Am I infectious with low level of immunity?

What do my lab results mean?
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Hi
I don’t know when I got the HBV virus, but as a guess 4 years ago.
I just found this group, hope i can find some answers
I had never heard of Hepatitis B until recently.
3 weeks ago, I did some tests and got the following results:
Hep B Surface Antigen: Non-Reactive
Hep B Core Total (IgG + IgM) Antibody: Reactive
Hep B Core IgM Antibody: Non-Reactive
Hepatitis B Surface Ab [HBsAb]: 8.8
INR: 1.1
Albumin: 48 g/L
Bilirubin Total: 19 umol/L
Alkaline Phosphatase: 73 U/L
Gamma Glutamyl Transferase: 22 U/L
Alanine Aminotransferase: 19 U/L
Aspartate Aminotransferase: 18 U/L

I am still waiting HB DNA results

The doctor said I had a previous Hepatitis B infection and that I am OBI (Occult Hepatitis B Infection).
I can’t get an appointment with my doctor soon to explain what’s going on, so I’m really confused and worried.
My main questions are:

  • Am I infectious right now?

  • Can I transmit the virus to my wife or kids?

  • Is it safe to have unprotected sex with my wife?

  • What are the chances of her getting the virus if she is unvaccinated and if she is vaccinated?

I’d really appreciate any help.

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Hi @Abcd1234
I hope you are doing well. Welcome to hepbcommunity. org. Your HBV profiles are compatible with isolated antiHBc positive due to the results of testing shows only anti HBc +ve alone and HBsAg and anti HBs -ve ( < 10 mIU/ml ) . The possibility of your HBV profile which shows antiHBc +ve that may be from false positive lab test but you have low titer of anti HBs due to your immune response (B lymphocytes) can’t produce enough antibodies to fight against virus and the antiHBc is the first antibody production from body immune response before antiHBs occurs, so your anti HBc is true positive.
I agree with your doctor that you may have occult HBV infection (OBI) due to the fact that your anti HBc +ve which means you have been exposed and infected with HBV and had cccDNA in hepatocytes which can produce small amounts of HBsAg that too low to be detected by laboratory tests or may be due to mutation of HBV genome at S region in cccDNA and produce S (surface) mutant proteins that can’t be detected by routine laboratory tests but we can detect low levels of HBV DNA which may help in diagnosis of OBI which is most likely possible in your case.
The other possibility in your case is you are infected with virus and have immunity (anti HBs) against virus and the immunity waning later , however , if you had HBV infection about 4year so it is unlikely for anti HBs to decrease . The option to proof this is to give HBV vaccines boosted, if you have high antiHBs levels, it means that you are infected and have immunity against virus and waning when time pass. You should consult with your doctor for definite diagnosis of your condition and it may help to answer your questions about risk of transmission of virus. I hope this may help you to clearly understand your HBV status.
chul_chan
Chulapong Chanta MD. Pediatric

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Does that mean the HBV DNA test is not definitive even if it is undetectable?
If I got vaccinated and maintained high immunity (>10), does that mean I am cleared and not OBI?

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Dear @Abcd1234,

Thanks for the questions and sorry to hear about your worries.

Your tests are consistent with having been exposed to HBV in the past and subsequent clearance. Your anti-HBs levels are below the threshold of being classed as protective - this may be due to being exposed some time ago and the antibody levels have waned over time.

The other option is OBI, which cannot be confirmed with these tests (HBV DNA tests are needed). The above interpretation of clearance is the more common explanation. Regardless, the clinical outcome is the same, I do not believe that people with OBI are treated any differently than those who have cleared and it is not very clear whether people with OBI are at significantly higher risk of liver disease progression taken by itself.
In answer to your questions:

  • Am I infectious right now? Can I transmit the virus to my wife or kids?

People with negative HBsAg levels are generally considered non-infectious in most circumstances. There are reports that blood transfusion from people with OBI are able to transmit to recipients, but this involves large volumes of blood to be exchanged. Your HBV DNA test will tell you more about this risk.

  • Is it safe to have unprotected sex with my wife? What are the chances of her getting the virus if she is unvaccinated and if she is vaccinated?

As above, your HBV DNA test will tell you more about this risk. However, if she is vaccinated and has a protective level of antibodies (>10mIU/mL), then she is protected and the chances of her getting hepatitis B from you (or indeed any other source) are negligible.

You might consider vaccination for yourself for your own piece of mind to see if you can get your antibody levels >10.

Hope this helps,
Thomas

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@Abcd1234 , did you get your HBV DNA test results?

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Yes I did, it says Not Detected

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Great to hear that, congratulations!

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What does it mean that DNA not detected?

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DNA not detected means that you have negligible risk of passing it on to your family. It also means you do not have OBI and it is much more likely that you have just cleared an exposure to the virus in the past.

Hope this helps,
Thomas

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