Chronic Hepatitis B: Positive HBsAg and Anti-HBs Explained

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

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%). <br>A positive HBs Ag indicates an active infection, while a positive HBs Ab indicates the presence of antibodies. <br>Generally, the presence o

Inquiry about Hepatitis B issues?

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 the name, and there is still a virus present.
What does this mean? Thank you.

Li Wenbin, 40~49 year old female. Ask Date: 2014/07/27

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 leads to the disappearance of HBs Ag.
The hepatitis B virus itself can be classified into different genotypes and subtypes.
Infections with different serotypes of the hepatitis B virus can sometimes produce antibodies, resulting in a positive HBs Ab without the presence of antibodies (positive HBs Ag), leading to a dual positive result.
This situation can also occur during acute infections.
However, since you have been HBs Ag positive for many years, even with a positive HBs Ab, it is possible that the subtypes differ, and you should still be considered a chronic hepatitis B carrier, requiring regular monitoring and treatment.
Wishing you peace and health.
Sincerely, Dr.
Lin Ming-Hui, Gastroenterology Department, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2014/07/27

More Info

Understanding your situation regarding Chronic Hepatitis B is crucial, especially given the complexities of your test results. When both HBsAg (Hepatitis B surface antigen) and Anti-HBs (Hepatitis B surface antibody) are positive, it indicates a unique scenario that requires careful interpretation.

1. HBsAg Positive: This means that you are currently infected with the Hepatitis B virus (HBV). The presence of HBsAg in your blood indicates active viral replication and infection, which is a marker of chronic Hepatitis B if it has been present for more than six months.

2. Anti-HBs Positive: This antibody typically develops after recovery from an acute Hepatitis B infection or after vaccination. In most cases, the presence of Anti-HBs indicates that the virus has been cleared from the body, and you have immunity against future infections. However, in your case, both HBsAg and Anti-HBs being positive is unusual and suggests a complex interaction between the virus and your immune response.

3. HBeAg Negative and Anti-HBe Positive: The presence of HBeAg indicates active viral replication and infectivity. Your negative result suggests that the virus may be less active, and the positive Anti-HBe indicates that your immune system has mounted a response against the virus. This is generally a favorable sign, as it often correlates with a lower level of viral replication and a better prognosis.

4. HBV DNA 0: A result of 0 for HBV DNA indicates that there is no detectable viral load in your blood. This is a positive outcome, as it suggests that the virus is not actively replicating at this time. However, it is important to note that the virus can still be present in the liver or other tissues, and periodic monitoring is essential.

5. Clinical Implications: The combination of positive HBsAg and Anti-HBs can occur in certain situations, such as in cases of reactivation of the virus or in specific subtypes of the virus that may elicit an immune response without clearing the infection. It is crucial to continue regular monitoring of your liver function and HBV status, as chronic infection can lead to complications such as cirrhosis or hepatocellular carcinoma over time.

6. Next Steps: Given the complexity of your results, it is advisable to have a thorough discussion with your healthcare provider. They may recommend additional tests, such as liver imaging or a liver biopsy, to assess the health of your liver and determine if any treatment is necessary. Regular follow-ups are essential to monitor your condition and adjust treatment as needed.

In summary, your situation reflects a chronic Hepatitis B infection with some favorable indicators, such as low viral load and an immune response. However, the presence of both HBsAg and Anti-HBs requires careful monitoring and management. It is essential to maintain open communication with your healthcare provider to ensure the best possible outcomes for your health.

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