Tuesday, November 29, 2011

Mutant Chronic Hepatitis-B or Hidden Hepatitis-C

Today I am going to talk about something I think is very important for all that you have a diagnosis of CFS.

As you know I have CFS diagnosed for 6 years now, and despite the fact that my serologies for hepatitis A, B and C were negative during these years, this year Gregorio Marañón Hospital and last year Carlos III detected B viruses in my blood test. This came as a surprise because I was vaccinated against Hepatitis B and I already passed Hepatitis A.

As you can see the evolution of these blood tests, surface antigen HBs came out negative ALWAYS, however HBc core antibody was positive on 2 occasions since 2009. Moreover HBe antigen was detected in blood also on two occasions, and there is as well signs of an infectious component when we observe 2 (IL-2R) in December 2010.

The interpretation of this evolution is NOT easy. Firstly because normally is not standardized to test for HBc nor HBe, and secondly because these results may be interpreted in isolation as a "false positive" because they do not fit together well with a negative HBs Ag.

However Gregorio Marañón Hospital advised me to go for a good Liver specialist to undertake a thorough study, because the B virus that they saw was not from the vaccine. For this reason I went to Vicente Carreño, which is the number 1 in Spain.

Dr. Carreño checked my liver with his hands and it was 2 cm rhomboid (sorry for this translation), which signals inflammation, and because of the abnormalities observed in the blood work, He stated that I could be infected with the Hepatitis B virus, despite of the vaccine. Apparently this is a possibility, although not everybody is aware of it.

There are several types of the B virus, and to some of them the vaccine is not effective. Also it can go unnoticed in a normal hepatitis blood work. So He prescribed some special molecular blood work at NUCLEOTEX laboratory in Spain that performs molecular tests to detect two possible cases:

-Hidden Hepatitis C
-Mutant Hepatitis B in Pre-S region

My Results:

Hepatitis B virus:

PCR DNA (ultracentrifugation): 13 copies / ml
Proliferation of CD4 + T lymphocytes specific B virus

Hepatitis C virus:
PCR-RNA (ultracentrifugation) NEGATIVE
Proliferation of CD4 + T lymphocytes specific to hepatitis C virus
NS3 (Helicase) NEGATIVE

Although at first glance it seems all negative, it is not. These tests show there is B virus in my blood (13 copies per ml).
Bear in mind that the standard DNA testing for B & C virus are not as sensible as the one I did here in Spain, normally they have a limitation: (116 to 989,400,000 copies/mL). In my case, I only had 13 copies/ml, therefore I would have come negative in standard DNA testing. This is a very low titer, but still shows is positive. At this point is not contagious, but if it peaks, it could be. Another important factor is that the titer might be very low in blood but not necessarily in the liver. It could also be a "false positive" therefore it needs to be confirmed with a biopsy.

For this reason He recommends a biopsy to confirm the infection and liver status, which not only going to look Hepatitis B and C, but also inflammation, tissue conditions, etc. The sample will frozen just in case more things need to be tested at a later stage (i.e. HGRV) .

In view of these results, the observed abnormalities in previous blood test and my clinical history, it is in the opinion of Dr. Carreño a must to perform a biopsy to confirm the findings.

When confirmed, chronic mutant hepatitis B, is treated with retrovirals (Tenofovir), normally for 6 months, given that this kind of hepatitis is more easily cured than regular chronic Hepatitis B.

I've asked him if it is possible that during these 6 years that I have thought to have CFS, perhaps I simply have had chronic mutant Hepatitis B undiagnosed, and his answer was YES.

It is too early to draw conclusions, however I think it's important enough share this writing, when I know the final results of the biopsy I will let you know. If it turns to be the case, I think everyone with a diagnosis of CFS should go through a good hepatologist who can rule out this possibility.

The standard treatment for this kind of mutant hepatitis is Tenofovir, and it comes to mind to think that people with XMRV treated with Tenofovir, might actually be responding because they might carry an undiagnosed B mutant B virus in the pre core S region.

