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How common is this case?

Oct 7, 2017

Dear Dr Young... How common is seronegative hepatitis B (hbv dna + despite all hbv serological markers are negative -hbsag, -anti hbc total, -anti hbc igm, - hbsab)in hiv positive patients? I keep reading that 20% of hepatitis B diagnosis in hiv positive patients is seronegative to all serological markers!!! They say that S mutations in surface antigen cause false negative hbsag and being immunocompromised make false negative anti hbc. Do you usually test your hiv positive patients for hbv DNA to rule out this seronegative hepatitis B before beginning treatment although being negative to all serological markers? Did you see cases like that or that being described in the literature only? Last thing if someone has no response to hepatitis B vaccine how do they know their hepatitis B status especially if they are on lamivudine based treatment and has no access to tenofovir?? And i know that lamivudine alone cause resistance if it's the only anti hbv and pcr testing isn't recommended routinely because of false positives? Thanks alot

Response from Dr. Holodniy

Yes, there are cases of occult HBV infection in the absence of antigen or antibody detected in serum. They are uncommon, but clearly seen. In general, people are not screened for HBV DNA if HBV core antibody or HBV surface antigen are negative. It would be difficult to sort out infectivity status while on lamivudine, whether one was vaccinated or not, if they have no evidence of HBV surface antibody response.

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