Questions from Readers and Answers by Medical Experts
on Treatment and Care for Chronic Hepatitis B Virus (HBV) Infection

I am confused. My daughter got a positive test at the hospital for hep B surface Ab and a negative for the rest. Our family doctor did the test before she went to the hospital and after she came back and both tests were positive for hep B core antibody, IgM. How is that possible?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

A positive test for hepatitis B surface antibody indicates immunity. It can occur because of vaccination or prior infection and recovery. If infection is the cause, then the core antibody is positive, but it is usually the IgG or total, not the IgM. You did not include the other relevant tests so it is not possible to be certain what is going on here.

I was diagnosed with chronic non-reactive hepatitis B when I was pregnant. The doctors told me I was born with it (my mothers' family came from Vietnam), but they never told me about it. I would like to know what my possibility of transmitting the virus is.

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

There is always a risk of transmitting hepatitis B as long as the surface antigen is positive. However, the risk of transmission is related to the level of virus in the blood. That can be measured using the HBV DNA test. It is not possible to "quantify" the risk of transmission precisely, but people with high levels of virus are more likely to transmit the infection than those with low levels.

I am HBV infected, but don't yet know the HBV DNA count in my blood. Since last year I have been tested 3 times for ALT and AST, which are normal. Does this mean that I am not an active carrier? I have been taking medicines for ulcers and rheumatism. Can these medications harm my liver?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

The HBV DNA level is the best test to determine whether you have an "inactive" stage of the infection. ALT may be normal even when there are high levels of virus present, so it is not possible to make that determination based on ALT alone. You will need to check with your doctor about the specific medications you are taking.

Our adopted daughter from India who is now 22 years old has had chronic hepatitis B since her arrival at age 4 months. Her ALT and AST have been normal with some occasional variation her first 2 years here. Just 2 years ago she had an HBV viral load tested, which was undetectable. However, this past summer she had what now appears to have been a "flare," with nausea, vomiting, and extreme tiredness.

When tested then, her viral load was 20,000. Just recently she was retested. Her viral load is now undetectable and she shows hep B "e" antibody reactivity. This is good, right? I'm not sure if it's time to celebrate yet, though. BTW, she has never had any treatment for chronic hep B. Is the "e" antibody reactive significant?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

Ultimately, the best outcome is for the surface antigen (HBsAg) to become negative. Before that happens, the "e" antigen becomes negative and the "e" antibody becomes positive. If the HBV DNA level remains below 200 IU/mL, that indicates an "inactive" carrier state of the infection. As you noticed, there can still be flares in the infection with reactivation and elevated levels of HBV DNA. Hopefully this will not happen frequently in the future. It is good to monitor the HBV DNA level about once or twice yearly to be sure.

I am a 22-year-old male from India. Recently, during a medical check up, I tested positive for HBsAg. The doctor later advised me to have an HCV test, which came out negative. A liver biopsy was done and the report was interpreted as my having minimal chronic hepatitis, and at the same time a HBV DNA test and HBeAg tests were done. Both tests came out negative. Now the doctor has called me after 3 months to check the activity of the hepatitis. How serious is my infection?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

The questions that you asked me can be answered more directly by your doctor. While hepatitis B can be a serious illness that leads to cirrhosis and primary liver cancer, it does not progress in every patient. Your liver biopsy showed "minimal chronic hepatitis" which is a fairly mild stage of the illness. You should discuss the results with your doctor to see whether there has been any change since the time of the biopsy and your initial evaluation.

I have a question about HBsAg carrier state. From 1989 until 1993, my brother was under control with HBV. His HBsAg was positive, anti-HBsAg was negative, anti-HBe was positive, ALT was never over 40, AST was never over 30, LDH was never over 350, echos showed every time a normal form and no signs of dysfunction.

In 2001, it was called an inactive carrier state because of the very low HBV DNA, still normal ALT, AST, gamma GT, LDH, and same viral testing with normal echo.

He is a medical doctor and does not perform major surgery or minor surgery without sight of his fingers or with sharp tools nearby. He does not cut into arteries and when necessary surgical cutting is done by coagulation.

