Brief Answer:
HBV infection

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.

You are having Chronic hepatitis B Infection with viral replication [HBeAg(+) , HBeAb(+) and HbcAb-IgG (+) ].With Anti-HBe, HBV DNa levels remain low and indicates relatively lower infectivity.

HBV DNA a quantitative marker of replicative phase. Low HBV DNa indicates transformation from replicative to the nonreplicative phase of chronic infection.Most such patients would be eventually inactive HBV carriers.You have to remain under surveillance of serological markers as occasionally, nonreplicative HBV infection converts back to replicative infection. Such spontaneous reactivations are accompanied by reexpression of HBeAg and HBV DNA, and sometimes of IgM anti-HBc, as well as by exacerbations of liver injury.

In chronic HBV infection, HBsAg remains detectable beyond 6 months,anti-HBc is primarily of the IgG class, and anti-HBs is either undetectable or detectable at low levels (as in your case marked negative).

You are beyond the stage of any Hepatitis B Vaccination.
Remain under care of a Hepatologist or Medical Gastroenterologist.






Regards

Dr. T.K. Biswas M.D. XXXXXXX

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Brief Answer:
HBV infection

Detailed Answer:
In chronic HBV infection, HBsAg remains detectable beyond 6 months,
anti-HBc is primarily of the IgG class, and anti-HBs is either undetectable (as in your case) or detectable at low levels .
In the nonreplicative phase , levels of HBV DNA is below a threshold of ~1000 IU/mL.(yours is less than 100 copies/ml).
HbsAG is surface antigen of HBV -hence level of HbsAg is expected to be low, as the viral load itself is low in this stage(nonreplicative).
The concentration of HBsAg may reach 500 μg/mL in HBV infection.
How low is considered negative depends on the technique used for estimation Of HbsAg and on the laboratory reference range (may vary from Lab to Lab).

There is no correlation between HBeAg and levels of HBV DNA.
Chronic HBV infection can occur in the presence or absence of serum hepatitis B e antigen (HBeAg).
HBeAg-negative chronic hepatitis B (i.e.,chronic HBV infection with active virus
replication) ,HBV DNA is readily detectable .

However compared to patients with HBeAg-reactive chronic hepatitis B, patients with HBeAg-negative chronic hepatitis B have levels of HBV DNA are several orders of magnitude lower (no more than 105−106 IU/mL) than those observed in the HBeAg-reactive subset.
No treatment is recommended or available for inactive “nonreplicative” hepatitis B carriers (HBV DNA ≤103 IU/mL documented serially over time).Hence no treatment is recommended.Monitoring without therapy is recommended for those with HBV DNA <2000 IU/mL, unless ALT is elevated.
You have not however mentioned anything about Liver function tests like alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels.

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Brief Answer:
HBV infection

Detailed Answer:
You are in transition of low replicative phase [when serum HBeAg is still positive and serum HBV DNA level is usually lower <2000 IU/ml) and minimal liver inflammation (ALT levels 55)] to the next 'non-replicative' phase [( manifested by seroconversion to anti-HBe, undetectable HBV DNA (by conventional techniques)] and resolution of hepatic inflammation. HBV DNA measured by PCR technique will still detect HBV DNA.
Hence so low.
This is the probable explanation .

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