I am not a physician, so I cannot give medical advice. It is best to ask this question of your care provider.
However, I can tell you some general things: HBsAg antibodies are highly protective against HBV infection. The accepted levels for protection are usually considered to be over 10-12 IU/ml. If I understand the units in the report below properly, you have 0.104 IU/ml. However that interpretation requires that the nomenclature for the units follow the standard SI naming conventions (ie, 1000 mIU = 1 IU), and sometimes medical tests use different naming conventions. Hence my strong recommendation you speak with your care provider.
If you are negative, you can still have a long and happy life, with children, together with your wife! The HBV vaccine is safe and very effective. If your care provider says that the interpretation of the test above is correct (ie, your antibodies are low), then I recommend being vaccinated promptly.
Others on this email chain, like Joan Block, can give you far better advice about sharing your life with a loved one who is HBV+. Many happy couples (and families) are in your situation, and so I’m confident with support from HepB Community, the Hepatitis B Foundation, and your medical providers that you can manage this safely.
I agree with John that you are always best discussing these things with your doctor to get the best advice. The tests that I’m familiar with use 10mIU/mL as a threshold for protection, but he is right that there may be different tests throughout the world that are different. Your local doctor would probably know best.
Thomas is right–I had a memory lapse (or they changed the definition of a unit in the ~25 years since I learned the protection cut-off value). I apologize for giving a mistaken reply that may have alarmed you. By this assay data and cut-off value, you are likely to be protected. However, as always with decisions that affect your health care, it is best to discuss this directly with your care provider.
Hi Everich, I agree with the knowledgeable scientists Thomas Tu and John Tavis that you can plan to enjoy a very happy, healthy and long life with your beloved wife. It does appear that you have surface antibodies that will protect you from infection with the hepatitis B virus. So once you confirm this with your doctor, he or she should be able to reassure that you can definitely plan to have children! Don’t wait … children are wonderful!! I live with chronic hep B and my husband does not, and we have had a very happy marriage for 25 years and our 2 children are healthy and married as well. I hope all of our messages are giving you hope and comfort!! Thanks so much for sharing your situation. Always, Joan
In response to your question, TDF (the precursor to TAF) is regularly used to treat pregnant women as it is much safer than entecavir (which is thought to affect the fetus from some lab studies). TAF is very similar to TDF, but TAF is slightly modified so that you need much less of it to get the same effect - you can use 90% less drug and still inhibit the virus.
Some clinical studies (some of them in HIV-positive mothers; TAF can be used to treat HIV too) have found that TAF has very low adverse effects on pregnant women and is very safe.
Hi Priyanka, I agree with Thomas Tu who is a knowledgeable scientist. But in case you’re still concerned, you could consider switching to tenofovir disproxil during the last 3 months of your pregnancy since there are many studies that confirm it is safe in pregnant women. And then return to TAF after delivery. Just an idea to consider asking your doctor. However, as Thomas wrote, it would most likely be safe to stay on TAF as well. Thanks so much for your questions. Please keep us posted if you’re able! Always, Joan
It surprises me that TDF is safer than TAF. My wife was underweight. When she was on TDF , she developed chronic kidney disease and Osteoporosis. As soon as she switch to TAF, her kidney disease reverses and her Osteoporosis score stop and now improving
Why will a pregnant women change her antiretroviral drug from TAF to TDF then back to TAF, was there a clinical documentation of such procedure for pregnant woman?