What is the risk he will transfer HBV to a patient?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

The risk of transmitting hepatitis B to a patient is very low, except during invasive procedures. The risk of someone who is an inactive carrier (HBV DNA < 200 IU/mL) transmitting the infection is even lower. There is unfortunately no way to quantify that risk. However, most states in the U.S. and most countries do not restrict medical practice except for invasive procedures. There are many places that have no restrictions.

I have had Hep B since around 1980, previously chronic active and treatment for 4 months with interferon. After the treatment I developed the antibody to the "e" antigen and for almost 13 years there was no detectable virus in the DNA. Two years ago the DNA was detected at 28,300 and recently at 31,400. Does the antibody to the "e" antigen mean I am less contagious or non infectious? At what DNA levels do most doctors begin treatment?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

The fact that the HBV DNA is elevated indicates that the virus is still present and therefore you are still potentially infectious to others. The tests that were used to measure the virus 13 years ago were not as sensitive as the current generation of tests. You should see your doctor to discuss whether further treatment with an oral agent such as entecavir or adefovir or telbivudine is warranted. That will depend on several other factors such as the ALT level and/or findings on liver biopsy.

We are adopting a year old baby girl from Asia, whose diagnosis is hepatitis B positive: HBsAg(+), HBeAg(+), HBcAb(+). The doctor has suggested that she have an HBV DNA test. All blood work and other tests are not yet translated. How can we determine whether she has acute or chronic hepatitis B, and what kind of treatment(s) are available? Thank you so much for your time and assistance.

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

A one year old from Asia who is hepatitis B positive most likely has chronic hepatitis B infection. Although acute infection can occur at that age, it is most often asymptomatic. More than 90% of children infected under age 2 will become chronically infected due to the late maturation of the immune system against hepatitis B. The HBV DNA level is likely to be very high and will not distinguish acute from chronic infection.

I was giving blood back in 1993 at a Red Cross and found out that I had hep B, not knowing what hep B was. I then went to my doctor and had another blood test and my doctor told me that I was a chronic carrier of hep B, but I have never taken any medication for the infection. I am wondering if I have sex with a partner and we use a condom, is there any way that he might contact the hep B virus?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

Based on your comments, I assume that the HBsAg is positive and that the HBV DNA is also detectable. Under those circumstances, condoms are recommended to prevent transmission of hepatitis B virus during sexual contact. Your partner should also be vaccinated to prevent transmission.

I have chronic hepatitis B. My ALT was at 102 before the interferon (Pegasys) injection treatment a year ago and ALT is still 170 now. The DNA is 3,000,000 copies. During the period of 48 weeks of treatment the ALT increased to max of 220 and after the treatment the ALT stayed at 180 and the viral count is still around 3 million copies.

According to the doctor, the Pegasys does not work on my body or it could be the genome of the virus which made the drug non-respondent? The blood test results show:

HBsAg positive
HBeAg positive
HBeAb negative

The doctor advised me to continue with the oral drugs, which are lamivudine [Epivir-HBV], adefovir [Hepsera] or entecavir [Baraclude]. According to the doc, Lamivudine becomes resistant within 1- 2 years and I would have to change to another drug. Please advise the efficacy of each of the above drugs and the side effects of each. How long do I have to take medication and are there any other drug treatments available?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

If you were never treated with lamivudine, then entecavir is the most potent drug and the best option for treatment. If you were treated with lamivudine and have resistance to lamivudine, then you should consider a combination of lamivudine plus adefovir, rather than a single medication. There are other combinations that are available. You should discuss the options with your doctor.

I am a 55-year-old male from India. I was diagnosed HBsAg positive in 1984. Since then my SGPT [ALT] level has been 30 to 60 for most of the time, except for a short duration twice when it increased to around 100 and then decreased to 30-50. I was informed by experts in India that no treatment can be given at this stage, looking at the results of liver biopsy and HBV DNA level at 1800 copies/ml, but this is not understandable to me since there is a reduction of liver size shown in sonography. The result of my recent biopsy is as follows:

"Serial sections reveal normal lobular architecture, many foci of spotty necrosis, moderate mononuclear infiltrate with some fibrosis in portal tracts, few groups of liver cells with fatty change and one small nodule encircled by fibrosis and inflammatory cells. The infiltrates also include few neutrophils."

