Hep B reactivation danger with hep C treatment

[Dan12]

I am unable to find any information about Hep C treatment and whether a higher antibody count reduces the likeliness of Hep B reactivation. My Dr. seems to think it makes a difference. My Hep B antibody count is over 500. I have no idea if that is good enough to fight reactivation. Can anyone help with information? I appreciate it!

[lporterrn]

Hi Dan,
Important to clarify which antibody. Am I correct in assuming you have had hep B and you aren't referring to HB surface antibody (anti-HBS) results that indicate immunity from vaccination? https://www.hepmag.com/basics/hepatitis-b-basics/hepatitis-b-testing

If you are referring to previous infection and positive core antibody results, I've not seen anything correlating the count with the likelihood of reactivation. I have seen some recent studies indicating that resolved past infection might not be an issue. http://onlinelibrary.wiley.com/doi/10.1111/jgh.13771/abstract

The European liver experts (EASL) just released their guidelines https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwiv6-nqvszTAhUV8GMKHWTHC6EQFggjMAA&url=http%3A%2F%2Fwww.easl.eu%2Fmedias%2Fcpg%2Fissue8%2FEnglish-Report.pdf&usg=AFQjCNEzAs5anu01qLZr9aHguWWPXUHruA&sig2=TO8S2v5pm0OB2FGnOY6PPQ

HCV co-infected patients
In HBV-infected patients, HCV co-infection accelerates liver disease
progression and increases the risk of HCC [187–189]. HBV
and HCV replicate in the same hepatocyte without interference
[190]. A proportion of these patients may have fluctuating serum
HBV DNA levels, thus indicating the need for longitudinal evaluation
of viral loads before starting any antiviral therapy in order
to clarify the respective pathogenic role of each virus [185]. Nevertheless,
HBV DNA level is often low or undetectable and HCV is
responsible for the activity of chronic hepatitis in most patients,
although this is variable probably due to indirect mechanisms
mediated by innate and/or adaptive host immune responses

Here's the FDA's latest: https://content.govdelivery.com/accounts/USFDA/bulletins/18741e2

Hope this helps.

[Dan12]

Hi Lucinda,
Thanks so much for the information. I'm so glad you responded.
Yes, I had Hep B in 1978 and recovered with antibodies to it. I tested positive for Hep C in 2001 and have been taking Zepatier for 12 days now. According to my recent blood results taken in February, my Hep B core Ab is reactive (positive?), and my Hep B surface Ab is 573.3 mIU/mL. Does this protect me from reactivation?
I have never injected drugs and do not drink much alcohol. I believe I must have gotten it when I had a piercing sometime in the mid nineties, or while in hospital for a gall bladder removal in 1998. I waited too long to get treatment and now have compensated cirrhosis stage F4, Necroinflammation Act Grade A3, ALT 77, AST 82, and my MELD score is 9.
 Luckily, no real symptoms other than some fatigue, so it was a shock to know how severely my liver has been damaged. But, the treatment may be successful!
Thanks again for being so helpful. 
Dan

[lporterrn]

I don't know enough about HBV lab data to say if that will protect you. Is your doc testing for HBV DNA?

I am curious - why do you think you may have contracted hep C in the 1990's rather than back in 1978 when you got the hep B? (Please don't answer if I am overstepping my bounds by asking.)

[Dan12]

No, not at all!
I was tested for Hep C in 1995 and the result was negative. I tried to find records from my gall bladder surgery but wasn't able to. The hospital said those records were destroyed, so I don't know if they tested for it at the time, but I imagine that they would have. And if they had, I have to believe they would have mentioned it. The next stop after that was a doctor's visit in 2001, and that's when they told me I had it. I was given the option to do pegalated interferon, etc., but the side effects sounded so horrifying that I passed. Now that I am able to be treated, it has become much worse, but not too late yet. It scares me to read so many stories of what others have gone through.
My Dr. has not tested for HBV DNA to my knowledge.
The links were very helpful. I'm learning a lot about this and am very thankful for your pointing me in the right direction for getting answers!