Hello . Can someone explain to me why some patients infected with hepatitis B have low quantitative Aghbs and others excessively high? . In my case, I have HBV DNA viremia 11 Ul/mL and Aghbs quantitative 212 Ul/mL. Does this small amount of Aghbs help me? Can someone explain to me how the amount of Aghbs is formed? I found out 2 years ago that I have hepatitis B, the first viremia HBV DNA 64 IU/mL and quantitative Aghbs 441 IU/mL. Treatment only complex B vitamins, vitamin E, silymarin.
This can be a bit complicated, in part because the production of anti-HBs antibodies (“HBs antibodies”) in chronically infected people is not fully understood.
Normally, a person’s immune system makes antibodies when it encounters a viral protein in the blood. However, HBV produces a truly huge amount of HBs, and that does a couple of things. First, the really high levels of HBs turn down the production of HBs antibodies so that very little is made (that is a part of the immune system’s safety circuits to keep from inadvertently hurting the body - sometimes called induced tolerance, anergy, etc.). Second, the antibodies promptly bind to the HBs floating in the blood and the complex is then usually removed from the blood quickly. This makes detecting the HBs antibodies difficult because it further lowers their already low levels. Third, the standard diagnostic assays can’t always detect the complexes as they were designed to detect free HBs antibodies.
The balance of detectable HBs antibodies in the blood therefore depends on how much is produced, how much HBs is in the blood, how rapidly the antibody:HBs complexes are removed, and how well the diagnostic assays detect the antibody:HBs complexes that are present. All of these variables are different from person to person, with the large majority of people having a balance where the antibodies are undetectable.
I hope this helps.
Thanks John for the deep explanation of what controls detectable HBsAg levels.
@MARIAN, thank you for a great question. To build on the answer John gave, I just wanted to include this video that might explain some of the aspects about HBV in a more visual format. Hope it helps: