Can Hepatitis B Surface Antigen Change from Positive to Negative?

Is it possible for the hepatitis B surface antigen to change?

Hello Doctor: I previously underwent a health check-up in January 2003, where the hepatitis B surface antigen was positive and the surface antibody was negative, thus I was determined to be a carrier (liver function tests, alpha-fetoprotein, and abdominal ultrasound were all normal).
However, during a follow-up visit to the hepatobiliary and gastroenterology department in September 2004, blood tests revealed that the surface antigen was negative (test value -1.5) and the antibody was also negative (liver function tests, alpha-fetoprotein, and abdominal ultrasound were all normal).
Therefore, the physician recommended that I receive the hepatitis B vaccine.
I would like to ask: 1.
Can the surface antigen change from positive to negative? (Or could there have been an error in the previous test?) 2.
Are there any side effects of receiving the hepatitis B vaccine in my situation?

chungyan, 30~39 year old female. Ask Date: 2004/09/17

Dr. Chen Zhiping reply Gastroenterology and Hepatology

Hello, previously the surface antigen was positive, but it is now undetectable, and the surface antibody is also negative.
There are several possibilities: 1.
The surface antigen may still be present but at a level too low to be detected due to the sensitivity of the test; 2.
It may have truly disappeared; 3.
The surface antibodies may not have developed yet, indicating a typical window period.
If this is the case, there is a chance that antibodies will develop in the future.
The third possibility is that there are surface antibodies present, but they are at such a low level that they cannot be detected.

To answer your question: 1.
It is possible for the surface antigen to change from positive to negative; approximately 1% of carriers spontaneously convert their antigen to negative each year.
2.
There should be no side effects; it may simply be unnecessary to receive the vaccine, and instead, monitoring the antigen and antibody levels would be sufficient.

Best wishes for your health,
Dr.
Chen Zhi-Ping, Internal Medicine, Taoyuan Hospital, Department of Health, Executive Yuan.

Reply Date: 2004/09/17

More Info

Yes, Hepatitis B Surface Antigen (HBsAg) can indeed change from positive to negative. This phenomenon is not uncommon among chronic Hepatitis B carriers. In fact, studies suggest that approximately 1% of chronic carriers may spontaneously clear the virus each year, resulting in a negative HBsAg test. This can occur due to various factors, including the immune system's response to the virus, changes in viral load, or even the natural course of the infection.

In your case, the initial positive HBsAg indicated that you were a carrier of the Hepatitis B virus (HBV). The subsequent negative result could imply that the virus is no longer detectable in your bloodstream. However, it is also possible that the antigen levels have dropped below the sensitivity threshold of the test, which means that while the virus may still be present, it is not detectable with standard testing methods. Additionally, the presence of antibodies (anti-HBs) is crucial in determining your immune status. If both HBsAg and anti-HBs are negative, it raises questions about your current infection status and whether you have developed immunity.

Regarding your second question about the Hepatitis B vaccination, it is generally considered safe for individuals with a history of Hepatitis B infection, especially if they are currently negative for HBsAg. The vaccine is designed to stimulate the immune system to produce anti-HBs, which can provide protection against future infections. Since you have a history of being a carrier, the vaccine may help in boosting your immune response, although it is essential to monitor your antibody levels post-vaccination.

In terms of side effects, the Hepatitis B vaccine is well-tolerated, with most individuals experiencing mild reactions such as soreness at the injection site, low-grade fever, or fatigue. Serious side effects are rare. However, given your medical history, it is advisable to discuss the vaccination with your healthcare provider, who can assess your specific situation and determine the best course of action.

In summary, the transition of HBsAg from positive to negative is possible and can occur due to various reasons, including spontaneous viral clearance. The recommendation to receive the Hepatitis B vaccine is generally safe and may help enhance your immune response. Regular monitoring of your liver function and viral load is essential to ensure your ongoing health and to address any potential complications that may arise from your previous Hepatitis B infection. Always consult with your healthcare provider for personalized medical advice tailored to your health status.

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