Is it possible for a resolved acute HBV to reactivate in a healthy person?and should one keep getting tested periodically for HBV? or is it that once recovered you will not get it again unless your immune system is compromised? My last Post was I believe earlier this year, but this has been stressing me out still.(I recovered from an acute infection- not sure when I got it, as per my mom who is a dr herself- she says she gave me the vaccine herself when I was a teenager)
Dear @ZiiTR ,
I am not aware of any reported cases of HBV reactivation in a healthy person who has successfully resolved acute HBV infection. It is true that HBV can reactivate if such a person becomes immunocompromised. The data we gave on this comes from people who take immunosuppresive therapy for cancer or autoimmune diseases.
In your case there is nothing to be stressed about. Your body has established a very effective immune control of HBV infection which is life long. However, it is important to make physicians aware of your acute resolution of HBV (your vaccination does not change this) if you ever have to have immunosupressive therapy or chemotherapy in the future. In these cases, starting NUC therapy prior to the treatment is an effective way to prevent reactivation.
Other than this, you really have nothing to worry about.
Thank you so much for your reply. It really eases the stress off my mind. And it is a blessing to have this community support us- with all our concerns and questions. So much respect for you all.
Hello, based on your answer herein, kindly shade some light for me. A part from Hbv patient, I also have issues with inflated legs. Which my doctors has said to be as a result of vasculitis. Currently, I’m on Prednisone and ibuprofen(for pain reliever.
From the studies have read, Prednisone is one of immunosuppressive drugs. Can Prednisone have any effect in my Hbv journey?
What if my system eventually clears Hbv and I develop antibodies for Hbv, yet still continue with Prednisone for my legs, do I stand a risk of reactivated Hbv?
This is a great question.
Following resolution of acute infection, spontaneous functional cure of chronic infection or functional cure following therapy, the capability to reactivate infection is possible because a small fraction of liver cells will always carry a dormant copy of HBV DNA which is cannot be recognized by host immunity (we call this inactive cccDNA).
In all these cases of resolved infeciton, viral replication does not occur in the absence of antiviral therapy because when these dormant copies of cccDNA try to reactivate, they are targeted by liver immunity and deactivated again.
So the reactivation of HBV requires the reduction in the activity of a special form of immunity in the liver (innate immunity) which controls cccDNA reactivation.
All of the clinical data we have right now shows us that HBV reactivation can occur with very strong immunosuppressive medication used to treat cancer or autoimmune diseases or to prevent transplant rejection and unfortunately, also with more mild immunosuppressive treatments like prednisone (please see here).
If you are currently under HBV therapy this is not a concern. But if you have resolved your HBV infection your prednisone use should be accompanied by prophylactic antiviral therapy, especially with prolonged prednisone dosing above 20mg.
Hello @ availlant
Thanks for your response… Much appreciated:pray:
The dosage I’m taking for Prednisone is 10 mg/ day but still under HBV therapy.
About prophylactic anti- HBV therapy, is it a vaccine? In case my system successfully clears HBV, can I be given such vaccine to stop reactivation of Hbv because Prednisone I’m using for my legs
Dear @Vera ,
Are you currently taking antiviral therapy? Prophylactic therapy involves taking one of three oral antiviral drugs with the following generic names: entecavir, tenofovir disoproxil fumarate (aka Viread) or tenofovir alafenamide (aka Vemlidy).
Yes I’m on therapy. I was given Tenefovir disoproxil fumarate lamivudine.
Is it the right therapy for Hbv?
Perfect @Vera !
You are on the right therapy which will provide excellent protection from potential reactivation of your HBV infection while you are on steroid therapy.
Your doctor is properly and safely managing your complication with vasculitis in view of your underlying chronic HBV infection.
Best of luck with the prednisone therapy.
Once again thanks so much for your time. I take 1 tablet of the therapy per day is it okay?
Incase HBV clears, will I still stand a risk of reactivation despite continued usage of Prednisone?
Hi @Vera ,
Depending on where to live, the recommended daily dose of TDF is 245mg or 300mg. This is actually the same amount of drug but these different amounts reflect different labeling conventions indicating dosing of the tenofovir molecule itself (245mg) or of tenofovir + disoproxil fumarate (entire prodrug: 300mg).
You should not be using prednisone if you are not being protected from reactivation of HBV by TDF. This includes if your viral load (HBV DNA) test result becomes undetectable.
TDF is typically a safe but life long therapy which cannot be stopped unless HBsAg becomes undetectable for at least 6 months.
Hello @ availlant, once again thanks so much. Actually Prednisone wasn’t prescribed for HBV, but for my inflated legs. Sadly, even when I was on TDF , they were still swollen and making my whole body to ache seriously. Most times I couldn’t even walk properly without depending on Diclofenac
That’s when my specialist ( surgeon) advised we try Prednisone and ibuprofen then monitor my legs afterwards. I got relief and he advised I be taking only 10mg/day as I still continue with my clinical check up regularly.
That’s the reason I’m on Prednisone not for HBV
I’m about to take another viral load test which will guide on the status of my Hbv