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Hepatitis B - Non responder?
Feb 23, 2013

On a routine yearly exam, labs came back HBsAg+, Anti-HBc IgM and Hep B core antibody total are both negative. Was just told I was infected. My spouse tested neg. I have had 3 series of immunizations over the years for college and the military. One in 2000, 2005 and 2006. Came back from Iraq in 2010 and was tested before and after and was negative. Now I'm wondering if I am a non-responder. My LFTs are AST86, ALT139, GGT266. Can you tell me if this is an acute infection from these test results? What are the next steps? I do not have any of the risk factors, single sex partner, no drugs. I cannot understand how I contracted this. Also, I am on Lipitor for cholesterol, should I continue? The doctor that drew these tests didn't say anything and just referred me to a gastro who said he doesn't take care of hepatitis patients, so not sure what to do next. How do I know how long I've had this?

Response from Dr. Taylor

I cannot tell for sure from these test results if this is an acute infection, but the results are not highly suggestive of acute hep B. Often the Anti-HBc IgM is positive in an acute infection, but it depends on the timing of when the labs were drawn after catching hepatitis B. See if you have had a test for the virus itself, HBV DNA. Are your LFTs higher now than in the past? Newly elevated? Have you had any symptoms? Typically acute hep B is associated with symptoms. Are you sure the SAg and not the SAb is positive?

This may be an old infection that pre-dated your vaccinations. Can you see if you were tested to ensure the vaccine worked, after you were vaccinated in 2000, 2005, 2006? The hep B SAb, surface antibody, would have been reactive/positive if so.

Hep B is highly contagious through many bodily fluids. Often people catch hep B through sex before they are vaccinated. Sometimes it is impossible to go back and figure out how we got it.

The VA should have good hep B docs to help you. I would ask to see a hep B expert. She/he can help you figure this out and guide you through any additional tests needed. If your local VA does not have a hep B expert, ask to be sent to another VA that has a hep B expert.

I am not sure of the full context of your other health issues so would confer with your doctor regarding the Lipitor.

It would be ideal if your spouse can be checked for hep B, sAg, SAb, core Ab, and get vaccinated if not infected and not protected. Again the VA should be helping you with this.

Thank you so much for your service.

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