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Variation in Hepatitis B Viral Load Titres in a Span of One Week in a Patient Not on Antivirals- How to Interpret?

Dhruv Gandhi, Ira Shah
Department of Pediatric Infectious Diseases, BJ Wadia Hospital for Children, Mumbai, India

Address for Correspondence: Dhruv Gandhi, 5B/13 Shyam Niwas, Breach Candy, Mumbai-400026, Maharashtra, India. Email: dhruvgandhi2610@gmail.com

Keywords: Polymerase chain reaction, sample processing, haemolytic interference, viral PCR, antiviral agents, hepatitis B diagnosis

Clinical Problem:
A 28-year-old primigravida presented in December 2024 at 17 weeks of gestation with incidentally positive results for hepatitis B surface antigen (HBsAg), hepatitis B envelope antibodies (anti-HBeAg), and total hepatitis B capsule antibodies (anti-HBcAg). She was negative for IgM anti-HBcAg and anti-hepatitis C antibodies. She reported no history of jaundice. Her husband was negative for HBsAg and was advised hepatitis B vaccination. On presentation, her weight was 44.8kg. Her initial hepatitis B viral load (VL) was 3,67,125 IU/mL with a log value of 5.5. Abdominal ultrasound was normal. Hepatitis B VL was repeated after 6 days of the initial test and was found to be 80,725 IU/mL with a log value of 4.9. She was advised to repeat the hepatitis B VL and follow-up in 1 month.

How do you explain the variability in the hepatitis B viral load results of the patient?

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