Thank you so much. This got me so worried
Hi,
Thanks, may I ask what is the significance of HBsAg quantitative?
Here the result is just showing Reactive.
Hi Suresh,
A qualitative assay (one showing reactive or non-reactive) is only useful for tell us when there is very little HBsAg in the blood. It is useful for determining if a person can have their antiviral therapy removed or when they have achieved functional cure but it cannot tell us accurately how much HBsAg you have circulating in your blood. Understanding if and how fast HBsAg is declining during therapy can tell us things about how likely you are to achieve functional cure of HBV.
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Yes I agree but my problem is HDV.
I have HBV but HDV is causing main concern.
Is there significance of HBsAg quantitative for HDV.
Dear Suresh,
Functional cure of HBV means that HBsAg is no longer being produced in the liver. If you recall, HDV needs HBsAg from HBV infection to produce its viral envelope and to be released into the blood.
HBsAg decline during TAF + pegIFN therapy is a good sign that you may achieve control of your HDV infection. It is also possible (but less likely) that control of your HDV infection will persist after removal of pegIFN if you dont have a good HBsAg response.
Hope this helps.
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Hi @ThomasTu
Was doing some readings online and came accross “AST to Platelet Ratio Index (APRI) Calculator” and
“Fibrosis-4 (FIB-4) Calculator” could these help ascertain a diagnosis for liver cirrhosis or Fibrosis?
thinking of sharing it here, for our community experts to help interpret values for us and give us good insight on it.
thank-you, hope to hear from you.
Cornelius
Hello everyone, and especially the experts who give so generously of their time here. I’m a new member!
My wife (37 y.o., U.S.-born, Taiwanese parents) and I recently found out that her mother and sister have chronic HBV. Her parents have apparently known about this for decades but didn’t think to mention it; they’re doctor-averse and have a “No symptoms, no problem” attitude. Wife has a bit of doctor-aversion herself – no offense! she’s had unpleasant experiences – and went for a few a-la-carte lab tests on her own. I haven’t been tested, and no one remembers whether or not my wife was vaccinated for HBV.
Here are the results, which I post with her consent:
HBsAg: Nonreactive
Anti-HBs >1000
Liver panel all normal (bilirubin on the high end of normal at 1.2)
Here’s the catch: her sister’s hepatologist recommended that the whole family get HBcAb tested in addition to HBsAg, and said that if either HBsAg or HBcAb is positive then they should get an HBV DNA test.
While my wife and I can both appreciate the wisdom of “just do it,” I’m wondering if the doctors and scientists here would agree that an HBcAb test and possible consequent HBV DNA test is warranted at this point.
More broadly, what would be your assessment of her results as they stand? She and I understand that this would not constitute personal medical advice, but we value your opinions all the same.
Thanks very much, and regardless of what her status turns out to be, it’s become clear to me from learning about all this that HBV curative research is a necessary and noble endeavor, and you have my deep gratitude for pursuing it.
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Hello @thomasTu and @Joan_Block
43 Asian m, USA. Can i get an explanation of this. I have an apt to see a gastro this tuesday. My general dr is no help, i cannot even get someone on the phone for my test results.
’m from the USA and just found out I am positive.
| ALBUMIN, SERUM | Your Value5.0 g/dL | Standard Range4.0 - 5.0 g/dL | |
|---|---|---|---|
| BILIRUBIN, TOTAL | Your Value0.4 mg/dL | Standard Range0.0 - 1.2 mg/dL | |
| BILIRUBIN, DIRECT | Your Value0.11 mg/dL | Standard Range0.00 - 0.40 mg/dL | |
| ALKALINE PHOSPHATASE, SERUM | Your Value91 IU/L | Standard Range44 - 121 IU/L | |
| AST (SGOT) | Your Value23 IU/L | Standard Range0 - 40 IU/L | |
| ALT (SGPT) | Your Value30 IU/L | Standard Range0 - 44 IU/L |
HEP BE AG
Your Value
Negative
Standard Range
Negative
HEP B CORE AB, TOT
Your Value
Positive
Standard Range
Negative
Flag
A
HEP B CORE AB, IGM
Your Value
Negative
Standard Range
Negative
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Hi Cornelius,
Yes this is a way for clinicians to predict fibrosis/cirrhosis just from blood results from a liver function/blood panel test. My understanding is that it is not as accurate as fibroscan, but it can be used if you are in a situation where you cannot access this sort of technology.
