Hep B patient tested neg for hep B surf antigen, but antibodies also neg. explain?

[Saba73]

A chronic hepatitis B patient recently tested negative for hepB surface antigen. The doctor told him to get hepatitis B. antibody test done . But the antibody was also non reactive. What does this mean. ? Does it mean the patient hasnt cleared the hep B virus. ? What are the next steps ?

[stef2011]

it was that simple a century ago.....

only hbsab confirms clearance (it is actually not clearanc ebut let's keep it this way to make it simple) and hbsab>250miu/ml could be safe enough to keep hbv cleared
at the same time hbvdna pcr must be undetectable to confirm there is no hbsag mutation, incase of hbsag mutation hbsab is useless

all other antibodies hbcab, hbeab are useless to indicate any clearance on a chronic hbv

[Saba73]

But stef, shouldn't the hep b antibodies have developed in response to the body clearing hep b virus?

[stef2011]

first a test of hbsag must be done with abbott architect or roches elycsys and not obsolete tests because all other machines can t detect the hbsag mutations and give hbsag negative when it is not......

once it is known hbsag is cleared zadaxin and hbv monthly vaccine are needed to make hbsab, hbv can be concidered cleared (or better controlled) when hbsab is at least 250miu/ml

also having a normal vitd level in blood can help, vit25oh from 50 to 100ng/ml, not less