Any comment about the lab results would be appreciated.
Note: 2017 was positive of Heb e antigen and it seems to have been negative last year (2024). Started treatment in 2014. I was on Viread for years and now on Vemlidy for the last 5years
Based on what I have read online, it seems to be a good response to treatment. However, my concern comes from dual positive of both Heb S Ab and antigen.
My question is , since Heb S Antigen seroconversion rates is high in those with Heb E seroconversion, is this likely what is going on with my Heb as well since I am currently positive for both Heb S Ab and antigen
Hi @Walenat,
Great question. Seroconversion on our current antivirals is not guaranteed. This only happens in about 5% of patients, irrespective of HBeAg. It is not possible to have HBV (positive surface antigen) and be immune against HBV simultaneously. Something is amiss with the results you have shared, unless your surface antigen results are probably a false positive.
Best, Bansah1
Thank you for the response. The interpretation of the results by the lab agent was based on the presence of Heb s antibodies (that’s why it says immune). However we know this is not the case for people who are co positive for Heb S antibody and Heb S Antigen.
I believe there is a typo in your response. Seroconversion [specifically surface antigen seroconversion] is NOT guaranteed on current antivirals. Also, it is possible to be both HBsAg and HBsAb positive at the same. It is very rare. It can be due to false HBsAg positive, as you suggested, but there are other possible explanations. The patients should monitor their HBV condition using other markers, such as liver functions, ALT, and hbvdna. Consult their Hepatitis doctor.
Thank you for the contribution. In other thread I posted in January , the impact/meaning of coexistence of hepatitis b surface antigen and antibody has been well explained with similar articles shared.
My current question is: is there any correlation between this ( coexistence of hepatitis b surface antigen and antibody ) and Hep e seroconversion.
Just for clarity, here is the information about stopping treatment as per 2015 WHO:
“NO CIRRHOSIS
and HBeAg loss and seroconversion to anti-HBe and after completion of at least one additional year of treatment and persistently normal ALT
and persistently undetectable HBV DNA”
I meet all these criteria (although the anti-Hbe is still indeterminate) except for the occurrence of the co-positive of Heb S antigen and Heb S antibody.
Hi @Walenat,
As we have shared, your situation of co-positive of HbsAg and HbsAb is rare. My knowledge on this is limited. We have some experts here traveling for international conferences, but be patient. Someone with much understanding will respond to your questions.
This is complicated, and probably why it is not that simple to say stop treatment. For someone to stop treatment, they need to have a cleared surface antigen, normal ALT and AST, remain undetectable for a period of testing, and a clean liver imaging. Testing positive for HBsAb is great, but you still have a positive HBsAg result. I bet this might be frustrating for you.
I don’t know how much you have engaged your provider on this matter, but it will make sense to do that if that is not the case already. They know your situation much better and can provide concrete guidelines or advice. Someone will respond with their take soon. Best, Bansah1
We may have some @HealthExperts who can specifically answer your question as to the management of people with both anti-HBs and HBsAg. My understanding is that as long as HBsAg is still detected, treatment should be maintained. It looks also like that people with both anti-HBs and HBsAg are more likely to get to HBsAg loss, so you may be one of the lucky ones as time goes on. It is best to keep your monitoring up to find out when this might be the case.
Hello I agree we would maintain treatment, I would check quantitative hepatitis B surface antigen levels if you have access to this test to determine if more likely to get HBsAg loss as time goes on.
Hi, I’ve recently talked about this with an IFD specialist who also agreed that treatment should be continued. As long as the HBsAg is positive, the treatment needs to continue. There have been cases where treatment can be stopped, as the article you mentioned, if HBeAg disappears and anti HBe appears, and there is no cirrhosis or family history of liver cancer. This is when people go into immune control (HBeAg-negative chronic HBV infection), but the decision to stop should only be made upon the agreement of the specialist, and close monitoring is then needed . Even with the presence of anti HBs, we follow this protocol.
I had experienced with HBe Ag +ve and anti HBe +ve simultaneously from my blood tests during 1992 with immune active phase (phase2 CHB) and it takes about 3-6 months that HBeAg became -ve and anti HBe +ve and turned into inactive immune control (carrier state) since at that time.
From your laboratory tests that showed HBsAg +ve and anti HBs +ve . First of all ,we should have to distinguish between true positive and false positive as this is a rare conditions and unusual serological pattern and is a complex issues in clinical practice. Study in children with CHB and HBeAg -ve who have coexistence of HBs Ag +ve and anti HBs +ve showed that they have lower HBsAg level and HBV DNA compared with CHB children without anti HBs and may correlate with HBsAg loss and turn to functional cure with appropriate antiviral medication.
In the case of adult with CHB and coexistence of HBsAg and antiHBs +ve , antiviral medication may cause pressure selection on HBV to mutate. This phenomenon may be explained by the point mutation of HBV genome at open reading frame S region results in alteration in immunogenicity of surface protein regions and produces immune escape HBsAg mutant which anti HBs can’t detect and eliminate it. However, until now , there has been no clear cut study and evidences on the cause and effects of HBsAg and anti HBs +ve coexistence in some CHB patients. Further researches are still needed. You should measure quantitative HBsAg levels, HBV DNA and ALT periodically for monitoring and evaluation about cccDNA transcriptional activity and inflammatory processes in your liver and consult with your doctor for proper management. I hope this may help you.
chul_chan
Chulapong Chanta . MD. Pediatrics
Hi
I would also support the ongoing Rx with antivirals in this scenario. With the increased duration of antiviral RX, we are seeing a range of atypical serology. As long as the HBsAg is positive, ongoing treatment is best
I’ve encountered several patients who test positive for both HBsAg (+) and HBsAb (+). There are two possible explanations for this. First, some individuals may experience acute HBV infection, during which liver function is often compromised, showing elevated ALT and AST levels. Initially, HBsAg is positive, but it decreases over time while HBsAb becomes positive and increases. In some cases, doctors may use immunosuppressive treatments, such as dexamethasone, to reduce liver injury. This can lead to a temporary rise in HBsAg levels and a decrease in HBsAb, sometimes even to the point of disappearance. As a result, the patient may progress to chronic HBV infection.
Another reason is that in China, For patients with low HBsAg (<1500), PEG-IFN therapy is often used with the goal of achieving a clinical cure. Approximately 30% of HBV patients can clear HBsAg, leading to positive HBsAb results. This can result in a situation where both HBsAg and HBsAb are positive at the same time. Therefore, it’s essential to monitor HBsAg and HBsAb levels dynamically.
@Walenat, you can consider quantitatively testing for HBsAg and HBsAb in a few months. Regarding treatment, you should continue the oral antiviral therapy until HBsAg becomes negative and HBsAb becomes positive at higher titers.
