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Positive - Negative - Negative (What does my test result mean?)
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Positive - Negative - Negative (What does my test result mean?)

Regular blood donor with no notifications.  Most recent donation was July.

Hep B Core AB Total - Positive
Hep C Antibody IA - Negative
HBsAG - Negative
Hep B Surface AB, Qual - