Can someone tell me what these results mean? My lab results are in the left column while the column on the right are the reference values. AK means “Antikörper”, the German word for antibodies.I’m very confused because the doctor who performed the blood test last October told me that I was cured and could stop taking the medication whereas my gastroenterologist told me today that I am not cured because I don’t have antibodies. Which of them is correct? Thanks in advance for responses.
Hi @Barry,
It is hard to follow the results because of how they are presented, but you are surface antigen negative currently, which is good. My understanding of this situation is that people with functional cure are more likely to not develop measurable antibodies since it is not induced by a vaccine. So expect not to have antibodies. The first doctor is correct. The second doctor is following the guidance that if someone is HBsAg negative and HBsAb negative, then they need vaccination. If you seroconverted from HBsAg positive to negative, then your case is going to be different. You don’t have to worry. Just keep monitoring from time to time. I hope this helps. Bansah1
Given everything is negative except for the anti-HBc, it’s probably a good idea to repeat the test and confirm that the anti-HBc really is positive. A possible explanation for this panel is that you have never been exposed and not vaccinated and that this is a false positive for anti-HBc. If this is the case, then the recommended action would be to get vaccinated to protect yourself from any future exposure events.
Thanks, Bansah1 and Thomas. But the thing is I HAVE been exposed. I was diagnosed with hepatitis B in December 2020 and started taking Tenofovir in mid-2021. In any case, my gastroenterologist wants to repeat the blood tests in April. By then it will have been six months since I stopped taking Tenofovir at the recommendation of the first doctor (a specialist in infectious diseases). I contacted his practice yesterday and requested that he ring me back to discuss the matter. His secretary said he will ring me on Monday.
Excellent news. So you cleared HBsAg on TDF therapy and have normal liver function.
Your doctor was right to take you off TDF: clearing HBsAg requires recovery of immune control which in the presence of TDF alone comes mostly from your immune system. This result means you most likely have HBV functional cure. Your next testing (6 months off TDF) will formally confirm this (HBV DNA and HBsAg not detectable with normal ALT).
There is no point in vaccination as you already have immunity to HBV. Often people who achieve HBV functional cure like you have do not develop delectable HBsAg antibodies.
Yes, I’m not sure about the reasoning. It is potentially due to the negative anti-HBs antibodies. Different people go by different definitions, but my understanding is that clearance/cure is becoming HBsAg-negative (regardless of anti-HBs status).
How did your discussion with the doctor go on Monday?
Ok, that sounds like you will have a chance to ask specific questions about your situation your clinician soon. It’s helpful to write these down ahead of time to make sure you get the most out of your consult.
Personally, I’m getting frustrated with this doctor. It’s like she doesn’t want me t be cured or something and would prefer having me on medication for the rest of my life. I also remember her attitude when I got diagnosed in 2020: She was judgmental, lacking in empathy and carried on as if I was going to die.
After around six months of not taking Tenofovir, me hepatitis B is back. My Hep B DNA is high and my liver values are elevated. The gastorenterologist advised me to stark taking Tenofovir again. I’m bitterly disappointed and shocked that the other doctor advised me to stop taking Tenofovir. How am I, as a layperson, as a patient supposed to trust doctors who give conflicting advice?
I’m sorry to hear this. Clinicians generally make decisions based on the information that they have. Many doctors would have recommended stopping antivirals once HBsAg became negative, as per the EASL guidelines (https://easl.eu/wp-content/uploads/2018/10/HepB-English-report.pdf):
NAs should be discontinued after confirmed HBsAg loss, with or without anti-HBs seroconversion (Evidence level II-2, grade of recommendation 1).
This reactivation does not often occur and I am saddened to hear that it has happened to you. However, this isn’t necessarily a reason to throw out all medical advice.
This community will be here for you to support you through your journey. Please keep us up to date.
So why did reactivation occur in my case? My gastroenterologist was adamant when I met her a couple of months ago that the other doctor was wrong to tell me to stop taking Tenofovir. I’m wondering if you and the others here read my lab results correctly. Where does it say for example that I had HBsAG loss when my blood was tested last autumn (see image of my lab results above). This is all highly confusing for me. I curse the day I ever got this diagnosis and I curse all the doctors who never recommended the hepatitis B vaccine to me.
The HBs-Ag quant. (highlighted in blue) shows 0.0IU/mL, which is negative.
I am not sure why there was reactivation in your specific case, as there is a complicated combination of host and environment factors that may affect it.
But does the 0.0IU/mL reading for HBs-Ag quant. simply result from the fact that I was on medication so reactivation was likely to happen as soon as I stopped taking the meds?
