Ambiguous Hbsag result, 1 "presumptive reactive", 1 positive ,1 negative

What do my lab results mean?
1

Hello,

I am a 52 years old Taiwanese man living in u.s. for the past 40 years. Recently I tested positive for HbsAg. The first HbsAg test was done about 2 months ago, the result came back “presumptive reactive”. Alt=48, Ast=68. In regards to this high Alt/Ast numbers, I’m hoping it can be explained by the start of a new daily 30 minutes of moderately intense swimming routine a week before I got tested. Before this I had not exercised other then slow walking for the past 6 years. I read online that sometimes strenuous physical activity can temporarily raise AST/ALT levels, so I’m hoping this is the case.

A couple of weeks later, I was asked to retest HbsAg. This 2nd HbsAg test came back “Non Reactive”

I was elated and relieved, but I wanted to be sure. So I was referred by my primary doctor to a gastroenterologist, who had me do a 3rd HbsAg test amongst other tests. This 3rd HbsAg test came back positive. I noticed this time it states that neutralization was used for confirmation. Ast=27, alt=23 (For this 3rd test, I stopped daily swimming for about a week before the test. Which in my mind might explain the normal values ?). The rest of the 3rd test are as follows.

- HBV DNA not detected (HBV real-time PCR, Quant) the reportable range for this assay is 10 iu/ml

- Hep B Surface AB, Qual = Non Reactive

- Hep B Core AB, IgM = negative

- Fibroscan result was normal. CAP 210 db/m, steatosis grade s0, E=3.4 kPa Fibrosis stage F0-F1

- liver ultrasound : The liver is normal in size measuring 13.8 cm and is normal in echogenicity. There are scattered cysts measuring up to 1.2 cm which within the right hepatic lobe, unchanged.. There is no focal mass. There is no intrahepatic biliary dilatation. The common bile duct. CONCLUSION 1. Benign hapatic cysts. There is no new focal hepatic abnormality

- Hep A AB, total = positive

- Hep C virus AB = Non Reactive

I apologize for the lengthy post. Here are my questions.

1. What is the likelihood my raised AST/ALT levels in the first HbsAg test is due to my new swimming routine ? ( since it came back down to normal when I stopped swimming for a week before the 3rd test )

2. Why is my first HbsAg test result = “presumptive reactive” ? What causes this result ? Is it due to really low HbsAg count that resulted in this ambiguous result ? In my third HbsAg test, neutralization was used for confirmation. Can I assume that when neutralization is required for confirmation, it is due to very low count of HbsAg ? It’s wishful thinking on my part, but I get the impression that 1st and 3rd test, HbsAg is really low level and 2nd test is outright HbsAg negative. Again wishful thinking on my part, but I’m hoping this seemingly fluctuating result means I’m near the point of clearing HbsAg ?

3. Assuming the below are true. What are my chances of clearing HbsAg naturally ? if so, what is the timeline for this clearance to occur ? Should I consider taking medication to attempt to clear HbsAg ?

- hbv was contracted either 10 years ago or possibly 20+ years ago

- current HbsAg level is low ( need quantitative HBsAg to verify )

- hbv dna level undetectable

- liver health is normal via ultrasound and fibroscan

- no drugs or alcohol

- no anti viral medication was ever taken

4. In 6 months I will be tested for HBeAg, HBeAb, HBV DNA level, FibroSURE, AFP. On top of these tests, is it reasonable to ask for anti-HBc total and qHBsAg and should I ask for HDV test as well ?

5. I was also diagnosed with erosive gastritis via endoscopy about 3 years ago. Negative for h. Pylori. Should I be worried that hbv has something to do with my gastritis ?

Thank you so much for all your support. Ever since my diagnosis, there have been dark days. Whenever I get the blues, I find reading posts and watching videos, some from Dr. Tu somehow makes me feel better. I really appreciate it. Sorry again for the lengthy post.

2

Hi,

From someone who has probably had Hep B even longer than you, the chances of losing HbsAg spontaneously is rather small, I believe only about 1% annually. Also, I don’t think that moderate intensity swimming could elevate your ALT/AST levels much. Every form of physical activity should be beneficial in our case. Of course if you are not overdoing it. Our best bet for finally clearing HbsAg are the new advances in HebB treatment, and hopefully within 3-5 years will have a new drug that can clear HbsAg and result in functional cure. Good Luck!

3

I can’t really answer this question in an informed way, especially without knowing your current level of quantitative HBsAg. If it’s below 10, I’d think your chances of clearing it in the next 5 years are actually quite good. Even if it’s below 100, with undetectable viral load, I’d say the chance is much higher than 1%.

4

Dear @George7523 ,

Welcome to the forum and thank you for the kind words. I’m sorry about the anxieties that you’re going through. I’ll try to answer your questions as best as I can.

I’m not sure I can give you a specific percentage, but the ALTs aren’t particularly high and indeed levels such as these could be caused by strenuous exercise.

There could be many causes for this that I cannot comment about. The neutralisation test are meant for confirmation of HBsAg level as it includes a step that decreases the likelihood of a false positive. Indeed, I would be thinking on the same lines as you that this could indicate a very low level of HBsAg and even if you were HBV positive, would be a high probability of clearing the infection.

Generally, even in an acute infection, there is no recommendation that treatment should be started as studies show that it does not increase the rate of viral clearance. Treatment is generally used to protect the liver and taken to lower any ALTs/liver inflammation to a safe level. It is hard to tell what the timeline for clearance is as this is not a well studied time in an infection’s natural history.

Indeed, I think these tests would give a broader understanding of the situation.

There is no connection between HBV and gastritis as far as I know.

Hope this helps,

Thomas

5

Thank you very much Dr. Tu for taking the time to answer all our concerns and questions expertly and professionally. I have your YouTube videos play in the background in the morning to get the day started. It’s like a shot of vitamin B2, boosting my motivation and morale. All the best to you !

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Thank you very much for your input @et5656 and @Ace, I will update my qHbsAg result once I get them soon.

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