Anonymous
Anonymous asked in HealthDiseases & ConditionsInfectious Diseases · 7 years ago

Hepatitis B antigen, Hep B core IGM - Acute or chronic?

About 4-5 MONTHS ago I showed symptoms of Hepatitis B and was tested & confirmed.

Now, 3-5 MONTHS AFTER the symptoms I have had full Hepatitis blood work done and these are my results.

Hep B surface Antibody level - <10iu/litre

Hep B surface Antigen - Detected

Hep B core Antibody - Detected

Hep B core IGM level - Not detected

Hep B e Antigen - Not detected

Hep B e Antibody - Detected

I'm a bit confused and don't know what to make of them. The Hep B Antigen is present so I'm clearly infected and since the Hep B Antibody is very low I have no immunity. However, Hep B core IGM is not detected which I believe should be present in any infection >6 months (acute)?

The tests are a little confusing and if I had to diagnose myself I would say I'm a chronic carrier with low levels of the virus due to the presence of the Hep B e antibody?

Can anyone share some knowledge? I'm really confused as to why the Hep B core IGM is not detected?

Thank you

Update:

Thanks for the responses. I am of course seeing a specialist for my Hepatitis but there is a bit of a waiting list here in the UK with the NHS and I am anxious to learn as much as I can as quickly as possible.

First my response to TWEETY

Why do you say that <10 isn't consistent with confirmed Hepatitis B infection? Is this very low? Unfortunately it is not a mistake, it's correct. My doctor talked to me about the results briefly and she also told me it was <10, I also have a hard copy of the results so it's no mistake.

As the HBcIgM is not detected, does this mean I am 100% a chronic carrier, or is there still a chance that this is just acute, even if it is a small chance.

Presence of the HBe AB is a good sign if indeed this is chronic, correct?

Thanks.

In response to FLASHFLOOD -

I can not say if the IgM was present as the time of symptoms as I was in Asia and was only tested for the Hep B antigen, not a full panel test. I was tested for A and C also and th

Update 2:

My enzymes at the time of symptoms were as follows, I should also add I don't drink alcohol.

Total protein - 7.6g/dL -

Albumin - 4.1g/dL -

Globulin - 3.5g/dL -

Total bilirubin - 4.45mg/dL -

Direct billrubin - 2.37mg/dL -

AST (SGOT) - 1,030 IU/L

ALT (SGPT) - 231 IU/L

ALK.phosphatase - 135 IU/L

As you can see my AST everything was pretty elevated, AST in particular was very high with range being 8-40. I was pretty ill at the time that's for sure. I should say that everything is in range now except for the ALT with is sitting in the 60's.

I had not been tested for Hepatitis previous to this, but nobody in my family has had the virus. Risk factors were unprotected sex, how foolish of me. I was born in the UK and live here but was living in Asia for 6 months when I came down with the symptoms, and I believe that's where I caught the virus.

Thank you for your time guys, hope to hear anything you have to add. I am going to be having more blood work done at the end of t

3 Answers

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  • 7 years ago
    Favorite Answer

    The core IgM does not persist. It is the definitive marker for an acute infection and will disappear by 6 months after onset. It seems a little early for the IgM to have FULLY disappeared however (unless you are indeed at the 5 month mark and it has fallen below detectable limits)

    Was the Hep B IgM definately present at the time of your symptoms? Just to note that IgM tests CAN have false positive (I see them all the time with Hep. A IgMs especially from Warde labs, but occasionally Hepatitis B IgM can be a false positive) Did you have a full acute Hepatitis panel done? Hep A and C?

    What were your liver enzymes at the time of your symptoms? There are other illnesses that can cause hepatitis symptoms (Mono or CMV are two of them) as well as chemicals (like tylenol or alcohol)

    Have you ever been tested for Hepatitis B before this? Do you have any risk factors? Where were you born? Depending on the answers to these questions, it may be possible that you've carried the Hep B virus for a long time OR you did just get it 5 months ago and you are still in recovery stage. Whether or not you are a chronic carrier state after an acute infection, is not determined until HBsAG persists after 6 months)

    If you want to give more information, I will be happy to help you sort it out as best I can.

    EDIT: Your ALT is not that high for being acute Hepatitis. Your AST was significantly high and speaks more to maybe medicines you were taking at the time of your symptom onset? Your onset of symptoms being in Asia makes sense if you were born in the UK, because Hepatitis B is very widespread in Asia.

