EXPLAINER: Lab results and their interpretation

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1092

Dear @Jay,

Welcome to the forum and thanks for sharing your story with us. I’m sorry to hear that it has been so hard on you, but rest assured that you are not alone and many people on this forum have been through the same situation.

As others have mentioned, there is no need to wear the guilt of this. Most people with Hep B have had it for their entire lives without knowing. The good thing is that you know about it and can do something proactive about it. I understand that this diagnosis is hard on you at the moment, but it does get better over time.

Regarding your lab results, these are consistent with a chronic hep B infection. HBeAg-negative and anti-HBe positive are indicators of low risk of transmission and generally line up with lower disease progression.

To be completely sure, you will need some follow-up tests including a liver function test (which will check your ALT levels, a marker of current liver inflammation); fibroscan (which is a painless abdominal test and measures any damage to your liver built up from the past); and HBV DNA test (a measure of how much virus is in your blood and will help determine if you need treatment as well as your risk of onward transmission).

Hope this helps,
Thomas

1093

Hey all thanks for accepting me into the group! My question is cause I’m all confused. In 2021 I tested positive for Hep b core ab IGG and IGM nothing else. Then went got retested 2 weeks later with different doctor only IGG was positive I’ve attached below all bloodwork from 2021 and then in 2024 I brought it up to the doctor again and they retested but only retested the core ab and if I was immune and the Viral load. why didn’t they check the surface antigen etc like 2021? I don’t know I’m so confused if someone could please Help id really appreciate it. I also have Crohn’s disease and on immunosuppressive infusions (I know not good for this) if it’s what I think. But they monitor my liver enzymes often since blood is constantly drawn and they have always been perfect only once was it ever borderline still within range but just at the top of the healthy range. So since I’m confused if someone could please look at these and interpret for me? Also The note from The second doctor saying concerned bout false positive was the one that retested the first photos r the first tests from another doctor after those are his that he redid about 2 weeks after those other ones came in. Never heard back from the guy though which messed me up I’m assuming for almost 3 years now. But all photos r in date order oldest to newest.
July 1st 2021
Hep B core AB IGM reactive,
Hep B core ab IGG Reactive.
Hep b surface antigen non reactive,
surface antibody non reactive.
Hep be ag non reactive,

hep be ab non reactive.

July 19th 2021 met with different doctor these are his notes before he retested what does it mean?Assessment/Plan:

  1. Hepatitis B core antibody positive, R76.8
    Patient appears to be low risk for hepatitis infection, will repeat hepatitis
    serologies concerned that we may be leading to a false positive. If positive
    will discuss with patient and hematology whether or not to monitor LFTs (He never did this by the way)
    and periodically monitor hepatitis B
    viral DNA versus entecavir/lamivudine prophylaxis given low risk. May need
    to get revaccinated
    Results to his retest :
    HBV IU/mL HBV Not detected

Log 10 HBV IU/mL Unable to calculate result since non-nuberic result obtained for component test. Test information:
The reportable range for this assay is 10 IV/mL to 1 billion IU/mL.

Hep B surface Antibody Qual : non reactive

HepBsaG screen negative

Hep be Ag Negative

Hep Be AB negative

Hep b core AB. Tot positive

Hep b core Ab IgM Negative

Why did IgM go away so quick from july first to the 19th?

November 2021 unrelated MRI I had done for an unrelated reason months after 2021’s positive test. They labeled it fatty liver to be exact the report says “There are some loss of relative signal intensity on out of phase imaging of the hepatic
parenchyma compared to in phase imaging compatible with some fatty infiltration of the
liver. No enhancing hepatic lesion is identified.
The portal and hepatic veins are patent.” Consistent with Fatty liver. could that be confused with Hep issues on liver or Hep b cause the fatty liver? Or is it just fatty liver and unrelated to Hep B ?

Now 2024 results

hepatitis B core AB total reactive

Hep b surface antibody non reactive

Hep b surface ab immunity :<5 not immune

Also 2024. Hep b virus DNA IU/mL :not detected

Hep b virus DNA Log IU/mL : not detected.

Why didn’t the doctor check surface antigen envelope stuff etc like last time?

So my main questions are

what kind of damage could have been done from 2021-2024? I have an ultrasound next week.