Hi Carlos, I’m sorry for creating any confusion! I was not suggesting that TDF was safer than TAF. They’re both safe, but as you pointed out, TDF does increase the risk for kidney and bone loss issues. I actually switched from TDF to TAF because I was developing osteoporosis (which is now improving, just like your wife’s). I was only suggesting to Priyanka about talking to her doctor about switching to TDF if she was worried about taking TAF during her pregnancy since it’s a newer drug than TDF. There are years of study with TDF in HBV-infected pregnant women and TDF is now recommended for pregnant women in their 3rd trimester if they have high viral loads t(o decrease the risk of transmission to their newborn child during delivery). I’m not sure TAF is formally recommended yet because it’s so new. It could be, but I would have to check around. But please know that I agree TDF and TAF are both considered safe and effective!! But TDF has been around a lot longer so more is know about its safety profile in pregnant women. Thanks for making me clarify what I wrote. Always, Joan
Thanks Joann. I agree that TDF has been around for a long while. And there maybe safety profile for pregnant woman and developing fetus. You are right, when I suggest to our hepatologist to switch my wife to Vemlidy ( after only one month in the market) from Tenofovir, he hesitated and told me he wanted to see Vemlidy another 6 months to a year but my wife’s kidney was getting worse and her Osteoporosis is getting bad. So he consider to switch her first after Vemlidy was on the market for 6 months then switch me later to Vemlidy even my kidney is ok and I had a slight Osteopenia.
Thanks for your clarification. That’s what I thought you mean on the safety profile of TDF for pregnant women
You’re right Carlos. My liver specialist was initially at first hesitant to switch me to TAF as well since it was so new. But I didn’t want to get worse osteoporosis, so insisted! And I’m glad because my osteoporosis has also reversed significantly, so now I don’t have to start an osteoporosis drug … yet. Those osteoporosis drugs scare me because of the side effects and none of them are recommended for more than a few years. So if I start now and stop in several years, what happens when I’m really at risk of falling when I’m in my 70-80’s? Anyhow, so glad your wife’s kidney and osteoporosis have improved on TAF!!! Always, Joan
Hi Carlos,
This is because that FDA has not approved TAF for pregnant women to prevent MTCT. To protect themselves from potential litigation, physicians would not normally recommend TAF for this purpose. However, several clinical studies have shown that TAF is at least as safe as TDF in pregnant women. This new indication probably will be approved soon. /Jacki
Hi all,
I was just reading through this interesting post and wanted to add that as a Chronic Hep B carrier, I’ve given birth to 2 children, the last being born just last year. They have all received the Hep B vaccinations at birth, 6 weeks, 4 months and 6 months as per the Australian protocol.
I did not require any anti-viral treatment whilst pregnant. My HBeAg was not detected and I’m assuming this was why my viral load was not checked in either pregnancy? Otherwise I’m not sure how routinely this gets checked during pregnancy.
I think as long as your healthcare professionals looking over your care are aware of the diagnosis, active steps can be done to prevent your children from contracting Hep B as already mentioned above.
Hi @kimbopumpkin. I think since the chance for HBeAg-negative mothers passing it on to their newborns is generally low, this was not followed up in the past. However, in my discussions with clinicians, the guidelines now recommend much more strongly that any mothers that are Hep B positive are treated (CORRECTION: recommendations are to treat any mothers who have a viral load higher than 200 000 IU/mL) and that newborns are given both vaccines and HBIG (antibodies against Hep B).
Hi Thomas,
I am shocked! So any mother with Hepatitis B regarding of serology status (ie eAg +ve or -ve etc…) should have treatment during pregnancy?? Do you know roughly when these guidelines came into practice as this did not seem the norm when I gave birth just a year ago. If possible are you able to forward me the guidelines in writing? I’m assuming the treatment is to guard against risk of passing the infection to the newborn but how does this risk of treatment compare to no treatment exactly? I just assumed that the Obstetrics people would know about this but my obstetrician did not mention about any treatment… At what stage of pregnancy is it commenced and for how long?
Newborns receiving vaccines and HBIG should be standard in Australia right? I think at some point later, can’t recall, the child gets a blood test to confirm their immunity to Hep B and if it shows they’re immune then that’s the end right - there is no further chance of developing the illness as they are now immune correct?
