HBsAg Positive and Anti-HBc Negative: Am I a Chronic Hepatitis B Carrier?

Based on your results, you are a carrier of Hepatitis B (HBsAg: positive, anti-HBc: negative)?

Hello Doctor: I am currently very troubled by this matter.
I can hardly find information online about a positive HBsAg result with a negative anti-HBc (core antibody) indicating a carrier status.
Thank you for taking the time to respond.
Five years ago, during a university health check, I did not test positive for the hepatitis B antigen.
Recently, from June 3 to June 22, I was ill and took antibiotics for almost a month.
On June 24, during my first health check, my GPT was 150.
On June 27, during my second health check, my HBsAg was positive (7.12) and my GPT was 117.
On July 21, during my third health check, my HBeAg was negative (0.37), anti-HBe was negative (2.090), and anti-HBc (core antibody) was negative (0.14) with a GPT of 23.

I initially thought that my results indicated that although my first health check showed a positive HBsAg, the titer was low (7.12), and since the anti-HBc core antibody was negative in the third health check, it suggested that the HBsAg might be a false positive.
However, someone told me that this indicates I am a chronic hepatitis B carrier, and that the negative anti-HBc means I am not in the acute phase, suggesting that I contracted hepatitis B at a very young age, which is why the anti-HBc is negative.
This contradicts what I found online, so I am very eager to seek your professional advice.
Could you please tell me if I have hepatitis B and if there are any other recommendations? Thank you.

Feichang Kunrao Zhe, 20~29 year old female. Ask Date: 2022/07/25

Dr. Chen Shidian reply Gastroenterology and Hepatology

It is recommended to retest in 2 to 3 months for comparison.

Reply Date: 2022/07/25

More Info

Understanding the implications of a positive HBsAg (Hepatitis B surface antigen) test alongside a negative anti-HBc (antibody to Hepatitis B core antigen) can indeed be perplexing. Let's break down what these results mean and their potential implications for your health.

1. HBsAg Positive: The presence of HBsAg in your blood 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 are infectious to others. The level of HBsAg can vary, and while you mentioned a value of 7.12, it is essential to interpret this in the context of clinical symptoms and other laboratory results.

2. Anti-HBc Negative: The absence of anti-HBc suggests that you have not been exposed to the virus in the past or that you are in a very early stage of infection. Typically, anti-HBc appears shortly after infection and remains for life. Therefore, a negative result here raises questions about the nature of your infection. It could indicate a recent infection where the body has not yet produced antibodies, or it could suggest a false positive for HBsAg.

3. Chronic Carrier Status: The combination of a positive HBsAg and negative anti-HBc does not typically fit the profile of a chronic Hepatitis B carrier. Chronic carriers usually have positive anti-HBc antibodies, indicating past exposure to the virus. However, some rare cases exist where individuals can have a positive HBsAg and negative anti-HBc, often referred to as "occult" Hepatitis B infection or a very early acute infection.

4. Clinical Context: Your elevated liver enzymes (GPT) and the fluctuation in your HBsAg levels are concerning. Elevated liver enzymes indicate liver inflammation or damage, which can occur in acute or chronic Hepatitis B infections. The fact that you have had multiple tests showing varying levels of HBsAg and liver enzymes suggests that your liver is under stress, and close monitoring is essential.

5. Next Steps: Given your situation, it is crucial to follow up with a healthcare provider, preferably a hepatologist or a gastroenterologist specializing in liver diseases. They may recommend additional tests, such as HBV DNA quantification to assess the viral load, liver function tests, and possibly a liver biopsy or imaging studies to evaluate the extent of liver damage.

6. Treatment Considerations: If you are confirmed to have an active Hepatitis B infection, treatment options may include antiviral medications such as entecavir or tenofovir, which can help suppress the virus and reduce liver inflammation. The decision to initiate treatment will depend on several factors, including your liver function, the presence of symptoms, and the level of viral replication.

7. Preventive Measures: Regardless of your current status, it is advisable to avoid alcohol and hepatotoxic substances, maintain a healthy diet, and monitor your liver health regularly. Additionally, if you are sexually active or have close contacts, discussing vaccination against Hepatitis B for them may be beneficial.

In conclusion, while your current test results indicate an active Hepatitis B infection, the negative anti-HBc complicates the picture. It is essential to work closely with your healthcare provider to clarify your diagnosis, monitor your liver health, and determine the best course of action moving forward.

Similar Q&A

Understanding Chronic Hepatitis B: Positive HBsAg and Anti-HBs Explained

Hello doctor, my situation is special. My HBsAg and Anti-HBs have both been positive for 4 years (yes, both are positive). HBeAg is negative and Anti-HBe is positive. HBV DNA is 0, indicating no viral load. I paid out of pocket to test for another type of viral load, but I forgot...

Dr. Lin Minghui reply Gastroenterology and Hepatology
Hello: It is rare for patients with hepatitis B to test positive for both HBs Ag and HBs Ab (literature reports indicate 2.9% to 6.7%). A positive HBs Ag indicates an active infection, while a positive HBs Ab indicates the presence of antibodies. Generally, the presence of HBs Ab...

Understanding Hepatitis B: Distinguishing Between Infection and Carrier Status

Hello, Doctor. I would like to ask you some questions regarding hepatitis B. 1. What is the difference between hepatitis B and a hepatitis B carrier? 2. I recently underwent a labor health examination and received the following results: - GPT: 26 - HBsAg (EIA method): P...

Dr. Chen Shidian reply Gastroenterology and Hepatology
A weak positive reaction, while not dangerous, cannot be determined definitively at this time. It is recommended to retest in 6 to 12 months for comparison.

Understanding Healthy Carriers of Hepatitis B: What You Need to Know

I apologize for the oversight. My hepatitis B test results show positive for hepatitis B surface antigen and negative for hepatitis B surface antibody. After confirming the information from the previous issue, it is clear that I am a carrier of hepatitis B. However, my liver infl...

Dr. Li Xuanshu reply Gastroenterology and Hepatology
Hello, if you are a carrier of hepatitis B but your liver inflammation markers are normal and an ultrasound examination is also normal, you can be classified as an inactive carrier of the virus. Currently, the term "healthy carrier" is less encouraged.

Understanding Your Hepatitis B Test Results: Infection or Carrier Status?

Hello doctor, here is my hepatitis B test report. Could you please tell me if I am infected with hepatitis B or if I am a carrier? Should I seek treatment urgently? Also, should I use condoms during sexual activity? Thank you. Anti-HBs: Negative Anti-HBc (col): 2.39 HBs Ag ...

Dr. Yang Zhichao reply Gastroenterology and Hepatology
Hello Mr. A-Cheng, currently, the negative Anti-HBsAb indicates that you do not have antibodies. Please provide the reference ranges for the other values so that I can assist you in the evaluation. Thank you for your inquiry.