Query Re: HBsAg negative after being in chronic stage for over 14 years plus

Hello, I was introduced by the Hep B foundation and glad to be here. This is the first time in 15 years, I am able to express openly as I was sidelined by my relatives and friends and lived with shame for all this period. I was diagnosed in 2005 and ended up in chronic condition, had ascites, portal hypertension, oesophageal varices and cirrhosis. Medical professionals wrote me off but I survived somehow. I took Baraclude for a couple of years (prescribed by a gastroenterologist) but was asked by another liver specialist to stop the medication as he thought it was not needed. Currently my HBsAg is negative (am puzzled) and HBsAB is negative and have a titre of 8 (I know I should have beyond 10). I know I have to undergo another blood test - HBcAB (core antibody) as well. I am not sure if I will be allowed to work in the medical field as I am currently pursuing a clinical degree to work in the ward and theatres. Is it possible for this virus to clear after being in chronic phase for over 14 years? I would be grateful if any expert can shed some light on this and I would appreciate wholeheartedly. Thank you.

Hi Vinu,

Welcome to the forum and thanks for sharing your story. I am really glad this forum is helping you express your worries openly; it is one of the reasons why I started this forum in the first place and it feels very rewarding for me to see it working.

As to your situation, I’m not sure how you were diagnosed with Hep B in the first place, but assume they have done the anti-HBc test or HBsAg test and found that you were positive? If so, I wouldn’t think an extra HBcAB test now will tell you much.

From the test results you present, it looks like that you are one of the lucky ones that have cleared the virus: if you have lost HBsAg and your HBsAB is at 8 IU/mL, this means you don’t have infectious virus in your blood any more. It is definitely possible to clear the virus (~1% of people with chronic HBV infection will clear their infection each year).

I would say that this then should have no impact on your work on your clinical degree. However, there is still a lot of misinformation and ignorance about hepatitis B (even in health services), so you may need to be forthright about your situation if you are confronted with discrimination. The best way to do this is be informed about your status and what it means.

Cheers,
Thomas

Dear Thomas
Thank you very much for your information, support and positive energy. It means a lot to silent sufferers like me. I am also pleased to know that 1 % of people with chronic HBV can clear infection each year.
With regards to you questions: Yes, I was diagnosed with Hep B infection and HBsAg was positive for nearly 13 years. Now that my HBsAg and HBsAB (surface antibody) are negative, I have given bloods to test for core antibody (HBcAB). If this is also negative, I think I can get my vaccination right? I am eagerly awaiting my blood report anytime now. I was told that I cannot vaccinate due to my past infection. But some doctors tell I can vaccinate if all three are negative. So, its quite confusing, Also, my titre level on HBsAB shows 8. So, I am confused what that implies.
Kind regards
Vinu

Wow that’s good

I was told not to take drugs as my viral load is very low but I want the virus out of my system

How do I completely clear this off

Hi Vinu,

I wouldn’t say that you’re HBsAB is negative; it is at 8, which is positive, just below the threshold of “protection”. I put this in quotation marks because (as far as I know) the science behind using 10 as a threshold for protection is fairly arbitrary: it is known that a response above this level does prevent infection, but it is not very clear if an intermediate level of 8 is still protective or not.

From what you are saying, I would expect the HBcAB to be positive (given you were previously infected). That said, vaccination after you have been exposed to HBV is not particularly dangerous, it just won’t do anything.

What do you think of this @MarkDouglas?

Thomas

Dear Oluchi,

This is a great question and one that a lot of scientists are asking too. There’s a lot of research going on to find ways to completely clear the virus (my own lab included). Basically, we don’t know yet, but we are working on it. I believe with all the research going on that there will be a way soon.

Thomas

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Dear Thomas
Thanks for your email and clarity, which no one provides.
I have had my results now which is as follows:
HBsAg NEGATIVE (surface antigen) HBsAb <10 (surface antibody) HBcAb (total) POSITIVE (core antibody) HBcAb (IgM) NEGATIVE HBeAg NEGATIVE HBeAb POSITIVE (encapsulated antibody)
What does the above result indicate?
Do I need further follow up of DNA test and LFT, something like that?
Your advise would be monumental for me.
Thanks and kind regards
Vinu

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Oluchi, let’s hope the research is successful soon so we can all be healthy one day. Don’t let anything bring you down. Maintain your healthy life style.

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The results sound great, Vinu. They are a definite indication that you have cleared your chronic HBV infection. Congratulations!

For follow up, I would probably suggest an ultrasound or fibroscan to find out if you have liver fibrosis. Liver injury can reverse over time after you have cleared the infection, but it’s important to know how damaged it may be and how much risk there might be of further liver problems before your fibrosis resolves.

It will also be important to let any doctors in the future know about it, as the infection can reactivate if your immune system is suppressed (e.g. by some medications).

Thomas

Oh my god! Thomas. This sounds so reassuring for me. It means a lot to me. I did have a normal ultrasound scan recently which did not detect any abnormality in liver. I will try another fibroscan as per your suggestion. I will also be mindful of the infection reactivating. Will I be re-infected again in future if I am exposed? (as the vaccine would not be beneficial). A Doctor suggested me to check viral DNA - therefore I am puzzled if there is low viral load inside my blood still.
I also wanted to inform you that I followed vegetarian diet always and took a lot of naturopathic herbal preparations few years ago. Not too sure if that has helped in a way.
Kindest regards
Vinu

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Hi Vinu, I am an Infectious Diseases specialist and virologist. I agree with Thomas’s comments. The serology confirms that you were infected and have cleared your chronic hepatitis B. If the clearance was relatively recent it can take some time (months up to years) for the HBsAb to appear, so that may increase over time. There is likely no benefit from vaccine, but no harm either if they want to give it. I agree with checking viral DNA (HBV DNA), as this will confirm you do not require any ongoing treatment and reassure people about your safety to work in a clinical environment. If you had cirrhosis (sounds likely if you had varices etc) and/or you are over 50 when clearing HBsAg then you should also have ongoing surveillance for hepatocellular carcinoma (HCC, liver cancer), as the risk is still increased, although much reduced now that you have cleared HBsAg. This requires an ultrasound and AFP test every 6 months. You may also still need endoscopy to see if the varices have disappeared. A Fibroscan is an excellent idea to see how much scarring is in the liver now. It does all sound a bit complicated so I would go and see your Hepatologist or specialist to make sure everything is being done correctly. Hope that helps!

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