Questions:

(a) Is it necessary to start medication immediately or can I wait longer?
(b) At what HBV DNA Quantitative level should medication be started?
(c) Does the sonography result indicate anything serious in the near future?
(d) What medication should be taken (of course in consultation with gastroenterologist) under these circumstances?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

The biopsy reports some evidence of active chronic hepatitis. Some experts would advise treatment with an oral agent for this stage of hepatitis B, but others would not. There may be policies in India about who is eligible for treatment. Since there was no sign of fibrosis or cirrhosis on biopsy, the size of the liver should not be a concern. Entecavir (Baraclude) is the most potent oral agent available.

I am a chronic hep B patient and was on lamivudine for the past 3 years until this year, when I stopped medication to start family planning. Based on my last blood test done 2 months after stopping medication, my liver enzymes are normal and my HBV viral load is 3940 copies, which is within the normal range. I was diagnosed with polycystic ovary syndrome. To normalize my hormones and increase the chance of fertility, it was recommended that I take metformin.

I understand this drug is also used to treat diabetes and I have read that there are concerns about prescribing this drug to patients with kidney and heart problems. Although I do not fall into any of those categories, I am concerned about whether this drug will have any bad effects on my liver. Along with the metformin, I am taking clomiphene [a fertility drug]. Are there any risks involved with receiving these drugs?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

Metformin should not be used by people with advanced liver disease, but otherwise is considered safe when used as directed. I do not have any information about potential interactions with clomiphene. You should ask your doctors about this issue.

I have had hepatitis B since 2005 and my test results were HBe antigen positive, HBe antibody negative, HBV DNA <240. Then I started taking Baraclude [entecavir] 1 mg daily for one year. Now the test result is HBe antigen (still) positive and HBe antibody negative, HBV DNA <40, ALT 38, but I am HBs antigen negative.

My doctor recommended liver biopsy, and the results are "nonspecific reactive change of liver, encompassing minimal steatosis and focal sparse mononuclear inflammation of the portal tracts. Trichrome stain reveals no increase in fibrosis. Iron stain reveals trace iron staining in hepatocyte.

Immunohistochemistry analysis results: Hep Bs antigen negative, and the last result for my blood test shows HBe antigen positive, HBe antibody negative, hepatitis Bs antibody positive, and hepatitis B DNA <40 IU/ML, AST 25, ALT 38. Please explain what my test results mean. My doctor told me to stop my medication.

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

It is hard to interpret these results. It is extremely rare to have a positive e antigen and a negative surface antigen, which is what you reported. Since the HBV DNA is undetectable, it seems most likely that the e antigen is a "false positive" result. I assume you are no longer taking Baraclude. You may want to discuss this further with your doctor.

I am a 28-year- old Asian. A few years back (2004) I had a hepatitis profile test when I was pregnant with my first child, who had a shot of immunoglobulin right after birth. I am confused about my lab results. Can you please interpret the results for me?
I am expecting my second child this year. What would you recommend me to do? I am not doing anything about my liver nor taking any medications. Should I be worried?

Hepatitis Profile

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

You have evidence of chronic hepatitis B virus present in the blood. Your baby should receive a combination of hepatitis B vaccine and hepatitis B immune globulin within 12 hours after birth.

