Obviously without bloodwork and tests there’s no way to know for certain. But what symptoms usually present in reactivation of hep b?
Dear @Michaelmike223,
You can feel tired and in extreme cases of reactivation, you may even experience yellowing of the skin (jaundice). However, for most people, the early stages of reactivation are not accompanied by any external symptoms.
Thanks for the response I suspect my Crohns is flaring but there’s always that what if the hep reactivated. Bloodwork ast and alt all good. My globulin and protein are high so that’s got me a little concerned.
Dear @Michaelmike223,
If you have been diagnosed with chronic HBV you should be followed every 6 months even if you are not on therapy unless your HBsAg is not detectable. Elevated globulon and protein are not normally associated with HBV reactivation.
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Hi Michaelmike223
The symptoms of HBV reactivation especially anicteric hepatitis like anorexia , nausea , vomiting and fatigue may be nonspecific and can’t differentiate from other gastrointestinal diseases eg gastritis, dyspepsia . We can use basic biological (AST/ALT , PT, INR) , virological (HBV DNA , HBeAg , HBsAg )and immunological ( anti HBs ,anti HBe ,anti HBc IgM ) markers to confirm HBV reactivation.I hope this may help you understand.
chul_chan
Chulapong Chanta MD. Pediatrics
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No one used the word chronic directly. But I’m assuming it is. If we check my viral load once a year. I do recall the doctor saying it stays in your body like chicken pox does that mean chronic? . My blood only shows hep b core antibody total + ( confirmed multiple times knowing sometimes that could be false positive) I’m actually in the process of getting revaccinated since I didn’t develop the immunity. So no one directly said it’s chronic but did say it stays in you. I also worry about reactivation more than I would normally since I do have IBD and I’m on immunosuppressive infusions every 6 weeks.
If you have symptoms at all most common symptoms you can notice is dark urine (dark brown ỏ green), autoimmune hives,mild to extreme fatigue in which rest or diet doesn’t help improving. Unfortunately it’s better that you have some symptoms otherwise you don’t know until it’s too late.
Yes your doctor’s analogy with chicken pox is a perfect analogy. Vaccination for HBV is unlikely to be successful but not to worry, your body has already developed a competent immune response. Your anti-HBs antibodies are already there, they are just occupied doing their job (reacting to HBsAg) so they are not likely to show up on an antibody test.
If you have been on immunosuppressive therapy for a while e.g. at least two cycles (I guess using one of the standard antibody therapies) and have not yet seen any reactivation then I would not be concerned. This period is where HBV reactivation normally occurs.
So the interesting thing is my blood does not show the natural antibodies. So that’s why they’re trying to revaccinate. I also have been on immunosuppressants for 8 years now. So I’m assuming that’s relatively ok since it’s been so long according to your response? Thanks again I love this page. I wish there was a crohns page with experts as active and helpful on it. All of you rock!
Undetectable anti-HBs is to be expected since you have been previously infected and have achieved functional cure. You are actually making anti-HBs antibodies but these always are quickly sequestered by the very low levels of HBsAg which are present but below the detection limit of standard HBsAg assays. Also, standard assays for anti-HBs can only detect free antibodies which are not in complex with HBsAg already. I am not sure why your physicians are attempting HBV vaccination (it will not produce antibodies) but it cant hurt.
If you have been on immunosuppressants for 8 years and are still HBsAg negative, you have nothing to worry about from your Chrons!
Interesting yeah the only thing in blood that’s persisted the core AB tot
This is because even though you have functional cure, there is a very tiny bit of cccDNA activity present (this is in all people who have functional cure). As a result, there is a very tiny amount of core antigen production which maintains a chronic antibody response to core antigen. In this case though, the levels of anti-HBc IgM stay ahead of the core production so they are always seen by the anti-HBs IgG test.
anti-HBc total = IgG + IgM (IgM disappears once infection becomes chronic).
Thanks again quick follow up it’s looking like my inflectra infusions stopped working for my Crohn’s disease. They’re looking to shift biologics. Should I be concerned about reactivation of the hep b. With starting a new medication?
Dear @Michaelmike223,
I am sorry to hear this. Other biologics not be worrisome with respect to your HBV infection but your doctor may consider a HBsAg test 1-3 months after starting the new medication. Good luck!