I’m seeking knowledge on behalf of my mother, she was recently diagnosed of an acute hepatitis b infection, her viral load is considered low 415, and strange thing is she has anti body surface at same time, I dont know if this is a goos sign
she was put on tenofovir alfmanide but apparently she reacted to it, she had severe jaundice and anemia though there are several tests to see if there was another cause, the results are not out yet
But the doctor has stopped tenofovir currently, they want to monitor her without medication yet since its acute infection (Hope its a good idea) she’s just on live supplements mostly and good diet then rest, her appetite is actually good, she eats well
Sorry to hear about your mother. I’m not a doctor, but hopefully the infection may be on its way to resolving itself. Did she have a core antibody (IgM) to confirm that it is in fact an acute infection? This antibody generally appears soon after a hepatitis B infection starts, and goes away after a few months. Otherwise, you can probably assume it’s acute if she had a known recent exposure to the virus.
Please keep us posted on how she’s doing, and what you find out from the other results.
I am sorry to hear of you mother’s diagnosis. I am a senior HBV researcher and hopefully can help you understand the the test results.
Your mother has moderate-level HBV infection–HBV DNA levels can be orders of magnitude higher, so these numbers are not bad.
Antibodies develop in a very specific pattern, with IgM developing first, and then shifting over to other types such as IgG (usually in the blood) and IgA (usually in mucous membrane-covered areas such as the mouth or colon). So having anti-HBc IgM indicates a relatively recent infection. The IgM will go away and be replaced by IgG; that is normal with time. It is interesting that she has a substantial HBV DNA level in her blood plus a fairly high level of anti-HBs antibodies. HBs antibodies are protective, and that level is about 10 times higher than what is considered to provide immunity against HBV. That’s a good sign–it may indicate that her immune system is winning the battle with the virus. 90-95% of people who get HBV as adults (such as your mother) clear the virus, and this may be the case here.
As to the case of acute hepatititis coincident with starting TAF–she may have had a reaction to the TAF, but that is very rare. It could also be a coincidence. In that case, the acute hepatitis would be a sign that the immune system is being highly effective in attacking HBV in the liver. There are usually spikes in ALT levels (a measure of the liver damage associated with overt hepatitis) when the immune system starts clearing the virus out of the liver.
I’m not a physician, so please do not consider this to be a diagnosis. However, the pattern your mother is experiencing is consistent with the clearance phase of an acute infection leading to removal of the virus from the body. Please ask her to continue monitoring with the physician as only repeated tests for HBV DNA and HBs antibodies will reveal how this infection turns out. I’m hoping for clearance!
Thank you @john.tavis for the detailed explanation. I’m not sure how frequently medication such as tenofovir is prescribed for acute cases, and I’m not sure what the data says on the clinical benefit of this. Maybe some of our @HealthExperts could help?
I think the best thing to do would be to continue to treat any symptoms that your mom is facing, and then retest for hepatitis B 6 months after the first positive test. I’m hoping that the high levels of antibodies that your mom is developing mean that the immune system is winning. Getting lots of rest, staying hydrated, and eating a healthy diet will certainly help, as will avoiding alcohol.
Sir ,in the starting when I diagnosed with HBV in my pregnancy, I have around 400 antibodies in my body later after months they became zero and hbv DNA detected and viral load is 7 does that mean in that anti bodies present stage if I took tefnovir in that stage does that helped me to remove virus from my body??? Please someone tell me
And yes, doctors are investigating if there are other causes that led to the reaction, maybe it wasn’t the TAF. Her symptoms generally were jaundice, anaemia and weight loss,
No evidence for that and no evidence that acute HBV patients treated with NUC have lower probability of clearing HBsAg. But again, in most acute HBV, NUC treatment is not necessary
This is the interesting question. I think that NUCs treatment inhibits HBV DNA polymerase leading to decrease viral replication and HBV DNA suppression. As HBV DNA decreases , it may enhance the host immune response especially cytotoxic T cell lymphocytes to easily clearance of HBV infected hepatocytes rather than decrease immune response. However, there were no clinical trials studies about NUCs treatment group in mild to moderate cases of acute hepatitis B and no NUCs treatment group to compare duration time it take for seroconversion between the two groups, as we know that most acute hepatitis B had spontaneous HBsAg seroclearance rate about 90-95%.
So some new tests were done for her liver functions compared to previous results, seems there’s has been some improvements, her ferrtin levels are high but we dont have a baseline result because her previous ferrtin tests are yet to be released, hopefully we can get that to know if current result is an improvement, the hand written results are compiled by me, i keep them to compare results after a new one is out
@Quasimodo thanks for sharing those results. I’m not a doctor, but generally when I see ferritin levels that far outside of the normal range, I would start to think about a condition called hemochromatosis. This is a metabolic disorder where the body absorbs and stores too much iron. It is also hereditary. Basically, when the iron levels get very high, the body can start to store iron in the organs, including the liver, so hemochromatosis can also cause abnormal liver tests. Please don’t consider this a diagnosis, but please do ask the doctor to run the test for the hemochromatosis gene mutation.
So actual due to anaemia she had several blood transfusion too two pints in December and January, the doctor also said it could be that, they have suggested a drug to reduce the iron level , maybe it will tally and help stabilise her liver enzymes better, I was read high iron overload can cause liver inflammation, I will see if they can also do tests for hemochromatosis though the doctor already prescribed a drug but surely a further iron test will be done to check the current level maybe in some weeks time
From the liver function test results you showed, considering the values with R- factor calculation (the ratio of ALT/ALP) which is equal to 4.4(between 2-5) indicating that inflammation of the liver are of the hepatocellular injury mixed with bile duct injury thus resulting in elimination of liver enzymes and ALP and GGT due to the fighting between the body immune system and HBV. Your mother had anemia but MCV was normal so it is unlikely from hereditary anemia which has low MCV and RDW was quite high , these may be due to hemolysis of RBC from acute infection resulting in anemia which lead to slightly elevated iron level and normal TIBC which indicates capacity of transferrin protein to bind with iron in the circulation
For the level value of serum ferritin that is very high, I think it may be from severe hepatocellular injury leads to release of ferritin from hepatocytes into the circulation rather than being caused by hemochromatosis or iron overload. Considering serial AST , ALT , Total bilirubin that rising, these may be from hepatitis flares from rebound viral replication after discontinuation of TAF or it may be caused by TAF itself leading to hepatocellular and bile duct injury.
However, follow up and monitoring LFT, INR and HBV markers to assess the severity of disease progression. I hope that it will improve after stopping TAF and your mother’s immune systems should be able to eliminate and clearance of HBV in the near future.