As I said, it has taken me 6 years of running from one doctor to another to find out, is not an easy diagnosis. And I am not suspect of a wrong CFS diagnosis, De Meirleir, among 6 other specialist diagnosed me in 2006 with my RNASe-L, PKR, Elastase etc. Shara Mhyll also did with my mitochondrial failure. I also met the criteria of Cheney of diastolic disfunction of the left ventricle, Irsi Caixa also observed the same pattern than the CFS group studied with NK & CD8 abnormalities.

I could go on and on...but what I mean with this is that this B virus may be behind many many CFS diagnosed patients, and Tenofovir may be doing the trick for that reason. I also read that GcMAF is a more efficient treatment for Hepatitis B than retrovirals, and that would explain why some patients are responding to this therapy.

Having normal levels of GPT/GPO, and negative serology for hepatitis is not enough to rule it out as you could see. Not that you can do biopsy directly, first make the liver specialist need to run the molecular blood work, and if the virus is found, it is recommended to run the biopsy to confirm it. To be completely honest, in the opinion of my doctor, even if the blood work came negative He would have recommended a biopsy to make sure, given the many years of symptoms of hepatitis like that I had. Bear in mind that you need a very good specialist that is aware of these advances. They are published by the way.

To be continued ...


Lee Lee said...

Thanks for all of this, i will show my Dr to see if he can do more testing for me.

Anonymous said...

¿Y las transaminasas del hígado como las tienes, bajas, intermedias o elevadas?

Anonymous said...

Me refiero a GOT, GPT y GGT, podrías postear los valores exactos que tienes de estas transaminasas?

carlitos said...

Las transaminasas están en rango, una de ellas está en la parte alta 40 creo recordar, cuando el límite son 43, pero aun así en rango. Yo sospechaba que mi hígado no estaba bien por otras razones, mi bilirrubina salía elevada en el 30% de mis analíticas, que son muchas. También notaba algo de ictericia en mis ojos en ocasiones. De vez en cuando tengo un dolor en el hipocondrio derecho, justo debajo de las costillas, es muy intenso y necesito buscapina para calmarlo. El cansancio me ha acompañado los últimos 6 años, las nauseas también. El caso es que tengo todos los marcadores de SFC positivos, pero claro, siempre había pensado que una hepatitis cronica era imposible, porque estaba vacunado y porque mis serologías eran negativas. Hasta ahora que he ido al especialista. Aun queda ver la biopsia, no hay nada definitivo aun.

Anonymous said...

Respecto a la hiperbilirrubinemia, hay 4 síndromes que la pueden causar, uno de ellos es el síndrome de Gilbert:


Por otro lado, cuáles son para ti los marcadores de CFS, porque que yo sepa no hay ninguno reconocido oficialmente...

P.D. Cuando te vas hacer la biopsia?

carlitos said...

Anonimo, no te puedo contestar si eres anónimo...os agradezco que si comentáis por aquí no lo hagáis como anónimo.

Es cierto que no existe un biomarcador diagnóstico aceptado para el diagnóstico del SFC. pero también es cierto que en los más de 4.000 estudios realizados se han definido una serie de "marcadores" que apoyan el diagnóstico clínico, y muchos de ellos han sido recogidos en el documento de Consenso Internacional de Criterios Diagnósticos del SFC.

El síndrome de Gilbert no tiene ninguna importancia patológica, y no creo que fuera la razón por la que yo tenía la bilirrubina elevada, además yo tenía otra serie de huellas de mal funcionamiento hepático:

-presencia de amoniaco en sangre
-niveles elevados de bilirrubina frecuentes
-dolor muy intenso en el hipocondrio derecho que podía durar 8 horas
-ictericia leve ocasional
-fibrinogeno elevado de forma frecuente
-proteína C activa elevada de forma frecuente
-inversión del sueño (cortisol invertido)
-prurito ocasional
-acolia ocasional
-coluria ocasional
-déficit de aminoácidos esenciales
-niveles elevados de colesterol y triglicéridos
-anticuerpos HBc positivos en dos ocasiones, intercaladas con resultados negativos en los últimos 3 años.

Ya me están mirando la biopsia, y ya he colgado la información en el siguiente post.