this will definitely be a great help for people like me seeking answers for themselves or their loved ones.

My wife is now 15 weeks pregnant with our second baby and has been tested positive for HBV. I pulled her old test reports from the first pregancy about more than 4 years back from now and they were non-reactive for the HBS AB... it is surprising to know now that they did not do the HBS AG test. She was vaccinated about 6 years back from now and received all three shots. Since we were in Pakistan then and due to relatively greater occurance of Heb-B there, the vaccine centres were administering it a bit differently as a common practice. They give the three shots each following month, (instead of 1, 2 & 6), then followed by a booster a year after receiving the first dose. My first child also received the three shots with the same schedule starting a month after his birth.

I have just received my son's HBV AB reports literally a couple of hours ago and it shows very good immunity levels of >1,000. I am also tested negative for HBS AG and have immune levels of >390.

We are seriously concerned for my wife. Her HBV profile and DNA Quantitative tests are indicative of probably a chronic infection, but the LFT results came out fine. THe gastroentorologist suggests to have regular LFT done every 2 months and will repeat the HBV profile and DNA test after 6 months to finally decide where the virus stands. Currently, the DNA result (done at LMM France) is 7.7 log copies/mL i.e. 9430544 UI/mL, which seems to be very high. Everyone says its quite a high count.

I need your advice on:
1/ Is it possible for the vaccine to have not worked? Did she get the correct alternate vaccine schedule?
2/ what are her chances to get cured?

Will await your feedback.

Kind regards,

Mustafa

[zellyf]

Typically with an infected mother the newborn is given a shot of immunoglobulin and teh first shot of the vaccination series.  This is done in the first 12 hours of birth. In over 95% of cases this is sufficient to prevent a vertical transmission. All three of my children were delivered w/o c-section, all were treated at birth (with me issuing constant reminders at about 1 minute intervals) and all are HBV free and protected.  

I'm not a big fan of unnecessary c-section, which is considered major surgery, and in this case I do think it unnecessary.  The risk outweighing the benefit as there is no guarantee that the scalpel wouldn't nick the baby or some other skin trauma wouldn't occur in a c-section.  I was never advised to consider a c-section nor have I ever heard or read of this as an option.

Then again, I'm not a doctor nor do I work in the medical field.  Just the opinion of a lay person.

Have fun with gender day! I love that day.  Let us know the happy news.

Cheers,
zellyf

[Mustafa_Iqbal]

Many thanks for your help. Will keep you posted on the outcome from her next labs.

I will complete my 10 years of vaccination this year and still have HBVAb levels of 390. Do you think I should get a booster this year? Looking at the counts for my son, doctor says he's very much immune and may need a booster 10 years later... what to you say to that?

Also, we are considering having a c-section for our next baby to minimize possibility of vertical transmission as one of my work associates, who is into medical profession, suggested that vertical transmission mostly occures during normal birth due to scarred body tissues of the baby while it passes through the birth canal. Scarred / teared skin tissues are the reason why babies are red when born naturally.

Any suggestions?

My wife has her routine OB/Gyn appointment for 17th weeks on Sat 23rd Feb and your feedback prior to that will help us discuss this with the doc as well.

Hope to find out baby's gender this week too!!! :o)

best of luck to you too!

regards,
M

[stevenNYer]

Zelly explained the immuno-tolerant phase well.

Your posted labs are indicative of a chronic infection.  

Usually for chronically infected the  IgM Anti-HBc is negative.  
Acutely infected, the  IgM Anti-HBc is positive.  

My guess is that your wife completed the vaccination but didn't produced the antibodies needed for immunity.  Sometime later she was acutely infected and is still to be determined if she could clear the virus on her own.

I would redo the labs in a month or two to moniotr this.  Good luck.

[zellyf]

In the immuno-tolerant phase the body does not recognize the HB virus as a foreign invader.  This is common when one has been infected in infancy/childhood.  The immune system *tolerates* the virus and does not try to fight it.  This allows the viral levels to climb very, very high.

