high. ribavirin and vaccination can protect the patient for long period of time.

Do you think so? Even the patient is positive HBV?

What was the status of anti HBe?

It appears the patient is not replicating or replication is low. So the patient is in inactive carrier state (AASLD 2016 recommendation). No way you can vaccinate this patient for hepatitis B. Followup is the recommendation.

Can u kindly elaborate on:

"patient is not replicating or replication is low. So the patient is in inactive carrier state (AASLD 2016 recommendation"

I believe you try to explain the patient has Inactive carrier of the HBV.

Is there any chances of the HBV become active?

What is the downside of having vaccination, is there any evidence that vaccination will not help other than traditional understanding of the vaccination only prevent pre infection, any trial for a patient with post infection?

Thanks

HBV vaccination decreases the prevalence of HBV infection.

Tenofovir is the choice of treatment.

Hi one issue is whether HBV is increasing its number ,it is called replication, when virus is replicating chances of liver injury is more , at this stage HBeAg test remains positive. After this phase HBV may enter a state when replication is low that is growth is slowed down. At this phase HBeAg antigen become negative and antibody against this antigen antiHBe become positive.

So replicative stage: HBeAg +ve and antiHBe negative; more chance of liver injury

nonreplicative stage: HBeAg-Ve and antiHBe+Ve; less chance of liver injury.

This change is called seroconversion.

Yes there is chance that a seroconverted person may revert to HBeAg+Ve again.

AASLD 2016 means the recommendation made by american association of hepatology to treat chronic HBV infection 2016 edition.

Since patient has normal ALT, no replication, DNA not detectable he /should be followed up.

The vaccination against HBV has no place in this situation

Sir, is it evidence based reason, is there any trial or a pilot study on the patient yet?

The answer lies in immunology.

well if a person have HBV infection in most cases the virus will be eliminated from host within six month giving life long immunity. When virus not eliminated in 6 months he will be chronically infected.

When a person is yet to be infected with HBV he/she can be protected by inducing natural protection via vaccination.

So a a chronically infected person has no scope of vaccination.

"Well if a person have HBV infection in most cases the virus will be eliminated from host within six month giving life long immunity"

the above comment is very much interesting, can you kindly confirm if you meant by this: for instance,

A person is diagnosed HBV positive on the 1 of January 2018, and the blood test shows the following

• E antigen Negative
• low viral load
• normal ALT
• fibro scan (5.4)
• fibro Scan IQR (9%)
• AFP & liver cancer maker is Negative
• HIV and hepatitis C Negative
• Hepatitis B DNA negative

after six months or a bit longer the patient done another test and the result was the same as above, which indicates the HBV is not chronic.

So as result, this person is immunised against HBV? as the patient immune system eliminated the virus ?

Thank you for your participation and your reply, can you kindly reply if i understand you correctly.

Regards

Vaccination will not be necessary in this case when the patient is infected. A combination of pegIFN-alpha and tenofovir may help resolve the disease.

Thank you for the treatment recommendation

There is not necessary a medical treatment. Just simple observation and regular follow-up once a year

Well explained, thank you

Strange as it may seem, for chronic Hepatitis B patients with HBeAg negative and low serum HBsAg (< 1,000 iu/ml), several recent clinical studies have indicated that a course of prophylactic Hepatitis B vaccine can lower serum HBsAg and may even achieve HBsAg seroclearance.

1. Ming-Wei Lai et al. recently reported that in a clinical study - Hepatology International September 2018, Volume 12, Issue 5, pp 456–464 Multiple doses of hepatitis B recombinant vaccine for chronic hepatitis B patients with low surface antigen levels: a pilot study - 2/20 patients achieved seroclearance and 14/20 achieved significant serum HBsAg declines.

2. Zhao W et al. in Oncotarget. 2018 Jul 13;9(76):34213-34228. doi: 10.18632/oncotarget.25789. eCollection 2018 Sep 28. Clearance of HBeAg and HBsAg of HBV in mice model by a recombinant HBV vaccine combined with GM-CSF and IFN-α as an effective therapeutic vaccine adjuvant

reported HBeAg and HBsAg seroclearance in a mouse-model study.

In addition, there is a study that showed a Recombinant Hepatitis B Human Immunoglobulin can also temporarily reduce serum HBsAg (as expected) but a few patients also achieved durable HBsAg seroclearance in patients with HBsAg < 1,000 iu/ml.

Hopefully, all these studies will lead to a functional cure of chronic Hepatitis B patients with low serum HBsAg using HBV Immunoglobulin, and HBV vaccines with innovative adjuvants.