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precore mutant HBV?
May 19, 2007

I was diagnosed with HIV/HBV in May 2004 and by Dec 2004 was classified as HBV chronic. I have been reading about precore mutant HBV online. How does one know if one has that strain, and what should I be watching for?

I have been on Sustiva and Truvada for several months and my HIV has been undetectable since Nov 2004.

My latest HBV tests (Apr 2007) were:

HBV DNA undetectable as of Jan 2007

HBeAG negative HBeAB positive as of Jan 2007

HBsAG positive HBSAB positive (23,000) as of Apr 2007

ALT levels normal since Jan 2007

My doctor was pleased that I had sero- converted to eAG neg / eAB positive in Jan, and also that I had developed surface ABs in high quantities by April; more than double what was considered protective, he said. This was the first time that surface ABs have appeared.

What is puzzling is that I was also still surface AG positive too as of April.

What does all this mean, and could I possibly have the precore mutant strain?

Dave Pasadena, CA

Response from Dr. McGovern

Congratulations - your seroconversion is great news! This occurred due to the excellent choice of medications by your physician which has addressed both your HIV and HBV extremely well.

However, the simultaneous reporting of HBsAg (antigen) and HBsAb (antibody) is almost never seen - only in case reports in the literature.

I would have your physician speak to the director of the laboratory at your hospital to point out the discrepancy since these serologies should be re-run. First I would check the surface antibody because the result is sky high and I would want to be certain that is correct. Then I would have the surface antigen be retested to be certain that it is still positive; all HBsAg tests are supposed to be confirmed.



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