This is not damaging to the liver because that damage is actually the result of one's immune system attacking the virus, not the virus itself.

At some point, typically when the immune system matures, the body recognizes the virus as a intruder and begins to mount an attack.  That is the next phase of the disease.

[Mustafa_Iqbal]

Hi Steven,

Here's the complete profile:

HBsAg:                   Postive
HBsAb:                   0.0mlU/mL
HB "e" Antigen:        Positive
HB "e" Antibody:      Negative
HBV core antobody: Positive
IgM Anti-HBc:          0.0 PEIU/ml

Do let me know what you think...

Cheers,

M

[Mustafa_Iqbal]

Many thanks for your feedback... apologies for delay in getting back. Just logged in today after a very busy weekend.

Zelly, the doctor adviced only to take the antibody test, which would determine if he did not have antibodies, then could have asked us to go for the HB surface antigen test. Since he is very much immune, so doctor is satisified and says there's no need for the HBSAG.

Steven, I am at work and do not have her reports on hand at the moment. Will get back to you with the eAntigen and eAntibody status reports later today. My wife is 27.

Having discussed with the GI recently, he mentioned that the HBSAG count they got in their lab facility was quite borderline and the lab actually had to consult him for determine whether to call it a negative case or positive. They then tested it at an external lab facility, which gave negative results!!!

If we put together her medical history and how we found out about her being a career...
1/ received vaccine (all three shots) in 2002 at a month interval each
2/ tested negative upon her first pregnancy 5 years back
3/ moved to Dubai in March 06 and had immigration medical test, covering HIV, HB, HC and TB... tested negative for all
4/ tested positive for HB in Jan 08
5/ 51 months old son's results show high immune levels hence negative for HBV (could be indicating that she was not carrying the virus when he was born, considering the fact that he received his first vaccine shot a month after birth)

Could the above mean that it is accute?

Steven, can you please also explain to me the relationship between her being immuno-tolerant and high DNA count? is this good to be immuno-tolerant? does high DNA count indicate that the body is fighting back?

Many thanks for your very detailed feedback. I look forward to your support.

All the best... Mustafa

[stevenNYer]

Zelly answered your 1st and 2nd question.  I think it's likely that your wife was infected before the vaccination, probably at a young age.  If she would have gotten infected as an adult, she would have had acute hep symptoms.

What the GI said makes alot of sense.  Since the test just came back positive for the surface antigen, she has HepB.  At 6 months if still positive, then it's basically confirmed to be a chronic infection.  If this case, as zelly points out, a cure is highly unlikely.  Then it becomes disease monitoring and management.

If your wife is in the immuno-tolerant stage (and she very well may be), her DNA could be high.  7 or even 8 logs are not uncommon.  But the immune system ignores the virus, so there is little to no liver cell damage, hence the normal ALT levels.  So I think the doctors wants to see if your wife is having an immuno-response to the virus.  If so, labs every two months could probably catch the ALT flusctuating and going up.

If your wife is still in the immuno-tolerant stage and she pregnant, I don't think her doctor will treat.  Maybe towards the very end of the pregnancy to reduce viral load to further minimize the risk of vertical transmission to baby.

How old is your wife?
What is her eAntigen and eAntibody status?

[zellyf]

Steven,

Does it seem like 6 months is too long to repeat the DNA on a viral load in the millions?  

It is possible that she was infected before the vaccine was administered. It is also possible to be a non-responder to the vaccines...not entirely uncommon in fact.  

Mustafa, if she is chronically infected then there is no cure. Fortunately, there is lots of life with chronic HepB with proper monitoring and well considered treatment options.  

When your baby is born he/she should receive a dose of immunoglobublin and the first vaccine w/in 12 hours of birth.  What was the result of your son's HB surface antigen test.

Steven will have lots more for you.  Best.