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Isolated Hep B core: can I infect someone?
Jan 28, 2007

6 mos. ago, I tested: HBsAg: -ve; Anti-HBc (Total): +ve; Anti-HBS: -ve [I also tested -ve for HCV, HIV 1 and HIV 2 and all other STDs. ALT/AST levels were normal (14/17 if i recall right)]

Since then, I've had the following tests: HBV DNA PCR (Quantitative): undetectable at 100 copies/ml; Anti-HBc IgM: -ve; HBeAg: negative; Anti-HBe: -ve. Also confirmed the original serological pattern of the isolated Anti-HBc (Total).

I've also since taken two shots of the Hep B vaccine (and the first shot of the Hep A vaccine). I had a qual/quant anti-HBs test 1 mo. after the first 20 micro-g Hep B shot: the qual was negative, and the quant was undetectable at 5 mIU/ml.

My questions: -With a negative PCR, but no vaccine response after one shot, is there any chance i'm a low-level carrier and can infect a sexual partner? My doctor says no, but I'm sexually active and absolutely do NOT want to take any chance of infecting anyone

-What more should I do? I intend to complete the vaccination, and check the anti-HBs titers again. Also, I will repeat the HBV DNA PCR test to ensure that I'm virus-free six months after the initial test. I'm concerned that if I'm a vaccine non-responder and remain isolated Anti-HBc positive, with no other markers, is this indeterminate or can I have peace of mind? Also, should i make any modifications in diet or alcohol intake? I have excellent access to healthcare and am willing to do anything that has even a low chance of success to put my mind at ease about infectivity to partners, and health risks to myself.

Thank you for all the excellent answers on this forum.

Response from Dr. McGovern

Not having a surface antibody result after one shot does not surprise me. I would check only after three immunizations, and only in patients whom I am concerned about a poor immune response (such as an immunocompromised patient).

As for having occult hepatitis B with isolated HB core antibody. Yes it is possible, but I rarely check for this since the vast majority of the time the HBV DNA is negative. If positive, it is so low level positive, again I don't know what the clinical significance of such a test means.

Most likely, the result is a false positive. Your liver function tests are normal as well and reassuring. I would not suggest further testing.

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