Can somebody help me understand my lab results?

What do my lab results mean?
1

Hey Everyone,

I recently did my blood work and found out my hbsag is positive while my total core antibodies (total anti Hbc) is negative, igm is negative, anti hbs is negative, hbeag is negative, HBV DNA viral load of 145 IU/ml. My doc told my liver function and enzymes levels looks good.

Can someone help me understand my test results ? @john.tavis @ThomasTu Any comments on the above results ?

2

Hi @Nick1,

These is not a standard test profile, so it is difficult to understand exactly what might be happening. It could be a false positive anti-HBc test, or it could be very early on in an acute infection. It is hard to tell, and maybe the only thing to really confirm is to repeat the tests after some period (as suggested by your health professional) and see how things change.

Hope this helps,
Thomas

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3

Thanks @ThomasTu for your comments on my test results. My doc repeated the tests after one week and the test results are same. Do you think one week is very short time to repeat the tests ? Also have you seen similar test results before ? Can I know what makes you think I’m in very early stage of acute Hepb ?

4

Hi @Nick1

I agree with Thomas’ interpretation. One week between tests is enough to see if the anti-HBc test was faulty, but not enough to determine if you are early in an acute HBV infection or if your body for some reason is just not making anti-HBc during a established chronic infection. I encourage you to monitor this. Follow your caregiver’s guidance, but a very informative time point would be 6 months from the initial detection of HBV. Being HBV+ for 6 months is the clinical definition of a chronic infection, so that time point will be definitive to separate a (hopefully) resolving acute infection from a chronic one.

I wish you the very best,

John.

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5

Thank you for your comments @john.tavis. Since these are not the standard test results, What might be the reason for total anti-HBC being negative ? Is this scary ? Have you seen any such combination of test results before ? I’m trying to understand my case better.

6

HI @Nick1 via Hep B Community

There are a few possibilities:

  • Not everyone is the same—in particular, each person’s immune system is slightly different. It is possible that you are just not able to produce good anti-HBc antibodies. A precedent for that is about 5-7% of people don’t make adequate antibodies to the HBV vaccine I’m one of them—I’ve been vaccinated 2x without success.
  • You could be very early in an acute infection, before anti-HBc typically appears.
  • Your body may be producing antibodies to HBc but against epitopes (ie, the specific part of the protein recognized by the antibodies) that are not conserved with the HBc antigen used to detect the anti-HBc antibodies in the diagnostic test.

Note that not having anti-HBc is not dangerous. Anti-HBc is not involved in controlling the infection because HBc is masked on the viral particles by the viral envelope comprised of lipid and HBs. Anti-HBc antibodies are monitored in diagnostics just because it is a good marker for having been infected.

I hope this helps.

John.

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7

Thank you @john.tavis, this is helpful.

So, not able to produce good anti-HBc antibodies means increases the risk of clearing the virus in acute stage will be difficult ?

  • You could be very early in an acute infection, before anti-HBc typically appears - In this case, IGM will also be negative ? My results say negative.

  • Your body may be producing antibodies to HBc but against epitopes (ie, the specific part of the protein recognized by the antibodies) that are not conserved with the HBc antigen used to detect the anti-HBc antibodies in the diagnostic test - Is this something that I should be concerned about ?

  • Finally, Have you seen this combination of results before ?

8

Nick1 23 October Thank you @john. tavis, this is helpful. So, not able to produce good anti-HBc antibodies means increases the risk of clearing the virus in acute stage will be difficult ? You could be very early in an acute infection, before

[https://www.hepbcommunity.org/letter_avatar_proxy/v4/letter/n/47e85d/45.png]
Nick1https://urldefense.com/v3/__https:/www.hepbcommunity.org/u/nick1__;!!K543PA!PsCH7FaiMiEu6HzIRIl63GzAzSN2UM5YYgBdISpd3_kOjg43-C-NYdVxYtOGM0YTRjT-o5higzZy-XQwJl-ugg$
23 October

Thank you @john.tavishttps://urldefense.com/v3/__https:/www.hepbcommunity.org/u/john.tavis__;!!K543PA!PsCH7FaiMiEu6HzIRIl63GzAzSN2UM5YYgBdISpd3_kOjg43-C-NYdVxYtOGM0YTRjT-o5higzZy-XShECignw$, this is helpful.

So, not able to produce good anti-HBc antibodies means increases the risk of clearing the virus in acute stage will be difficult ?

· You could be very early in an acute infection, before anti-HBc typically appears - In this case, IGM will also be negative ? My results say negative.

· Your body may be producing antibodies to HBc but against epitopes (ie, the specific part of the protein recognized by the antibodies) that are not conserved with the HBc antigen used to detect the anti-HBc antibodies in the diagnostic test - Is this something that I should be concerned about ?

· Finally, Have you seen this combination of results before ?

9

Good HBc antibodies are irrelevant to clearance as far as I know, so I strongly doubt it changes your chances of clearance.

IgM is the first type of antibody that appears, and then the antibodies shift to a different type, like IgG or IgA. However, not having IgM could be due to either being very early in the infection or from inability of your immune system to make anti-HBc antibodies.

No diagnostic test is perfect–they always have lower limits of detection and can have blind spots. In this case I would not worry about it because HBc antibodies are just used as a diagnostic tool, and they are not involved in controlling the infection.

I’m not a clinician, so I only see test results when someone shares them with me to ask a question like you did. Sorry for not being able to answer this question!

John.

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