Is this chronic? Because I know they say IGG could just mean a resolved infection? But I never developed the surface antibodies.

Do I have to disclose this to sexual partners is this contagious based off these results?

And basically what are we looking at as far as life expectancy I know we could never know for sure for anyone what that is but based off the assessment of these results and me on immunosuppressant infusions inflectra to be exact. What kind of life are we looking at?

Thanks in advance I know it’s a lot just trying to get some answers and be prepared.

1094

In my opinions about your limited HBV profile results in 2024, I think that there may be explained by the following reasons.
1 your laboratory tests showed Anti HBs negative , Anti HBc positive, HBV DNA not detected . But you don’t have HBsAg result, 1.1 if your HBsAg was negative , you may be in isolated AntiHBc positive status which mean that your antiHBsAg negative could be from waning of immunity after a long time and if you get vaccinated with 1dose of HBV vaccination,it will boost your immunity or you were occult hepatitis B infection (OBI) status but it look less likely because your HBV DNA was not detected.
1.2 if your HBsAg was positive, you maybe CHB disease and immune control but most patients had detected HBV DNA or you have HCV coinfection which can suppress HBV replication, so HBV DNA can’t be detected.

1095

Thanks for the response this is all so confusing can’t wait to talk to my doctor to get some answers. Just so confused as to why they didn’t test the Surface antigen this time.

1096

Hi @Michaelmike223,
Thanks for your question. On the issue of not getting a test for HBsAg, it is possible that it might have been confirmed previously that you do not have hepatitis B which was the case according to your 2 results from July 2021 (HBsAg were both negative). It also shows you do not have antibodies in your 2021 test either (both test for HBsAb were negative as well). I get your point about all this being confusing and the best person to help you understand this all is your provider. Reach out to this provider if you are able to and he or she can walk you through all these test results and what they mean.

It is possible that they think your fatty liver is from hepatitis B, but based on the results you shared you do not have hepatitis B. Fatty liver can happen with or without this virus. I hope this helps. Thanks, bansah1

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1097

Hi @Michaelmike223,

Welcome to the forum and thanks for sharing your story. It definitely is not a standard pattern of serology that is reported, but there are several papers talking about “isolated HBcAb positivity”, which is what this looks like.

My understanding is that there is no consensus in how to treat people with this pattern or if they are at higher risk of liver disease. There are some suggested treatment models, where people with this pattern should be vaccinated: Patients With Isolated Hepatitis B Core Antibody: Has the Time Come to Vaccinate? | Clinical Infectious Diseases | Oxford Academic. Indeed, some studies show that this approach successfully induces protective anti-HBs antibody levels in the majority of people (90% after 3 vaccine doses, The Response of Isolated Anti-HBc Positive Subjects to Recombinant Hepatitis B Vaccine - ScienceDirect).

To answer your question about transmission, given your undetectable HBV DNA levels, there is negligible risk of transmission in every situation outside of donating blood (even then, the risk may be small).

Hope this helps,
Thomas

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1098

Hello @Michaelmike223

I am not a doctor or health professional, but I have lived experience hepatitis B 40 years.
I can’t answer all your questions, except the fatty liver, maybe. I have fatty liver , it’s a first world problem from diet, mostly.
Can you see your doctor and ask him the questions you have?
I’m thinking MAYBE, because I’m not a health professional, you may have had the virus but didn’t become chronic. You cleared the virus.
A professional will answer your questions more factual soon.
Welcome to the group
@ThomasTu @john.tavis @HealthExperts

1099

Thanks for the response I’m sorry you’ve been battling this for so long. Yea I was more curious if fatty liver could be related to having or have had the virus. But I’ve actually lost 40 pounds and have been eating a better diet since that test so I’m seeing my doctor after an ultrasound next week so I will get some answers. Figured I’d post here to hopefully get some idea of what I’m walking into. So your fatty liver is unrelated to the hep? Again thanks for the response! Wishing you all the best!

1100

Dear @Michaelmike223,

There are 2 possibilities here. First, the test could have been a false positive as your physician originally speculated. All tests, including medical ones, have an error rate. Those rates are usually very low and come into play only when trying to detect very low levels of the target. However, this is inconsistent with the persistent HBV core antibody positivity.

