Partner is not positive for HBsAg, anti-HBs, or anti-HBc

Hi

thank you so much @ThomasTu @Joan_Block and @pradeepmlk. You have taken away a lot of fear from me. I feel much better since a few days.

To my person:
I am 39 and relatively thin. Always been. I have drunk almost no alcohol in the last 6 years and I have no symptoms. I think that is quite good in relation to my infection.

There are still a few worries:

  1. The uncertainty about my wife. She is HBsAg negative. But I dont know if she has been through an infection before and is immune or if she has never been infected. I think the latter is very unlikely.

  2. I think a lot about financial things. I am not sure if our house credit will be extended. Does anyone have experience with rejections?

  3. I don’t know what my liver looks like, of course. I think my viral load can be considered high (HBV 4880 IU/ml). ALT and AST are unknown.

I am very thankful that the forum exists.

Greetings
Alexander

Hi Alexander just wanted to quickly answer your questions to the best of my abilities:
(1) Your wife should have positive test results for her hep b surface ANTIBODY (HBsAb or anti-HBs) that would indicate whether she is immune. The anti-HBs could be positive because she was vaccinated OR because she was exposed to the virus and her immune system was able to get rid of the virus on its own. This actually happens about 90% of the time in healthy adults. Make sure you see if she has this test result? If not, ask the doctor to order it for your peace of mind.
(2) I’m not sure about house credit? Maybe others can respond!
(3) Actually your viral DNA of 4880 isn’t really that high. It’s certainly within the treatable range, but considering many of us, including myself, our viral loads were in the hundreds of millions before treatment! So it will be important to find out what your liver enzymes (ALT/AST) are and to have an ultrasound of your liver.

But yes, it sounds like you are in good shape overall. You’re young which is also good. Thanks for sharing and hopefully others will respond as well. Always, Joan

P.S. Pradeep thanks for you very thorough and thoughtful response to Alexander!!

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Dear @Alexander,

I agree with what Joan has already mentioned and just wanted to add a few more points.

  1. Yes, your wife should have an anti-HBs test and an anti-HBc test. The results from these will be able to answer your questions.

  2. I had lived in Germany (Heidelberg) for 4 years, though never bought a house. However, my feeling from the German system is that they have very stringent medical privacy and data protection (Datenschutz) laws. To me, denying you house credit would feel like a violation of this. Perhaps some Germans (@Tassilo, @aploss, @Greg) or people with experience in Germany (@19Kaipe59, @Benno) could give their opinions or experiences.

  3. Joan is right and a viral load of 5000 is not particularly high. To answer your question about your liver health, you should follow up with a liver function test (which will include ALTs) and a fibroscan or ultrasound.

Thomas

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Dear @ThomasTu

Today we received the test results of my wife. Now the situation is very weird.
HBsAg had already been tested negative.

Now the result what we would have expected:
anti-HBs positive
anti-HBc positive
because we have had unprotected sex for years.

But the actual result is:
anti-HBs negative
anti-HBc negative

My interpretation of this is that my wife has never been in contact with the virus. But how is that possible?

We read about diagnostic gaps, low level infection, mutation etc. Somehow the facts don’t seem so clear.

Thanks again for your posts @ThomasTu and @Joan_Block

Greetings
Alexander

Hi Alexander.
I am sorry I have to put some small response to your mail although you have needed Thomas response alone.
Your results are still good. Probably you organise for your wife to be vaccinated. I am also very expectant on what the experts will be saying about your unique situation.
Regards
Kinoti

Hi Alexander,

Thanks for updating us on your wife’s results. I think that this is an important enough topic that it should have its own thread so it is easily searchable, so I hope you don’t mind that I’ve moved this discussion.

Hep B is a blood-borne virus and needs to be transmitted by blood. Your sexual contact would have to break the surface of the skin (e.g. generate scratches) for there to be a chance of exposure. Perhaps this has not happened before. I also think having a low viral load helps a lot. There is a lot of couples on this forum who have had children without knowing they have Hep B and have not transmitted it to their negative partners, so this does definitely happen.

