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Looking forward to hearing from you, again.
Feb 4, 2006

Dear Dr. McGovern:

If you recall, I recently wrote you re my wifes HBV tests. To recap, my wife and I recently found out we are having a baby. After taking prenatal blood work they found that she tested positive for Heb B (HBsAg). All other tests were fine including her liver test. The doctor was pretty confident it was a false positive, due to her not falling into one of the high risk categories as well as the fact that I have been vaccinated.

So, she immediately took another test. (In the meantime, I took blood work to make sure I was properly vaccinated and immune. My results came back fine as all my titers are where they are supposed to be.) Her results came back as follows: HBsAg Non reactive Anti-Hbs Non reactive IgM Non reactive HBeAg Non reactive Anti-HBe Non reactive Viral DNA 9,321 Liver test Normal

Our doctor was completely baffled and suggested we see a liver specialist. We went to the liver specialist and he retook her blood work (this being her THIRD test in five weeks) and everything came back clear. All of the above was retaken and there are no signs anywhere. Five weeks later we retook her blood work again (this being her FOURTH test) and everything came back clear AGAIN.

Now he feels it could either be 1. bad tests (considering nothing gels together) or 2. her infection is so minimal that when it flares it comes up on certain tests. IS THIS POSSIBLE? The catch here is, remember, her first two tests showed signs (first test = hbsAg positive; second test hbsAg turned negative, but small amounts in her DNA ) and the last two tests were absolutely clear.

We are more encouraged due to her last TWO CLEAR tests; however (being the worrier I am) I would like to know if it is possible to have fluctuating HBV DNA levels going from 0 to 9,321 (in a five week timeframe) AS WELL AS having an on and off surface antigen (hbsAg)? From my research, it seems a bit odd.

Ive researched this quite a bit and it seems highly unlikely for HBV patients to lose their surface antigen and further, HBV DNA tests are uniquely vulnerable to lab contamination. That said, what are the chances these tests are false positive given the subsequent negative tests? It just seems odd they were taken so close to one another, given reason in my mind it could be an HBV flare up? However, I am a worrier, so perhaps I am looking for unnecessary stress.

I just would love finality with this situation and to hear you expert opinion now that we have took four tests. Looking forward to hearing from you.

With deep regards.

Response from Dr. McGovern

Yes I agree with your analysis that this is all "a bit odd". Hepatitis B surface antigen tests ALWAYS need confirmation. I have seen needless worry about an antigen test that was subsequently deemed a false positive because the test was reported without confirming it first.

Chronic hepatitis B has a natural history of fluctuation. So you can have viremia some times and not have viremia at others. However, surface antigen does not come and go.

In medicine, we are often stuck with laboratory tests that do not make sense and need to look at the general clinical picture. If I remember correctly your wife had no risk factors for hepatitis B. Tests - no matter how good they are - do NOT perform as well in patient populations who are not at risk for the disease in the first place. Testing in patients without risk leads to false positive results much more frequently than testing in patient populations at risk for disease.

I would just put this behind you and I would advise no further testing.

Dr. M



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