Dear @ConcernedHusband,
With such a high antibody concentration, it is unlikely that there is infectious virus in the blood and I think most clinicians would deem this not worthwhile to follow-up on (she is basically immune from infection). There is low risk for liver disease progression from HBV (even if it was from an infection rather than vaccination). As to whether it is appropriate testing, I would ask for an opinion from a HBV specialist: @MarkDouglas; @simone.strasser; @PLampertico.
@Tnn, there isn’t enough information here to say if you are infected or not. While your HBc-antibodies are positive (which shows that you have been exposed to the virus) there is no result on HBsAg, which is needed to figure out if you actually still have the virus. If you aren’t, a test should also be done for HBsAb to see if you are protected/immune from any HBV infection in the future.
Hope this helps,
Thomas
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Fib-4 and other non invasive tests can be useful but the assessment of fibrosis/cirrhosis requires full hepatological evaluation which includes physical evaluation, full blood tests, non invasive tests for fibrosis (fibroscan being very popular), ultrasound and, in selected cases, a liver biopsy.
Prof. Pietro Lampertico, MD, PhD
Full Professor of Gastroenterology
Head of Gastroenterology and Hepatology Division
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico
University of Milan
Via Francesco Sforza 35
20122- Milan
Italy
Phone +390255035432
Fax +390250320410
Email pietro.lampertico@unimi.it
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HBsAg: Nonreactive
Anti-HBs >1000
Liver panel all normal (bilirubin on the high end of normal at 1.2)
With this HBV profile, assessment of anti-HBc is not so relevant but it depends if this profile follows HBV vaccination or an acute hepatitis B with recovery or HBsAg seroconversion after many years of CHB. According to the profile, we can estimate the risk of liver complications which in general is almost zero, unless HBsAg seroconversion occurred in a patient with cirrhosis
Prof. Pietro Lampertico, MD, PhD
Full Professor of Gastroenterology
Head of Gastroenterology and Hepatology Division
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico
University of Milan
Via Francesco Sforza 35
20122- Milan
Italy
Phone +390255035432
Fax +390250320410
Email pietro.lampertico@unimi.it
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Dear Cornelius,
I agree with Thomas that with negative HBsAg and high anti-HBs antibody there is no need to do HBV DNA.
This shows that you have cleared the active virus infection and are now immune.
The only thing to keep in mind is if you ever get severely immune compromised in future (i.e. not just “run down” but serious illness or immune suppressive therapy like organ transplant, cancer chemotherapy, lymphoma) then there is a risk of virus reactivation. You would need to talk to your doctors at the time whether or not you might need to take antiviral medication for prophylaxis.
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If we combine the treatment of option 1 and option 2 i.e. TAF+pegINF+bulevirtide
will it increase the chances of the success.
Dear Suresh,
Certainly this triple combination therapy will increase the change to effectively control HDV infection on treatment. However we do not have any data on how combining bulvertide with TDF/TAF + pegINF changes the likelihood of control of HDV after therapy. The clinical data to date shows that removal of bulvertide following NUC + bulvertide therapy is accompanied by rebound of HDV infection.
There are no known safety issues around TDF/TAF + pegIFN + bulvertide in patients that do not have advanced cirrhosis so it may be worth considering this approach.
This is problem with Bulevirtide as well as pegINF as soon as you stop these, the viral load will rebound. Any permanent solution for HDV
Hi Suresh,
In limited phase II clinical studies with NAPs + pegIFN (see the Research Showcase 2022), 48 weeks of combination therapy has led to sustained undetectable HDV RNA for at least three years after therapy. These compounds are still in clinical development.
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36.7% achieved End point with 2mg dosage, does it mean this percentage cleared the HDV altogether
Dear Suresh,
I agree the wording of this is confusing. During the development of bulvertide, an endpoint of a greater than or equal to 2 log10 (100-fold) reduction of HDV RNA from the baseline value before starting treatment accompanied by normalization of liver function (normal ALT) was adopted.
This is indeed a significant response as the normalization of ALT is a very important event for patients with HBV / HDV infection. Thus bulvertide is an important option for the treatment of this disease.
However most of the 36.7% of patients meeting this endpoint failed to achieve HDV RNA clearance.
Hope this helps…
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How many cleared the HDV ?
Hi Suresh,
The latest number with NUC + pegIFN + bulvertide was 50% with 24 weeks of treatment (which is a modest improvement over NUC + pegIFN [36%]). You can read more here…Microorganisms | Free Full-Text | Novel Therapies of Hepatitis B and D
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