I am a 31-year-old Nigerian and was recently diagnosed as hepatitis B surface antigen positive when I visited the hospital to donate blood. I was referred for liver function testing, and the results are:

AST = 70 IU/I
ALT = 76 IU/I
YGT = 6.0
ALP = 288 IU/I
Total Bilirubin = 12micro mole/I
Congested Bilirubin = negative

I feel very strong at the moment and have no signs of any illness. Please advise me what to do. The doctor said I should come back after one month with the results of the tests. Do you recommend treatment for this ALT level and if yes, what type of drug would you suggest?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

It appears from the lab tests that you have chronic hepatitis B. The elevated ALT suggests it is an "active" stage of infection. You should discuss treatment options with your doctor. Currently there are several medications that are effective. Baraclude (entecavir) is the most potent of the oral agents. I would not recommend lamivudine (Epivir, Zeffix) as first-line treatment. Interferon is also an option. You should avoid alcohol, but there are no other dietary restrictions.

In determining if one has had Hepatitis B, is a Hep B surface antigen and Hep B IGM or core needed? Can one test determine if one is a carrier?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

The definition of a "carrier" of hepatitis B is a positive surface antigen. The other tests are helpful only in determining other characteristics of the illness. A positive core antibody only does not equal a "carrier" state.

I am a Hep B chronic patient diagnosed in March 2006. Then my HBV DNA rose from 470,000 copies/ml to 1million copies in 2 weeks. I was then advised to take adefovir [Hepsera]. I have been on it since then. June 14, 2006 I went for another HBV DNA test and it was 2,700 copies/ml. Do you think it will be wise to continue with adefovir with the current rate of decrease in HBV DNA? What are the effects of taking adefovir even after HBV DNA is undetectable?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

It will take approximately 6-12 months for HBV DNA to become undetectable. In most instances, one needs to remain on anti-viral therapy such as adefovir to maintain suppression of the virus. The only exception to this is if the e antigen was positive before treatment and becomes negative on therapy. In that situation, the medication can be discontinued after 6-12 months longer than the time of seroconversion.

I had all three shot for hepatitis B 7 years ago and a titer done last year that said I was protected. How can I have Hep B? With these lab results, does it look like I do or don't have hep B, and if I do, is it chronic or acute?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

The results are confusing, because there are some inconsistencies. It is likely that you had hepatitis B in the past and have recovered from it. The vaccination probably did not matter since it may have been administered after you recovered from hepatitis B. The positive IgM core antibody is definitely an atypical finding, although the total core antibody would remain positive in this situation. The negative surface antigen makes it very unlikely that you have any hepatitis B virus in your blood. You could have a hepatitis B DNA level done to be sure.

I am a 58-year-old man with HIV-HBV coinfection who started HAART 2 years ago. Cirrhosis was detected 3 years ago.

FibroScan showed 24.5 KPA. CD4 cells 19%. CD4 cell count 101 cells/mm3. AST 69, ALT 37. No ascites. MEDICATION: SUSTIVA + TRUVADA. PCP prophylaxis.

QUESTIONS:

1) MELD SCORE?
2) IS CIRRHOSIS STOPPED?
3) MARIHUANA 3 TIMES/MONTH IS A PROBLEM?
4) CAN I RUN OR PLAY TENNIS WITH PORTAL HYPERTENSION?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

It is not possible to calculate the MELD score with the values you provided, since it would require conversion to mg/dl for creatinine and bilirubin. It is not possible to determine the extent of liver damage (e.g. is cirrhosis "stopped") without liver biopsy. The FibroScan is good, but not precise enough.

Marijuana may cause fibrosis, so it is not recommended. There is no evidence that the medications you listed are helpful or harmful in cirrhosis. I suggest vitamin E, but not the others to my patients.

It is generally OK to do aerobic exercise even if you have portal hypertension. Cirrhosis usually does not progress when the HBV is not replicating and the ALT is normal. In your case, the ALT is still abnormal, so it is not possible to be sure.

Since I last wrote, my mom has still not begun treatment, but her numbers have improved. From her results on Jan 12, 2007 her AST level was 69 U/L and her ALT was at 136 U/L. Since then, her latest results (May 1st, 1007) have improved to AST 34 U/L and ALT 55 U/L. However, her HCV viral load is still high at 109,000 IU/mL. Do these numbers still warrant continued treatment? Especially, since her ALT is now within the normal range (30-65 U/L)?