Not at all ! According to international guidelines, antiviral prophylaxis, not antiviral treatment, is indicated only in high viral load mothers in the last trimester of pregnancy to reduce viremia. Of course, this strategy must be coupled with HBIG and vaccination in all babies
Prof. Pietro Lampertico, MD, PhD
Full Professor of Gastroenterology
Head of Gastroenterology and Hepatology Division
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico
Sorry, Kim. I perhaps misspoke here. I mean that pregnant women should be considered for treatment if their hbv DNA levels are high (I think it is over 200 000) and not necessarily only based on their e antigen results. I can link you to the recommendations when I’m back at the computer.
“All HBsAg-positive women should be tested for HBeAg anti-HBe, and HBV DNA level, to identify pregnancies at increased risk of post-exposure prophylaxis failure. … Women with a high viral load in the third trimester (>200,000IU/ml, equivalent to 6 log copies/ml) should be offered antiviral therapy during late pregnancy to reduce viral load prior to delivery, and the risk of mother-to child transmission of Hepatitis B”
and “In addition to routine vaccination, infants born to HBsAg-positive mothers should receive passive immunisation with HBIG…Anti-HBs antibody and HBsAg levels should be measured in infants born to mothers with chronic hepatitis B infection 3 to 12 months after completing the primary vaccine course.”
So, to clarify, I again think I may have been misleading in my prior post (I will go back and add some corrections) - the standard is to measure HBeAg and HBV DNA, giving antivirals if you have a high viral load. People who are HBeAg-negative generally have a lower viral load as you say.
Hi Kim, just to add to what Thomas Tu wrote, I would also recommend that your children get tested for the protective antibodies against hep b (called anti-HBs or HBsAg) to ensure that the prophylaxis that they received after delivery was effective. This blood test should be “positive” or greater than or equal to 10 IU/mL (at least here in the U.S.). Just so you know, most OB doctors and personnel do NOT understand hep b and maternal to child transmission!! As others have said already, we really must be our own health advocates and make sure we’re getting the proper care. For pregnant women who are hep b positive, there is a much higher risk of transmitting the virus to their newborns if they have high viral DNA levels - even if the newborn receives the proper prophylaxis (1st dose of HBV vaccine and one dose of HBIG within the first 12 hours after delivery). Because of this, the new recommendation is for pregnant women in their 3rd trimester (6-9 months) with high viral DNA levels to start taking tenofovir (Viread) at this time to bring their viral DNA levels way down to reduce the risk of mother to child transmission.
But as Thomas pointed out in his message, since you’re HBe-Antigen negative, your viral DNA level is probably already pretty low. So you probably wouldn’t have been a treatment candidate. At this point I wouldn’t worry about this. To ease your mind, getting both your kids tested for the hepatitis B antibody would make most sense at this time. Thanks … always, Joan
My first child had her blood test done at age 2 showing:
HBsAg NOT DETECTED
HBcAb NOT DETECTED
HBsAb 23 IU/L
Report states: “No evidence of past/current infection but consistent with hepatitis B immunity post-vaccination”. So thankfully she is fully protected at least.
I think in the second line of your post, Joan, you mean HBsAb not Ag?
Is it correct the terminology that viral DNA levels is the same as viral load as I am only familiar with the latter. If it is standard practice in Australia I do wonder why my viral load was not routinely tested just to check. And I am also surprised that obstetricians are not aware of this as different specialties are meant to keep up to date with their field of expertise
Thanks for the link, Thomas - I note as you’ve pointed out, it recommends kids be checked at 3-12 months for their immunity which doesn’t make sense given the last vaccine is given at 6 months of age, why the lower limit should be 3 months. If there is still time to wait as it would be difficult/traumatic having a blood test at 12 months, I would prefer to wait until maybe the 2yr mark like my daughter to get it checked but it is hard to know how the kid will turn out by then and I hope I won’t have wished to have it done earlier! Anyhow I will discuss further with the GP when we go for our 12 month routine vaccination anyway.
