Dual Positivity of Hepatitis B Antigen and Antibody

Q: Dual Positivity of Hepatitis B Antigen and Antibody

1. <br>First, here is a reference： Liver Disease Prevention and Treatment Academic Foundation https：//www.liver.org.tw/journalView.php?cat=67&sid=926&page=1 Scenario 3： Both Hepatitis B surface antigen and antibody are positive. <br>Regardless of whether Anti-HBs (Hepatitis B sur

Dual positivity for hepatitis B antigen and antibody?

Hello, my student’s health check revealed that they are positive for both hepatitis B antigen and antibody, with an antigen level of 944.1 (+) and an antibody level of 18.12 (+).
What does this mean?

Liao Xiansheng, 10~19 year old female. Ask Date: 2022/08/10

Dr. Liao Zhongxin reply Internal Medicine

1.
First, here is a reference: Liver Disease Prevention and Treatment Academic Foundation https://www.liver.org.tw/journalView.php?cat=67&sid=926&page=1 Scenario 3: Both Hepatitis B surface antigen and antibody are positive.
Regardless of whether Anti-HBs (Hepatitis B surface antibody) is positive or negative, the presence of Hepatitis B surface antigen indicates that you may be carrying the Hepatitis B virus.
Blood is infectious, so do not donate blood, and remember to have regular follow-up appointments for ultrasound and blood tests.
The reason we say "may be carrying" rather than being absolutely certain is due to a small caveat: within one month of receiving the Hepatitis B vaccine, because it contains "artificial Hepatitis B surface antigen fragments," it may result in a positive Hepatitis B surface antigen test.
In this case, since the vaccine does not contain actual viral genetic material, it does not have pathogenicity or infectiousness.
When a patient cannot recall whether they have recently received the Hepatitis B vaccine, we should treat the patient as a Hepatitis B carrier and check again in six months to see if they are still Hepatitis B surface antigen positive.
Of course, we can also directly test for HBV DNA (Hepatitis B viral load); although this incurs additional costs, it allows for earlier diagnosis.

2.
If there are still concerns, you can visit a nearby medical facility with a gastroenterology department for consultation and follow-up to alleviate any doubts.

Reply Date: 2022/08/10

More Info

When a patient presents with both positive Hepatitis B antigen (HBsAg) and positive Hepatitis B antibody (anti-HBs), it indicates a complex situation that requires careful interpretation. In your case, the HBsAg level is significantly high at 944.1, while the anti-HBs level is also positive at 18.12. Let's break down what this means.

Understanding Hepatitis B Markers
1. Hepatitis B Surface Antigen (HBsAg): This is a protein on the surface of the Hepatitis B virus. Its presence in the blood indicates that a person is currently infected with the virus. A high level of HBsAg, such as 944.1, suggests an active infection.

2. Hepatitis B Surface Antibody (anti-HBs): This antibody is produced by the immune system in response to the Hepatitis B virus or vaccination. A positive anti-HBs test generally indicates recovery from a past infection or successful vaccination, providing immunity against future infections.

Dual Positivity Interpretation
In your student's case, the dual positivity for HBsAg and anti-HBs is unusual and can suggest several scenarios:
- Acute Infection: If the patient is in the acute phase of Hepatitis B infection, they may still have detectable HBsAg while beginning to produce anti-HBs as part of the immune response. However, the high level of HBsAg suggests that this is less likely.

- Chronic Infection: The presence of HBsAg indicates that the patient is likely in a chronic state of infection. In chronic Hepatitis B, the body may produce anti-HBs, but this is not typical. It could indicate a waning immune response or a transition phase in the infection.

- Immune Tolerance Phase: Some patients with chronic Hepatitis B may enter an immune tolerance phase where they have high levels of HBsAg but also develop some antibodies. This is more common in individuals who were infected at a young age.

- Vaccine Response: If the patient had previously been vaccinated against Hepatitis B, the presence of anti-HBs would indicate immunity. However, the high HBsAg level contradicts this scenario, as it suggests active infection.

Next Steps
Given the complexity of this situation, it is crucial to conduct further testing and evaluation:
1. Liver Function Tests: Assess the liver's health and function, as elevated liver enzymes can indicate liver damage.

2. Hepatitis B Viral Load (HBV DNA): This test measures the amount of virus in the blood and helps determine the level of viral replication.

3. Hepatitis B Genotyping: This can provide information about the specific strain of the virus, which can influence treatment decisions.

4. Consultation with a Hepatologist: A specialist in liver diseases can provide a comprehensive evaluation and recommend appropriate management strategies.

Conclusion
In summary, the dual positivity for HBsAg and anti-HBs in your student's case suggests an active Hepatitis B infection with a possible immune response. It is essential to follow up with additional tests and a specialist to determine the best course of action. Early intervention can help manage the infection and prevent potential complications, such as liver damage or cirrhosis.

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