Her doctor has refused to give her medicine since she is currently traveling in Asia. They would prefer to start her medicine once she returns to the U.S. and can monitor her treatment. I believe, however, that her body is somehow repairing itself. She has only been taking 100mg of Aloe Vera gel tablets daily to aid in digestion. Any insight would be much appreciated!

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

The change in the ALT level is not significant. This degree of fluctuation often occurs and does not necessarily indicate improvement (or worsening if in the opposite direction). Most experts would still recommend treatment under these circumstances.

I am planning to work as a Support Engineer, which requires working the "graveyard" shift. I was diagnosed as a healthy carrier of hepatitis B. My doctors told me that I have a healthy liver and that there's no risk at all. But I failed to ask them if I am fit to work the graveyard shift. Will this be an obstacle to my work?

Answer by Ronald Baker, PhD
Ronald Baker is publisher and editor in chief of HIV and Hepatitis.com

No, your hepatitis B "healthy carrier" status should not affect your ability to successfully work a "graveyard" shift. However, your sense of well-being and even your general health might suffer from working during these late-night hours, which is not normal for most people. As a result you might experience fatigue, depression and other symptoms, but this is not necessarily the case.

I am 57-years-old and I work at sea. Before I left port, I took a screening for life insurance. After I was already here at sea, I was denied because my anti HCV qualitative showed a positive result. My ALT was 550, my AST 208, my GGT 181, and glucose was also high @113. I was negative for Hep B. At the time of the test I was drinking alcohol and using Advil & muscle relaxants for back pain. I am also overweight about 20 lbs. Does this mean for positive that I have Hep C? Is it possible to have a false positive? Could having the Hep B inoculations somehow interfere with my result? Approx 35years ago I used injectible drugs and had a tattoo. I have drunk alcohol since that time, though I do not consider myself an alcoholic.

My contract at sea is very strict and does not allow me to return home, as I am the Captain with no replacement. Money is also a factor. I also am concerned that I will either lose my medical insurance or be fired for having been diagnosed with Hep C. What should I do next as far as testing? I have quit drinking alcohol, stopped taking Advil & my muscle relaxants and am watching my diet, but I am working long hours in a stressful environment. I have internet but will not be into a port for at least a month. I feel lost here at sea. Thank you for any help you can give me.

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

The best test to confirm whether you have hepatitis C is the hepatitis C RNA. If that is positive, it means the virus is present. The ALT level is very high. You should have this problem evaluated when possible. You should not drink alcohol until this problem is evaluated further. How or where you get further evaluation is a personal decision. Fortunately, there are good treatments available for chronic hepatitis C.

I am 55-year-old male from India. I was first time detected for HBs Ag positive in 1984. Since then my SGPT level has remained between 30 to 60 for most of the time, except for a short duration twice when it increased to around 100 and then
leveled off to 30-50. In Feb 2000 my liver biopsy indicated following:

"Section Shows moderate architectural derangement due to broad portal tracts containing abundant Lymphocytes and condensed reticulum. Many foci of spotty necrosis are seen. Diagnosis: chronic active hepatitis B (Grade 2)." In June/ July 2007, the following results came back:

HBs Ag Positive
HBeAg Negative
Antibody to HBeAg: Positive
HBV DNA Quantitative: 1800 copies/ml
Liver sonography: Smaller size (13 cm) coarse Echo texture
SGPT (ALT): 30

Till now I have not used any medication.

Questions:

(a) Is it necessary to start medication immediately or can I wait longer?

(b) At what level of HBV DNA Quantitative level medication should be
started

(c) Does the sonography result indicate anything serious in the near future? (d) What medication should be taken? (of course, in consultation with a gastroenterologist); and what will be the side effects?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

The questions you asked will probably require more information to answer. The liver biopsy done 7 years ago is not recent enough to provide guidance about the need for treatment. This may need to be repeated. It sounds like there may have been some degree of fibrosis even then. The viral load is relatively low, below what is usually used as a threshold for treatment. However, it may be worth having that checked on more than one occasion.

There are a number of medications for treatment of chronic hepatitis B. Entecavir and adefovir are the two most widely used in new cases of hepatitis B in the United States.

