Fluctuations in Anti-HBs Levels After Hepatitis B Treatment

Hepatitis B Anti-HBs Value Issues

Dear Dr.
Chen,
I hope this message finds you well.
During a company health check in 2007, I was found to be a carrier of hepatitis B with elevated liver enzymes (approximately GOT over 800).
After follow-up at National Taiwan University Hospital, tests revealed that the hepatitis B virus load in my blood exceeded 200,000/ml, and I was experiencing ongoing inflammation.
The doctor immediately initiated treatment with antiviral medications.
After a long course of antiviral therapy (Hepatitis B treatment: Hepatitis B Antiviral → Hepatitis B Supportive → Hepatitis B Antiviral + Hepatitis B Supportive → Hecare), I was fortunate to find that during a routine check in 2013, my hepatitis B surface antigen was negative.
After continuing medication for another year, in 2014, my hepatitis B surface antibody was positive at approximately 15 mIU/ml.
Following the doctor's advice, I stopped the medication and have been having blood tests every three months and abdominal ultrasounds every six months for monitoring.
Over the past few years, my GOT and GPT levels have remained normal, and aside from fatty liver, there have been no abnormalities on the ultrasound.
Every six months, the doctor has been checking my Anti-HBs levels, which have gradually increased from the initial 15 mIU/ml to 115 mIU/ml on December 5, 2016.
However, during a blood test on May 18, 2017, I found that my Anti-HBs level had decreased to 79.27 mIU/ml.
I would like to ask the doctor why my Anti-HBs level, which was continuously rising, suddenly dropped to 79? Does this indicate a decline in my immunity? Thank you for taking the time to respond.
Best regards.

Lin Xiansheng, 40~49 year old female. Ask Date: 2017/06/16

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, sir.
The values obtained are not completely quantitative, so they should only be used for reference and should not be interpreted based on their magnitude.
Changhua Hospital cares about your health.
Chen Shidian.

Reply Date: 2017/06/16

More Info

Dear Patient,
Thank you for your detailed inquiry regarding the fluctuations in your Anti-HBs levels following your treatment for Hepatitis B. It’s understandable to be concerned about changes in your antibody levels, especially after a history of chronic Hepatitis B infection and subsequent treatment.

Firstly, let’s clarify what Anti-HBs (Hepatitis B surface antibody) represents. Anti-HBs is an antibody that indicates recovery and immunity from Hepatitis B infection. After successful treatment, the presence of Anti-HBs signifies that your immune system has effectively responded to the virus, and you are protected against future infections.
In your case, you initially had a low Anti-HBs level of 15 mIU/ml, which increased to 115 mIU/ml by December 2016. This increase is a positive sign, indicating that your immune system was responding well to the treatment. However, the subsequent decrease to 79.27 mIU/ml in May 2017 raises some questions.

It is important to note that fluctuations in Anti-HBs levels can occur for several reasons. One possibility is that the immune response can vary over time. While the presence of Anti-HBs is a good indicator of immunity, the levels can naturally decline after reaching a peak. This does not necessarily mean that your immunity has been compromised. The immune system has a memory component, meaning that even if the antibody levels decrease, your body can still mount a response if exposed to the virus again.

Another factor to consider is the timing of your blood tests. Anti-HBs levels can fluctuate based on various factors, including the timing of the test in relation to your vaccination or treatment schedule, your overall health, and any potential exposures to the virus. It is also worth noting that the measurement of Anti-HBs is not always a precise quantification; it can vary based on the assay used and the individual’s immune response.

Regarding your concern about whether this decrease indicates a decline in your immune system's effectiveness, it is essential to understand that a single measurement may not provide a complete picture. Continuous monitoring and a trend over time are more indicative of your immune status. If your healthcare provider has not expressed concern about your overall health or liver function, it may be a normal fluctuation.

In terms of protective levels, it is generally accepted that an Anti-HBs level above 10 mIU/ml is considered protective against Hepatitis B infection. Since your levels are still above this threshold, you are likely still protected. However, it is advisable to continue regular follow-ups with your healthcare provider, who can assess your overall health and liver function through blood tests and imaging studies.

If you have any further concerns or if your Anti-HBs levels continue to decline significantly, it may be worth discussing with your doctor the possibility of additional vaccinations or other preventive measures. Your healthcare provider can also provide guidance on lifestyle factors that can support your liver health and immune function.

In conclusion, while fluctuations in Anti-HBs levels can be concerning, they are not uncommon and do not necessarily indicate a loss of immunity. Regular monitoring and communication with your healthcare provider are key to managing your health effectively. Please feel free to reach out if you have more questions or need further clarification.

Best regards,
Doctor Q&A Teams

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