My pregnancy and Hep B journey

Hello everyone, thought I would share my journey here and get it off my chest a little bit. I’m currently 6 months pregnant and on Tenofovir for 3 months now. Initially my viral load was 18 millions and now down to 1000. But my AST/ ALT has been elevated for the last 3 blood test that I did ( every 2 weeks blood test ). But the most recent one for AST/ALT has slowly going down. My doctor has order a blood test called ANA MULTIPLEX BY IMMUNOASSAY aWITH REFLEX TITER and it is Positive. I’m not sure has anybody gone through the same thing? What does it mean for this test? I’m waiting on his response. Thank you all!

Dear @Olive,

Thanks for sharing your experiences and it’s great to hear that you have responded so well and that your viral load has lowered so much in such a short period of time. You definitely are limiting the risk of transmission to your child.

It’s a good thing to see that your ALT is going down too.

Regarding the ANA test, this is more of an immunology thing (which gets particularly complicated with pregnancy). Perhaps some @healthexperts can weigh in here.

Cheers,
Thomas

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Dear Olive,
Young women are ANA positive during pregnancy, pay attention to the possibility of autoimmune disease First, what is the anti-nuclear antibody titer, whether there is anti-SSA/SSB/SM, etc., and whether there is any other discomfort.
There are many changes in the body during pregnancy. For example, a simple ANA titer is positive, which has no special significance and can be observed; if there is joint pain, rash, fever, and frequent oral ulcers, you should be vigilant, and it is recommended to be a rheumatology clinic in a regular hospital. Check and complete medical history, whether there is any other discomfort。

Best regard
Yuanyuan

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Thank you Thomas for your reply!

Hello Yuan,

My specialist ordered this test as well : ANA BY IFA PATTERN/TITER ( |ANA Pattern/Titer - Homogeneous 1:160). I’m not too sure why he ordered those tests and never explain the result to me. He just told me that stay on Viread and repeat the blood test for my liver function and viral load count. My OB did tell me the same thing about see a rheumatologist, I’m not too sure why is this happening, what is the root cause for it?

Thank you!

Dear Olive,
Higher ANA titers (eg 1:640, 1:1280, or 1:2560) indicate more severe disease
There is usually less autoimmune disease if the ANA titer is low (e.g. 1:40, 1:80 or even 1:160).
If the ANA titer is in the middle (e.g. 1:320), the results are less clear and should be interpreted in a clinical context
If ANA titers are high, additional tests can be ordered to determine which type of nuclear protein is under attack.
*I think if you don’t have any symptoms, you can dynamicly observe. If you are still worried about it, you can go to see a rheumatology clinic.

Best regards
Yuanyuan

Hi Olive,

It would be easier to help answer some of your questions if we could get a bit more information:

  1. Any HBeAg / anti-HBe tests?
  2. For the four tests where you indicated you had elevated ALT can you give us the following:
    ALT / AST / GGT values and the values for bilirubin, albumin and INR for these same test periods?

Best regards,

Hi Availlant,

This is what I can find:
1/ Hep B Surface Ab 16.7 Standard Range:>9.99
Hepatitis B Core Antibody Total Reactive
2/
Screenshot 2022-05-17 180035

Thank you!

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Thank you for your reply. My doctor told me just monitor it for now and he will have to follow the pattern to see what’s going on. Especially after delivery.

Did anything happen to you between March and April?
I think they did the ANA to rule out autoimmune hepatitis, as a primary care physician, that’s why I would order it if someone had abnormal liver enzymes. What are your baseline liver enzymes? Both your AST and ALT are elevated.
ANA can be false positive in up to 15% of the population, agree with your doctor and @yuan to monitor for now if you don’t have any symptoms.
And you should continue to be followed closely if your enzymes are still high. Do you have high cholesterol, diabetes or has anybody ever mentioned fatty liver to you? Have you had a liver ultrasound before?
Have a great rest of your pregnancy and looking forward to hearing the good news! Make sure baby gets vaccinated within 24 hours of birth (the sooner the better) and if your hospital has HBIG, should get that as well!
Su

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Nothing happened to me between March and April. I feel completely normal. I had liver ultrasound back in March and nothing look remarkable. I do not have diabetes nor high cholesterol. My doctor did not mention anything about fatty liver. My AST/ALT has slowing a little bit base on my most current blood test.

Thank you!

Hi Olive,

First it looks like you have seroconverted for HBsAg (Hep B Surface Ab 16.7) which is a very good sign. You should have your HBsAg tested to see if it is negative. Decisions regarding your therapy should be made between you and your doctor, but HBsAg loss (this will be “negative” on a qualitative test or < 0.05 IU/mL on a quantitative test) is considered a key milestone in the restoration of immune control of chronic HBV infection and is a circumstance where removal of antiviral therapy may be considered according to current treatment guidelines.

It also appears as though you have experienced a mild transaminase (ALT/AST) flare which is now self resolving. It does not appear that this flare is caused by liver toxicity or autoimmune hepatitis as your actual liver function appears fairly normal. This kind of transaminase flare is typically associated with positive response to antiviral therapy.

Of course your ANA positivity is something that needs to be followed by your doctor…but I would consider that this is not related to your transaminase flare.

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Thank you for your reply. This gave me more confident and feel at ease through this difficult time!

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Hi Olive,

I wish you the very best during your pregnancy! I am not qualified to add to the medical discussion, but I think Andrew V’s interpretation of the virology has a good chance of being right, and the tests he recommends will be informative. As a father who is longing to be a grandpa, I am excited for you! (Unfortunately, neither of my sons show any signs of finding a nice lady to settle down with).

John.

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Hi John,

Thank you for your kind words. I wish you the very best as well as becoming a grandfather in the near future!!

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