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We hold you in high regard.
Apr 1, 2006

Dear Dr. McGovern: First let me say, that I have contacted you several times in the past nine months and each time you have gotten back to me. You have no idea how much your knowledge has meant to my wife and me. What you do on this forum helps so many people and for us, it has been not only helpful but a comfort when dealing with our situation. Thank you.

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 HsAg. 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 were no signs anywhere. Five weeks later we retook her blood work again (this being her FOURTH test) and everything came back clear AGAIN. She also just had her second round of prenatal testing (mandatory in the state for CT and this being her FIFTH test) and the HBsAg test came back non reactive no other HBV tests retaken this time though.

Her GI doctor still feels that she can have a minimal infection regardless of the other tests. He thinks that when there is a flare in her HBV DNA her surface antigen reacts. Plus he feels it is not highly probable that two separate tests indicate HBV (regardless if they never correlated together and regardless if the other tests thereafter showed no signs).

I have done a tremendous amount of research and totally disagree. 1. surface antigens dont come and go. 2. she has NEVER been reactive for Anti-Hbs, HBEAG, Anti-HBE, IGM or IGG NEVER.

Now here is our most recent worry my wife under went an amniocentesis; however prior to the amnio we retook her blood work found nothing however, due to the doctors conclusion we are worried. Could our baby (born in five weeks) have been affected? We are concerned. He is getting the HBIG and the vaccine just to play it safe at birth, but could the amnio have affected him given her tests?

Remember 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 three tests were absolutely clear.

Obviously, we are still struggling with this situation. If you can shed light on the amnio (keeping her case in mind) and further, give us additional insight re if you ever have seen her kind of test results and if you agree/disagree with her doctor, we would be ever so grateful. You cant even imagine.

I just would love finality with this situation and to hear your expert opinion now that we have taken FIVE tests (remember the fifth only tested for hbsag).

Looking forward to hearing from you.

With deep regards.

Response from Dr. McGovern

I am so sorry that your wife's pregnancy has been riddled with this puzzling situation.

Here is my opinion: 1. Very very rarely, is HBV DNA detected in the absence of surface antigen.

2. If I remember correctly, your wife never had risk factors for hepatitis B in the first place. If you put both points #1 and #2 together, the risk of your wife having chronic hepatitis B is slim to none.

3. I STRONGLY doubt that amniocentesis puts the baby at risk. First of all, even if she HAD chronic infection, her viral load is low.

4. I strongly agree however with the plan for immunization at birth. The vaccine is safe, effective, and will allay all of your concerns regarding the baby and risk of transmission.

Best wishes for a safe delivery of your healthy baby! Dr. M



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