wired case of cured heb b

[noora84]

Dear

I need a consultation for a 52 years old women who suffered from (hepatitis b) since Aug 2006 and have not taking and kind medication and have been doing blood test every 6 months since then and getting a positive result every time until oct-2009 the result was negative and they have repeated the test and got negative again and then they sent some blood samples to the USA to (Detroit boi-medical laboratpries) and made few tests  :


                               test name                                                result

HEPATITIS B VIRUS DNA QL REAL TIME PCR                         NOT DETECTED
HEPATITIS B VIRUS DNA QN REAL TIME PCR                         <29
HEPATITIS B VIRUS DNA                                                   <169              
HEP B Surface AB, Quant                                                    2.20

and the anti-HBS =Negative  which created a question mark on the dr

she also have Rheumatoid and she's on mabthera (rituximab) and because she had Hepatitis she use to take Baraclude (entecavir) 0.5 mg once aday for 6 months before the mabthera. she have a dose of mathera and the doctors advised her to take the baraclude although her liver is clean from hepatitis b , and they also advised her to take the vaccine.

*  what should she do and is it possible that the HEP disappear just like that without the antibodys found in her body ?

[stef2011]

rituximab

no this drug lowers immune system and reactivates hbv with very high rates of deadly flares even in those who cleared acute hbv from years.

all those who had contact with hbv and cleared or have cronichbv must take entecavir or tenofovir before starting rituximab, since the reactivation can be deadly i'd never use this drug

[stefen143]

really an interesting case which needed to be followed-up or investigated. thus this mean that rituximab may have caused the clearing of the virus based on your case scenario? did she really seroconverted naturally or spontaneously or was it with other medications that she may have taken?

[stef2011]

in the tests hbsag quantity is missing, this is the most important test together with hbsab quantity

[stef2011]

the antibodies are always present for anybody, it is just that hbsag is in higher quantity than antibodies so you don't see them
when hbsag is negative and hbab is negative too they are both balanced but she must take etv until hbsab appear in a good number because hbsag can get positive again without a protective antibody titer