Hope this helps.
Thomas

Hi @ThomasTu

thank you for your answer. It is hard to believe but obviously true.
I have a few more questions:

How secure is the result ?
HBsAg negative
anti-HBs negative
anti-HBc negative

Can you maybe explain something about escape mutation and the occult hepatitis B infection (OBI).
I read that this types can only be detected for sure by a HBV-DNA test.

Is this possible scenario in our constellation ?
I unfortunately have to ask all these questions as our doctor and his lab are unsure what the possibilities are. This is so sad. I have a feeling that Hep B is like a unicorn for them. Fortunately the appointment at the university medical center is already next week.

It is stress for us not to know exactly what is going on.

@Kinoti Thank you for your response.

PS: My wife is getting a vaccination next week.

Greetings
Alexander

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Hello Alexander ,

I think, the most important thing right now for you is to get her vaccinated as soon as possible.
I read, virus comes in body secretions also including semen. Maybe low viral load as Dr Thomas mentioned, was the reason she didn’t get infected. But as you said you had unprotected sex for years, I doubt you had low viral load all these times.

I too had unprotected sex before I tested positive, but I used to ejaculate outside her. Luckily, she didn’t get it. Now she’s vaccinated and has a very good anti Hbs titer.
( I had an acute infection, best guess).

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Hi Alexander,

Great to hear about your wife getting her vaccination next week. You’re doing all the right things.

Regarding your questions:

This is very consistent with not being exposed to the virus and it’s unlikely all three tests are inaccurate.

This is not likely at all to be an occult infection because the anti-HBc is negative, this means it does not match the definition of occult HBV infection.

Hope this helps,
Thomas

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Hi Alaxander,
You are saying you and your wife are stressed because you don’t know what is happening. The fact that your wife was not exposed to infection(and @ThomasTu explained well)and because of the same she doesn’t have after exposure immunity nor vaccination immunity are facts that seem clear to you. Hence your stress is a response to Hep b information you got after exposure which you are still digesting. Naturally, it will away.
Kinoti.

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Hi Alexander, everyone is giving you positive and reassuring advice! I would only add that for your peace of mind, you could ask you wife to be tested again for everything in a couple of months? But I assume she will start the hep b vaccine, so that would alter her test results (meaning, she should then test positive for anti-HBs). I can’t remember how soon after starting the vaccine series her surface antibody test would be positive? Maybe Thomas knows. But as Kinoti has written, it is wonderful that your wife is negative for hep b!! Always, Joan

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Hi

Thanks again to all of you for your inputs.

@Kinoti The main issue was that our doctor could not provide us with any reliable information. We first assumed the obvious, that my wife has already been through the virus and is immune. First the doctor only did the normal heptitis screening (including Hep C). Then we were also misinformed that my wife has no antibodies. Hep C antibodies were meant. Then were the vacations where we had to wait again. Only then was the anti-HBc and anti-HBs test done. After I researched what it means when all values are negative. The doctor and the laboratory doctor were not sure and said that they could not exclude an occult infection. This whole thing dragged on for several weeks and was so unnecessary. Maybe you know the feeling right after diagnosis of feeling like you are super contagious because you are not used to it. Thank you for the positive input.

@ThomasTu It helped a lot. Big thanks. What do you think about what Joan wrote? Can vaccination in a repeated test shadow the result? Is there a possibility that my wife is in the incubation period right now?

Greetings
Alexander

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I think the possibility of her not being exposed is more likely than you having tested her in the specific 4 week incubation phase when the serological markers have not come up yet. In any case, vaccination would be the recommendation for either case.

Regarding what Joan talked about I believe it’s recommended you test for anti-HBs a month after the last dose of the vaccine series.

Hope this helps,
Thomas

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