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HBV DNA Negative Elevated ALT and AST
Oct 20, 2004

Dear Dr Dieterich,,

My boyfriend was detected positive for Hepatits B in Sep 2003.The Doctor wanted us to have the tets for liver enzymes. His tests said HbsAg +ve,HbeAg -ve,HbeAb +ve anti HIV 1 and 2 -ve . He was also negative for Hep C and Hep A His ALT was 115 and AST was 36 and all other tests were normal. The ultrasound said mild Hepatomegaly.

After 3 months in Jan 2004 his tests said HbsAg +ve,HbeAg -ve,HbeAb +ve. His ALT was 36 and AST was 24. But HBV DNA was not done.

He got tested now again in October 2004. The lab reports said HbsAg +ve,HbeAg -ve,HbeAb +ve. His ALT was 42 and AST was 54 which is above normal. HBV DNA PCR was negative and HBV Quantitative PCR was less than detectable range.

I am about to get married to him.I had vaccination against Hep B and my HbsAb titre is 500 Miu/ml. The Doctor said I am very well protected from Hep B and can hav a normal sexual relationship with him.

My Questions are:

1) Why are his ALT and AST above normal when his HBV Quantitative PCR shows less than detectable range and when he his negative for Hep C and Hep A 2) As he is undetectable by PCR ,should his HbsAg not be on the road of clearance? 3) Will he ever show negative for HbsAg.(I understand the clearance rate is 1% - 2% every year . We are from India). 4) Is there any chance of me getting infected if we have a normal sexual relationship even if my antibody titre shows immunity . Can I take the risk? 5) Are there any other tests that should be undergone like alpha feto protein (AFP) an ultrasound every year.

Sorry for a long letter.I hope U understand my concern and will reply back to my questions.

Response from Dr. Dieterich

There is some other reason for his abnormal ALT. His HBV is under control and he appears to have cleared it. I rarely see the S Ag go away. Both because you are vaccinated and he is DNA negative it should be safe for you to have unprotected sex. You may want to get both of you vaccinated for hepatitis A. He should keep working with his MD to see why his ALT is elevated, but does not sound serious. Congrats on the wedding! DTD

follow up?
Mucousal exposure?

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