Help with lab results

General Discussion
#1

I tested positive for hep b antigen 2 years ago when I was in Sao Paulo, so I never had treatment and now Im leaving in the US and started seeing a Doctor, Ive been taking Descovy(200mg emtricitabine and 25mg tenofivir alafenamide) for at least 3 months now, a week ago I had these lab results that Im attaching to this email.

So my concern is hep b antigen is reactive and viral load is undetectable.

Can I pass hep b to others? Im concerned about passing it to my boyfriend (he started hep b vaccination but they said he will be fully vaccinated on sept this year)

My doctor said I have no hep B active, Can it re activate if I stop taking prep?

My doctor said I cannot pass it but Im just confused about the antigen still showing reactive.
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#2

Hi Royer, thanks for joining the community! In answer to your question about testing positive for the hep b surface antigen (HBsAg reactive), this is expected for those of us living with chronic hep b. It doesn’t become negative even if our viral DNA levels become undetectable with medication. With that said, there are new promising drugs in the research pipeline that may be able to eliminate the surface antigen. But that’s another discussion.

In regards to your infectiousness to your boyfriend - the fact that you’re hep b e-antigen negative and viral load undetectable, you are at low risk of transmitting the virus to others. BUT, to be on the very safe side, you ideally want to practice safe sex until your boyfriend completes his vaccine series (and he could be tested about 30 days after his last dose to test for the production of the protective hep b antibodies). Again, that is the most conservative advice so others on this forum might have less restrictive advice! Thanks again and I look forward to hearing what others have to say. Always, Joan

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#3

Thank you so much for your reply, this makes more sense from what my doctor said to me

#4

Hi Royer, Descovy as PrEP could be a problem for a person with hepatitis B if it is discontinued. Fortunately, you were tested for hep B so you are aware. You will not want to discontinue use without careful monitoring by your doctor. Now that you have been diagnosed with hep B, you’ll want to continue with regular monitoring every 6 months.

Everything Joan said is certainly true! I just wanted to be sure you were aware of possible issues with Descovy discontinuation. Maureen

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#5

Hi Royer,
I am in agreement with Joan. It is highly unlikely that you can pass it on to your boyfriend. But to be safe, I think Joan’s advice is great until he completes his vaccine series. It might be an inconvenience, but maybe a good one to protect him and to be safe until he is fully vaccinated against Hep.B virus. Be sure to stick with any plans you and your doctor have put in place. Try not make any changes without consulting with your doctor first. It is very important that you work with your doctor. I hope it helps. Good luck. Thanks, Bright.

#6

Hi, Here are direct answers to your questions:
"Can I pass hep b to others? "
Yes, but the risk is extremely low (virtually zero), unless via blood transfusion. Therefore, you can’t donate blood.
“Can it re activate if I stop taking prep?”
Yes, reactivation is almost a guarantee if you stop taking the medication. So, don’t stop taking it, and take it everyday.
“confused about the antigen still showing reactive”:
Hep B surface antigen HBsAg will always remains reactive/positive, unless you are lucky enough to become cured (or functionally cured) of hep B. When you are cured of hep b, surface antigen will turn into negative. If you were infected as an adult, you may have a good chance of being cured. Surface antigen is not infectious without hep B DNA, which is undetectable in your blood. However, surface antigen is still expressed from integrated and cccDNA inside your liver cells, that are very difficult to get rid of. Your doctor prescribed Descovy, probably because you might have a risk of contracting HIV, otherwise, monotherapy using TAF/Vemlidy is enough for suppressing HBV.

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#7

Hello.
Please can someone interpret my blood results.
I am 43 years old and 6 months ago I have been diagnosed with Hep B during a blood donation.
My Viral load was 10,054.
My fibroscan was 5.13 kpa
Few days ago I made the following test and Urea is low also EO%, MONO%, LYM% and some others are not in the range:

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Thank you very much have a good health

#8

Dear Aleksi,

As far as I know, Hepatitis B would not really affect urea levels, or eosinophil, monocyte or lymphocyte percentages by itself (particularly given your other results being fairly standard).

Thomas

#10

Hello again.

Please can you give me your views if I should do intermittent fasting in order to losse weight. I am 8 kg over weight and I have two months on plant based diet but still not losing but I also havent gained since on plant based

Cheers

#11

I think it is too difficult to tell over the internet what is the best way to lose weight. As I’ve said in the other threads (e.g.Understanding fatty liver desease - #7 by ThomasTu), nutrition and metabolism is very complicated and there are a lot of factors that are involved. Everyone is different. The best way for healthy weight loss is to talk to a certified dietician to help you in your context to lose weight appropriately.

Thomas

#12

Thank you for the add. I am somewhat confused and hope for clarification. I am and have been immune compromised with MS for many years. I was exposed to HBV 8 years ago. (And tested for months without incident after exposure.) My neuro recently did blood work in preparation of going on a new DMD therapy for MS that will suppress my immune system more, but should prevent or slow down further disease activity. The results of my tests were as follows
Normal cbc count and ast/alt levels. Everything good with liver , etc.

My IgG levels were low but that is common with my ms. However, this was the suprise:

HBVsAG-negative
HBVsAB-reactive
HBVcAb, core Ab ,IgM -positive
HbVcAB- core AB, tot- positive
Then I had an HBV DNA- result - not detected.

Is it possible that the Hep B can reactivate with my new medicine I start?.. or is active? I can not find this configuration through research with the positive IgM.
I interpreted tests as if I was exposed, endured and naturally fought and no longer an issue since I have the antibodies.
My doctors are having me see a GI specialist. I do not understand and any help would be appreciated. Thank you immensely for your time.

#13

Some additional clarity for those in the thread:

There are two main types of particles in the blood of HBV infected patients:

  1. Infectious viral particles (the scientific name for these infectious particles are Dane particles). These are the particles that can transmit infection from one person to another and drive the spread of infection in the liver. Dane particles are ultimately the cause of fibrosis and cirrhosis with long term, uncontrolled chronic HBV infection.

  2. Non-infectious subviral particles. These particles are produced by a different mechanism inside infected cells. In the blood, these particles outnumber Dane particles 10,000 to 1 and comprise > 99.99% of HBsAg in the blood. While these subviral particles are not infectious and do not contribute directly to fibrosis and cirrhosis, they block the natural immune control of HBV infection and are the reason why hepatitis from HBV remains chronic.

When you take TDF or TAF or another NUC, the production of Dane particles is suppressed but subviral particles are still produced. This is why you still test positive for HBsAg evem when your HBV DNA is not detectable. This is also why NUC therapy should not be stopped unless HBsAg also becomes undetectable.

Hope this helps!

#14

Yes, this seems like a reasonable explanation of your state.

In some instances of very strong immune suppression, the HBV can reactivate, but this can be prevented by taking antivirals during the period that you are being immunosuppressed (or waiting and monitoring for any reactivation). Good that you are getting it checked out and it was raised before your new medicine starts.

Thomas

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#15

Thank you very much for your reply. That is the most sense I have heard. I see the GI specialist then will start my new MS treatment. I was uneasy due to the fact no one could tell me if active, or not, or chronic, etc. Taking antivirals would be logical if it indeed could resurface after wiping out my immune system. I have dealt with that in other areas like shingles or coldsores and psoriasis flares, when my immune system has been depleted. I thought that the HBV might be different and gone. It sounds like there is a rare chance and I am a lucky “rare chance” type of person, so I will be armed properly to fight the right way. I really care for this community and again, appreciate you taking the time for responding.

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