I have a question that has remained unanswered for about 20 years now and I need help. Researching the Internet hasn't brought answers. In the 1980's during a routine blood donation, I was told to never donate blood again because I was positive for Hep B core antigen (negative for all other hepatitis tests). I reconfirmed this with a follow-up test with my internist, and again positive for Hep B core antigen only. I have never known what this means or what it would mean for my future. The only thing my doctor told me is that it would be permanent and it meant I may have had Hep B sometime in the past and didn't know it.

(Note: During this time I was working with surgeons in the operating room of a hospital and was stuck with a needle.) It is 20 years later, I have only had one time about 7 months ago where my ALT numbers were off (I was dieting), but I do experience unusual pains and tiredness and have over all these years. Can you give me any more information about what being positive for core antigen only means and should it still be present in my body? I am assuming I am not contagious. I do, however, get unexplainably tired about every 2 months and just collapse for a few days in bed.

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

An antibody to hepatitis B core antigen (the test that you probably had) with a negative hepatitis B surface antigen indicates one of two things: previous infection with hepatitis B or it is a "false" positive. It is often difficult to tell which is more likely without more precise history. It means that you cannot donate blood, but it does not mean that you are currently infectious to others, unless the surface antigen is also positive.

I have had hepatitis B for a little over two years and was just diagnosed with HIV. What should I be concerned about? I am currently on Paxil and nothing else. I am concerned about what my remaining life expectancy is. Could you help me?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

You have two serious, but treatable conditions: hepatitis B and HIV. There are some physicians who specialize in treating both of these problems. If possible, it would be good for you to see a specialist who can guide your decisions about which treatments are available and best for the stage of your conditions.

Hello. I am 29-years-old, from the Philippines. I was diagnosed with chronic hepatitis B. Here are my lab test results:

HBV-DNA-------------23 IU/ml.
HBeAg ---------------non-reactive
Anti-HBe--------------------reactive
HBsAg------------------reactive
liver ultasound-------normal

Please interpret my lab test results. My doctor told me I do not need to `take any medicine anymore. I am worried I might not be able to go and work in any country because of this infection. Is there any medicine for me to take? Please help me decide what I should do!

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

Most experts would not recommend treatment for the stage of chronic hepatitis B that you have. The levels of virus are extremely low. There is very little evidence that treatment will hasten the loss of HBsAg. The issue you raised about working outside the Philippines is a difficult one. Regulations vary from one country to another.

I am 36-years-old and recently I had a pregnancy blood test, but sadly I had a miscarriage. The results of my blood tests are:

Has serological markers suggestive of chronic Hepatitis B infection.
HBsAg (Biomerieux EZA) : Reactive
HBeAg : Negative
Anti-HBe : Reactive
Anti-HBc Igm (Abbott Murex EIA) : Negative
Anti-HBc (In house COMPRIA) : Reactive
Serological profile consistent with LOW infectivity
HBV carrier state.
Administer hepatitis B vaccine at birth and arrange completion of course and follow up testing.
If the baby weighs less than 1500g or if the mother had acute hepatitis B infection during this pregnancy,
Hepatitis B immunoglobulin should also be administered irrespective of the mother's current hepatitis B status.

Please would you explain what these results mean? I am shocked and anxious since I heard this news. Right now I'm waiting for an appointment to talk with the doctor. Can you offer any information to me right away?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

The results have been interpreted correctly. I suggest that you see your doctor to have your ALT and HBV DNA levels checked. If both are elevated, you should see a specialist who is familiar with treating hepatitis B to see if you need treatment for this infection. It can be spread to other people through blood or intimate contact.