Therefore, I think you had a very short term HBV exposure that was rapidly cleared. I suspect this as your earliest test had both IgM and IgG positivity against HBV, and your anti-HBV core antibodies have persisted (IgMs come up first and then the “class switch” to IgGs, so IgMs are only around transiently right after exposure to a new antigen).

The lack of anti-HBs antibodies is a bit unusual for clearing an acute infection, but the other arm of your immune system, “cell mediated immunity” can get rid of HBV too. Regardless, you are not infected as your doctor tested for HBV DNA recently and the test was negative.

Finally, you are not immune to HBV as your anti-HBs antibodies are negative. I recommend getting vaccinated against HBV.

I wish you the best.

John.

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1101

Hello @Michaelmike223

My case is different since I’ve had the virus for 40 years. I suspect my fatty liver is caused from the virus but no medical professionals will confirm. Maybe they don’t know.
I strongly suggest you get vaccinated against this virus. It’s a course of 3 injections over 6 months, please Mike make this a priority. I would not wish this virus on anyone.
Now that you know that you don’t have this life long virus, but was exposed, you have missed a bullet.
Blessings Caraline

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1102

Thank you for the detailed response. I just find it so odd being on immunosuppressive drugs for crohns Disease that my body would’ve been able to clear this off isn’t that like unheard of? Thanks again for the response.

1103

100% getting vaxxed thank you I was younger it didn’t stick apparently hoping for better luck! Thanks wishing you the best

1104

Thanks for the response and the informative articles

1105

Hi @Michaelmike223,

The human immune system is remarkably complex, so taking one type of immunosuppressant does not necessarily lead to a global down-regulation of all immune responses–it depends on what is being targeted with the immunosuppressant. As I said, it is extremely complicated!

The HBV vaccine is one of the best ever developed, but about ~5% of people do not respond adequately to it. For example, I’m a non-responder after 2 rounds of vaccination. So your treatment for Crohn’s Disease might not be the reason you did not respond adequately to the vaccine.

John.

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1106

Hi.
Your post was interesting to me. I found my twins. I also have the same symptoms while I had multiple negative results for STI.
I cleared acute hbv. My last hbv result was
Hbsab 1000
Hbsag negative
Hbc total negative
Hbv pcr negative

I want to give you some notices.
Drink water at least 7 glasses each day
Increase intake of fruits and vegetable particularly orange pomegranate kiwi
Eat nuts particularly walnut, almonds,…
Black seed and honey are also good.
Use this schedule for your food until several months all of your symptoms will go.

At this time how are you? Still have symptoms?

1108

I’ve been living with hepatitis b Since 15+ years, currently my LFTs and viral load are in normal range, current viral load is 27IU and HBV DNA is positive, my question is that can it damage my liver?

1109

Hi @Bismillah,
Good question. But with results and numbers that low, damage to the liver is less likely. That is why it is important to continue with frequent monitoring through blood work and abdominal ultrasounds. This virus can change without any warning hence the consistent and frequent monitoring. Thanks, bansah1

1110

How much time does virus take to lift itself as ihve been suffering from it since 15+ years and current results and imaging are bormal

1111

Hi Bismillah,
I am not sure I understand your question. If you have a chronic infection as it is in your case, the virus never goes away. It can remain inactive for many years without causing any damage in some people. It is a different story for other patients. Only a cure will help remove it but right now we don’t have a cure. Thanks, Bansah1

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1112

Hi,

Please share your thoughts and advice, my doctor says to go on anti viral therapy with tenofovir.
So my recent lab results, though the last one was 3 months ago,

viral load, 1 IU/mL = 1.72 copies/mL
24-nov-23 3000.000 copies/ml = 1,744,186 IU/ml
16-jul-21 150.000 copies/ml = 87,209 IU/ml
31-jan-20 57.000 copies/ml = 33,140 IU/ml

ALAT(GPT)
24-nov-23 51 U/L , normal range < 45
16-jul-21 normal range
31-jan-20 normal range

bilirubine
24-nov-23 26 umol/l, normal range < 17
16-jul-21 normal range
31-jan-20 normal range

I feel no pain, nothing.

Br,