Being new to this forum, I was not aware of some important background to your questions namely:
You are very concerned about the potential transmission of HBV to others.
You have been been HBsAg negative for the past 6 months.
So lets continue our discussion about the persistence of active and latent cccDNA in the liver and now include the most important variable of all: the hepatitis B surface antigen protein (or HBsAg).
For decades, we have reliably used HBsAg to determine the status of control of chronic HBV infection, whether it be during the nature course of disease or during and after treatment of the disease. When someone achieves persistently undetectable HBsAg (you meet this standard) we use this as a marker for the establishment of EXCELLENT immune control over infection. We know that people with chronic HBV infection who become HBsAg negative 1) no longer need antiviral therapy, 2) are not infectious and 3) enjoy normal liver function, reversal of liver disease and greatly reduced risk of developing liver cancer.
So why is HBsAg such a good marker for all of these excellent outcomes (especially the part about not being infectious)?
Recall we discussed how the innate immune response is very good at inactivating ALL cccDNA. This is an important part of the immune process which normally leads to the successful resolution of HBV infection in most people and lasts lifelong. In chronic HBV, HBsAg plays an important role in interfering with the ability of the innate immune response and T-cell function to control infection.
So when a person longer has any HBsAg in the blood (HBsAg negative), it means the following:
The innate and adaptive (T-cell) immunity can act properly to ensure that any and all cccDNA is either removed or maintained in the inactive state.
That there is no active cccDNA present - so no virus is being made.
You should comfortably assume (as I do) that you do not pose any danger of infection to others.
Its is my pleasure. The reason that my colleagues and I participate in this forum is to help patients. You are the most important part of the equation in the research and development work we do.
From your last emails it sounds like you developed acute HBV infection which self resolved without you having received any antiviral therapy (can you confirm this?) If this is the case, your immune system efficiently controlled the infection from the outset. This is the best of all possible outcomes. Even if this control occurred very early on in therapy it is still very good. Can you confirm that you have been HBsAg negative from Oct 2021 to Feb 2022 without antiviral therapy?
Yes it is possible that someone could theoretically lose all of the cccDNA in their liver but, I would like to suggest that you are focusing on the wrong issue. What you should be focusing on is that there is no viral activity in your liver - so no production of virus and no danger of you infecting others.
I good analogy to use is the varicella zoster virus (VZV, also known as chicken pox). People who become infected with VZV as children always resolve this infection and it remains completely inactive for the rest of their lives unless their immune system becomes compromised. This why shingles (which is the reactivation of VZV infection in adults) only occurs with the immune system becomes impaired. So only in the elderly or people experiencing high level of stress etc.
The key to a long, happy and healthy life for you is to be good to your self (good diet, no excessive alcohol use, exercise and relaxation). With these things in mind, the odds are excellent that you will never have to worry about your HBV infection in the future. With this in mind, it would still be good to have regular (6 month) follow up visits for the next year.
Yes. I had a surgery in first week of April and exactly after 3 months 12 days, I developed symptoms with jaundice. Test came positive for Hep B. I received no antiviral medicines. Just rest and good diet. When tested on 12, October21, my Anti Hbs came 5 IU/L and HBsAg Negative. Since then it’s negative till last test in February 22 with Anti Hbs moving up to 36 IU/L.
Having said that sometimes I do have days with fasting and some stress… hope this wouldn’t suppress my immunity
Though I don’t drink or smoke. Have been a sportsperson since my childhood. Regular workouts. But after Hep B hit me, I am still not in a condition to Play sports or go to gym.
So from your test results it is quite clear that you have achieved acute resolution and your immune function continues to improve (Anti-HBs going from 5 to 36 IU/mL). So you should really put your mind at ease.
When I speak of fasting, I am talking about fasting for several days at a time (which can be hard on your liver). This should be avoided if you are still convalescing.
Notwithstanding this, your test results have continued to improve with your current lifestyle which is a great sign.
I am a little worried now…Last month I was shifting to a new house, and as I am alone in the city where I work, I skipped breakfast and lunch for more than a week as I was too busy managing the process! It was tiring, I used to eat in the evening and then dinner. Though I have test planned next week. I hope this intermittent fasting wouldn’t have caused immunosuppression @ThomasTu
Absolutely not, this is not the kind of fasting I was speaking about. The kind of fasting I am talking about is eating nothing for several days and they doing this as a regularly repeated regimen. You have to understand that the immune recovery you now enjoy is very strong and will last you your entire life. It will see you thought all of the challenges that you may face.
So don’t worry about the stresses of getting settled in to a new routine in your new house. I really encourage you to not be concerned about your PREVIOUS HBV infection!
That being said, please keep on posting. We are all here to listen and help.
Hi, because I was worried about going intermittent fasting for weeks, I get tested again on 16.05
Results:
HBVDNA: Not detected/ Below detection limit
HBsAg: Non reactive
Anti-Hbs: 44 IU/L last test in February 22 it was 35.7. So didn’t went up much during this period?
Staring test results here as It may help someone/ researchers.
The viral replication in your liver has ceased so you are no longer infectious. By “previous” I mean that your infection is in the past. Your immune control will very effectively protect you from any possible future infection so there is no concern in this regard.
In very rare cases, reactivation of HBV infection can occur when persons who previously recovered from HBV infection take immunosuppressive therapies. This is why it will always important to mention to any doctor you see that you have recovered from HBV infection.
After 3 months, I have again tested today
Results:
HbsAg: Non reactive
HBVDNA: Below detection limit/ Not detected
Anti -Hbs: 97 IU/L
How do you see Anti-Hbs response considering just 3 months before it was 44 IU/L - An increase of just 8 IU/L during 3 months period (from mid Feb to mid May).
Only difference I can see is that I have been eating and taking rest for last 2 months.
Again great results, slow increase in anti-HBs is normal - this may continue or not and I don’t think this is related to your diet or resting. You have functional cure and you will have to put your body through a great deal of stress and strain to lose it. This would involve chemotherapy for cancer or immunosuppressive therapy for an autoimmune disorder or organ transplant.
I encourage you to be very comfortable and relaxed and please do not worry any longer about your PREVIOUS INFECTION. It is not necessary for you to get these kinds of tests done more often than yearly and even then I would only bother with qualitative HBsAg (its the cheapest).
Thank you. I do get your point, just surprised to see Anti-Hbs doubled in last three months (Mid May to August- 44 to 97) !! While it was just an increase of 8 IU/L over the same duration (Mid Feb to May- 36 to 44).
Immune function does not always work in steady and gradual manner. You may look in the the future and see ony a small increase in anti- HBs or even a small decease (no worry here again) or you may see a very large increase.