    Unfortunately, it IS going to be a waiting game (at least for a little longer) because like I said, you can't be diagnosed as being chronic until you still have HBsAG present after the 6th month mark.

    The HBeAB eventually develops regardless of whether you resolve the infection and become immune or if you become a chronic carrier. The good news is though, that if the HBeAB is increasing and the HBeAG is negative, that even if you do have the virus, you are much less contagious to others than if the HBeAG were still positive. It would be called remotely contagious. (People are at their most contagious when that HBeAG is present) You'd still want to take precautions though.

    I don't know the percentages off hand. I have a study on Hep B at work that I will check and get back to you with more info.

    Wednesday...ADD'L note: I reviewed the marker profiles for those who clear the infection vs those who become chronic carriers. At this stage (if acute), if you have already developed the HBeAB (and the HBeAG is gone) it is possibly a favorable sign. Usually, people who become chronic carriers don't clear the HBeAG for years after first aquiring Hepatitis B. That said, because you don't know what your status was prior to being in Asia and your ALT was not nearing the 1,000's range, and they didn't run other tests....there remains the question of if you'd already had it before going to Asia and the symptoms were from something else entirely. Has your doctor run a full acute Hepatitis panel? (to include A and C?)

    Source(s): Communicable disease investigation RN for 19 years.
  • 7 years ago

    I will tell you what I tell everyone who posts labs and then asks for interpretation. Doing this is a mistake. Follow up ALL diagnostics with the ordering physician. This is the one, single person who be interpreting your labs. Not people on Yahoo! Answers.

    I can give you general information but you need to follow up with your doctor, okay?

    "Hep B surface Antibody level - <10iu/litre" -- The HBsAb tests for the "surface antibody" that your immune system makes to fight off the virus. It will be positive if you have "recovered" from the infection or if you were vaccinated. Your results should be expressed as <10IU/L. The symbol "<" means less than. "IU" is International Units and is always capitalized. "l" should, by rights, be "L" and stands for liter (of blood). And less than 10IU/L indicates a lack of immunity to HBV. Are you certain you didn't "flip" the symbol > (greater than) and write it as < (less than)? Less than 10 isn't consistent with a confirmed HBV infection.

    "Hep B surface Antigen - Detected; Hep B core Antibody - Detected" -- This is consistent with a past or recent infection.

    Looking at results like these, because HBsAb is negative, HBcIgM is negative, HBcAg is positive and HBcAb is positive, I'd want to say chronic infection. If the HBsAb is neg and the HbSAg is pos, it doesn't matter if the core antibodies are post or neg.

    "Hep B e Antigen - Not detected; Hep B e Antibody - Detected" -- This should be written as "HBe". The absence of HBe Ag (antigen) and the appearance of HBe Ab is consistent with a loss of infectivity and, although the resolution of a chronic HBV infection generally follows the appearance of HBe antibodies, the HBV carrier state (which means chronic) may persist for some time.

    Make sure you follow up with your doctor.

    Source(s): I'm a nurse.
  • Nancy
    Lv 4
    5 years ago

    "Yes" did a terrific job explaining how Hepatitis B works and answered your questions better than most physicians could. The burning question is how you contracted the disease. I worked in the laboratory industry for many, many years. One thing I discovered was sometimes people are not quite as careful as they should be when performing invasive procedures on patients. This includes both medical and dental fields. Example, a few years back a phlebotomist for Smith Cline Laboratories was found to have used the same needle (without sterilizing it) to draw blood from many different patients. The needles are to be used once per patient, and then disposed of in a biohazard container. She would just pull out the same Vacutainer needle and use it again and again. The final estimate was she had used this "technique" on over 20,000 people. Several people ended up with infections like Hep B because of the stick with a contaminated needle. Poor sterilization techniques in the dental field have also been found to cause a spread of highly contagious diseases like Hep B. While the ratio is 1/3 people never know how they contracted the disease, these examples show you were probably an innocent victim of either a lazy, vindictive, or inept employee. In the past year, have you had any interaction with a phlebotomist for blood tests, cosmetic procedure (botox injection), manicure/pedicure, tatoo, or gone in for any kind of dental procedure. If so, the chances are good that you contracted the disease during that particular encounter. Hep B can be spread in many different ways. Sorry you are going through this. Good luck to you.

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