I am Egyptian, aged 32 years. I have been recently diagnosed with chronic hepatitis B. I have done blood tests and they show as follows:

HBs AG +
HBe AG -
Albumin, Serum 4.4 g/dl
Total bilirubin, serum 0.7 mg/dl
ALT, serum 14 U/L
AST, serum 18 U/L
HBV DNA, Quantitative 867.0 copies/ml (undetectable below 50 copies/ml) (1 IU/ml=5.8 copies/ml)

Comment: the detection level of the assay is 50 copies/ml

Please, could you help explain these results--my treating doctor does not reply to my mail. Note: I am suffering from loss of weight, though I eat well and have strong appetite for food. My friends and colleagues ask me every day why I am losing weight, but I cannot tell them. Has my liver reached the cirrhosis stage? I do not feel tired, although I have some sleeping disorder now. My urine color is normal. My skin color is not yellow.

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

These results are consistent with an inactive stage of chronic hepatitis B infection. The viral load is relatively low. None of these results provides any explanation for your symptoms. You will need to see a physician to determine the cause of your weight loss. Your skin color is not yellow (due to jaundice) since the bilirubin is normal.

After being diagnosed with hepatitis B, it was recommended that I take Truvada [fixed-dose combination of tenofovir + emtricitabine]. I have some questions about this choice of therapy." I am a 23-year-old Asian male. I was diagnosed with HBV infection after donating blood last November. I had two blood tests since with the following results:

Hep B s Ag Positive
Hep B e Ab Negative
Hep B e Ag Positive
Hep B Core Ab, IgM: Negative
Hep B Surface Ab <3.0 mIU/mL
AST 25 U/L
ALT 25 U/L
Hep B Quant PCR: A positive titer of >2.0 x 10(7) Intl Units (>1.16 x 10(8) copies/ml) of HBV DNA per ml; Ultrasound shows normal liver function.

Partly because I am an incoming medical student, my doctor prescribed treatment with Truvada. Since this drug is not on FDA-approved list for HBV and known to be associated with hepatitis flare-up. My questions are:

1. What is your opinion about this treatment choice? If not, what is the alternative?
2. How severe are the side effects?
3. What is the probability of long-term dependence?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

In answer to questions 2 and 3, side effects are minimal with most of the oral medications. I am not sure what you mean by long-term "dependence." The duration of therapy is determined by whether there is a loss of e antigen and a decline in the DNA to undetectable levels. If so, treatment is usually continued for at least 1 year.

Please help explain the results of my tests. Am I still a carrier of Hep B?

Hep B Viral DNA QT < 100 IU/ml
Hep B Viral DNA QA < 160 copies/ml

Hepatitis Be ANTIGEN Non Reactive
Hepatitis Be Antibody Reactive

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

There is no detectable virus by HBV DNA testing. However, the definition of a chronic carrier is someone who has a positive hepatitis B surface antigen. The positive hepatitis B e antibody indicates infection with hepatitis B at some point in the past.

Is there any way a person diagnosed with chronic hep B can become an inactive hep B carrier without taking any medication?

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

The natural history of hepatitis B is variable. In some instances, the disease is very active during adolescence and early adulthood and then becomes inactive later in life. The amount of damage to the liver is variable depending on many different factors. The best tests to determine activity of hepatitis B are the HBV DNA level, the ALT and the liver biopsy.

My husband has just been diagnosed with Hep B through a blood donation (his first). We have been together for 13 years and I am 21 weeks pregnant and have tested negative to Hep B & C, but I am not immune to Hep B. It has been recommended that I receive the vaccination for Hep B following the birth of our baby. His results are as follows:

Hep B core antibodies: detected
Hep B surface antigen: detected
Hep B e antigen: not detected

His liver function test returned normal results. What do these results mean? I am very confused about them. But I have been told its nothing to worry about at the moment, just to have protected sex until I am immunized.

 Answer by Mack Mitchell, MD  
Dr. Mitchell is Director of Gastroenterology at the Johns Hopkins Bayview Medical Center,
Baltimore, Maryland and Associate Professor of Medicine, The Johns Hopkins University School of Medicine

The results are consistent with chronic hepatitis B. To determine the activity of chronic hepatitis B, he should have HBV DNA level and ALT level checked. Ultrasound of the liver should be done if he is over the age of 40. You should use condoms to prevent transmission during pregnancy. After pregnancy, you and your baby should be vaccinated to prevent hepatitis in the future.