Positive Results for Hepatitis B Antigen and Antibody Tests

Regarding the positive results for both hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (anti-HBs)?

Hello, doctor.
Recently, due to my internship, I had tests for hepatitis B antigens and antibodies, but the report showed that both the antigen and antibody were positive (surface antigen: 1.16 / antibody > 1000).
Later, they tested the surface antigen again, and it was 1.07.
I have not been needlesticked or come into contact with hepatitis B-related blood or bodily fluids.
Additionally, I had a test at the end of November last year, which showed a negative antigen and positive antibody.
However, since the antibody levels were somewhat low at that time, I received the first and second doses of the hepatitis B vaccine in the past two months.
Could the vaccination affect the positive antigen result? Or could there be other reasons for this phenomenon?

Yen, 20~29 year old female. Ask Date: 2020/05/07

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hepatitis B antigen may yield a false positive result and should be monitored after 3 to 6 months.
If concerned, a self-paid test for Hepatitis B viral load can be performed.

Reply Date: 2020/05/07

More Info

Understanding the results of Hepatitis B antigen and antibody tests can be quite complex, especially when the results show both positive antigens and antibodies. In your case, the presence of both Hepatitis B surface antigen (HBsAg) and Hepatitis B surface antibody (anti-HBs) indicates a unique situation that warrants careful interpretation.

Interpretation of Your Results
1. HBsAg Positive: The presence of HBsAg (1.16 and 1.07 in your tests) indicates that you are currently infected with the Hepatitis B virus (HBV). This means that the virus is actively replicating in your body, and you could potentially transmit the virus to others.

2. Anti-HBs Positive: The presence of anti-HBs (>1000) suggests that your immune system has produced antibodies against the Hepatitis B virus. This typically occurs after recovery from an infection or after vaccination. In most cases, if HBsAg is positive, anti-HBs should be negative, as these two markers are generally mutually exclusive.

Possible Explanations for Your Results
Given your vaccination history and the recent tests, there are several potential explanations for your results:
- Recent Vaccination: Since you mentioned receiving the Hepatitis B vaccine recently, it is possible that the vaccine has stimulated your immune system to produce anti-HBs. However, the presence of HBsAg indicates that you may still have an active infection, which can occur if the vaccination was administered after the infection had already established itself.

- Chronic Infection with Antibody Response: In some rare cases, individuals can have a chronic Hepatitis B infection while also developing antibodies. This scenario is less common but can occur, particularly in cases of immune tolerance or in certain genotypes of the virus.

- False Positive Results: There is also a possibility of false positive results. Laboratory errors can occur, and it may be worthwhile to repeat the tests or confirm with a more specific test, such as HBV DNA quantification, to assess the viral load.

Recommendations
1. Follow-Up Testing: It is crucial to follow up with your healthcare provider for further testing. This may include a quantitative HBV DNA test to determine the viral load and additional serological tests to clarify your immune status.

2. Consult a Specialist: Given the complexity of your results, consulting a hepatologist or a specialist in infectious diseases would be beneficial. They can provide a more comprehensive evaluation and recommend appropriate management based on your specific situation.

3. Monitor Your Health: Regular monitoring of liver function tests (LFTs) and HBV serology is essential. This will help track the progression of the infection and assess the effectiveness of any treatment or vaccination.

4. Avoid Risky Behaviors: Until your status is clarified, it is advisable to avoid behaviors that could transmit the virus, such as sharing needles or engaging in unprotected sex.

Conclusion
In summary, your situation is indeed complex, with both HBsAg and anti-HBs being positive. This could be due to a recent vaccination, a chronic infection, or possibly a laboratory error. It is essential to follow up with your healthcare provider for further evaluation and management. Understanding your Hepatitis B status is crucial for your health and for preventing transmission to others.

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