EXPLAINER: Lab results and their interpretation

Dear @anonymous39,

The most pressing concern are the lesions in your liver and the elevated AFP. These may signal the presence of liver cancer (but these lesions could also be benign). You should have an IMMEDIATE follow-up with your doctor to discuss these results and how to proceed.

During this visit, you should also discuss antiviral therapy for your chronic HBV infection - this normally includes a test (HBV DNA) to see how strong the viral replication is.

With best regards,

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Am I correct in understanding that a Hepatitus B core IGM antibody test would/could come back negative for someone with chronic HBV?
Sorry-- newby here and I’m having difficulty understanding all the various tests results.

HI @Jjcourage

Newly developed HBV infection will first drive the production of IgM core antibodies. About 6 months later, with the establishment of chronic infection, core antibodies switch from IgM to IgG.

To total HBcAg antibodies or IgG HBcAg antibodies tell us that at some point you have been infected.

IgM HBcAg antibodies tell us that this infection is recently acquired.

Best regards,

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Dear Experts, @availlant @ThomasTu

Can Hbsag Quantitative have three different readings like mentioned below in a short period

15th Jan : 16209 iu/ml
18th Feb : 8135 iu/ml
21st March : 10824 iu/ml

All of these tests done at same lab.

Regards,

Red spots in palms, Red lines in legs, Light colored stool, Severe Constipation, Vitamin D deficiency. Aren’t these related to Liver ?

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Hi @rjktgj ,

Yes HBsAg can wobble like this.

Are you on antiviral therapy? If so which one? For how long?

Best regards,

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Hi Mr Avvailant,

I am not on any antiviral therapy.
I was told by doctors here that Hbsag would never change hence I asked.

Regards

Hi @rjktgj,

Perhaps your doctors were referring to achieving HBsAg loss. This is indeed rare in the natural course of HBV infection.

HBsAg can fluctuate over time as the turnover rate of HBsAg in the blood is very fast (within days) although I would agree that the speed of fluctuations in your case are somewhat unusual.

Did you have your HBV DNA tested as well? This would give us some extra clues.

Best regards,

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Dear @MARIAN,

I will try to understand your post as best as I can, as I cannot see the pictures you are uploading. Low HBV DNA, low HBsAg, and lower fibrosis are good signs. Being on a diet will help decrease steatosis over time, but this may take many years as will recovery of the liver fibrosis.

Hope this helps,
Thomas

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OK, this seems to show that your liver has minimal fibrosis, so it is not damaged. These are all good signs.

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Dear Marian,

It’s hard to interpret these as I do not speak the language nor do I understand what the numbers for the HBsAg means (it could be international units, but it could also be fluorescent units the lab gets from the machine). I do not think I can comment at all on these.

Thomas

Dear @Tusername1,

Welcome to the forum and thank you for sharing your story.

Yes, these are confusing results and not “textbook”. Probably the first thing the doctor will suggest is making sure that the HBsAg result is not a false-positive and repeat it. You are correct that if you have been infected, either anti-HBcAb (either total or IgM) should be positive. If your anti-HBs is positive and protective (more than 10 mIU/mL), then that is even more suggestive of a false positive HBsAg result.

I understand it is easier to say, but you have little to worry about right now until you know the full story. No matter what, there is a community here that can help support you through whatever you’re going through.

Hope this helps,
Thomas

Hi @Tusername1,

Great questions:

Both of these are not common according to the scientific literature, but that doesn’t mean they do not happen. This is why confirmatory/repeat tests are done, as per information about this program: Hepatitis testing in the emergency department (A&E) - Overview | Guy's and St Thomas' NHS Foundation Trust

If your test is positive for hepatitis B or C, we phone you and ask you to come to the hospital. We then repeat the hepatitis test to confirm your diagnosis.

Sometimes the result is not clear. In this case, we must see you again to repeat the test.

If it is a chronic infection (exposure since more than 6 months ago), total anti-HBc should be positive.
If it is an acute infection (exposure since within 6 months), anti-HBc IgM should be positive.
If the exposure has occurred within 4-8 weeks, it is possible that HBsAg is positive and anti-HBc is not yet positive.

As far as I know, these mutant variants are generally associated with HBsAg and not HBcAg. I’m not sure they would explain your negative anti-HBc results.

It might also be worth clarifying what was meant by “Pre Hepatitis B Vaccine (Hep B Core Ab)” (e.g. does this mean total anti-HBc) and what your levels of Anti HBs were.

If there is confirmation in follow up tests, it may be worthwhile to get a referral to someone who is a specialist in the area.

Hope this helps,
Thomas

Hi @tusername1,

Yes, i would think that the pre-vaccine anti HBc would be total anti-HBc.

Taken as a whole, it would really be worth getting a repeat of your HBsAg test, given the following:

  1. The anti-HBc results as mentioned.
  2. With an infection, either HBeAg or Anti-HBe should be positive.
  3. Your high anti-HBs antibody level is much greater than protective cut-offs, meaning infection is unlikely
  4. The note under the HBsAg result mentioning that this result should be confirmed with a clotted serum sample.

If the clinic is not willing to repeat the test at your insistence, it might be worth asking your GP to refer you.

Any @HealthExperts have any comments here?

TT

@Tusername1 Push for a repeat surface antigen test. Lab errors and mistakes happen more than doctor’s offices and labs want to admit.

Hello! I’m confused about my results and my doctor has forwarded them along so to someone else so I’m waiting to hear back. My hbsag test was reactive but the neutralization test came back non confirmed? What can cause a false positive like that?

Hi @Bbeale,

Welcome to the forum and thanks for sharing. I’m not entirely sure what the “neutralisation test” means. It would be worth clarifying and getting a copy of the results so we can provide you with more information.

Cheers,
Thomas

Dear @Tusername1,

It’s great to hear that you were able to get another test that shows that you are HBsAg-negative, which is more consistent with all of the other test results. It is most likely that the original hospital results were a false positive.

Thomas

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Hi Experts,
I would like to have a deeper understanding of my results:

Age: 32 Years Old (First diagnosed at 23 years of age)
Sex: Male

AST: 12 U/L
ALT: 20 U/L
Total Bilirubin: 0.7 mg/dL
Albumin: 4.4g/dL
Alkaline Phosphatase: 81 U/L

HB e Antigen: Non-Reactive
HB e Antibody: Reactive
HBV DNA IU/ML: 26 IU/ML
HBV DNA LOG10: 1.42 Log 10
Alphafeto Protein: <3.0ng/mL

  1. Can any expert comment on interpreting my results?
  2. Do I need to speak to my doctor for treatment?
  3. Am I infectious to others?
  4. Am I eligible for any on-going clinical trials (GSK B-Well Study Phase 3 Trials)

I would greatly appreciate the help!

Hello Thomas,

Could you please help me the the meaning of my report in brief?
HbsAg: Positive
HBV DNA: 1233.85 IU/mL
Anti HCV: Negative
IgM anti HEV: Negative
Anti HBe: 0.01
HBeAg: 0.37
HIV: Negative
ALT: 36.9
AST: 34.1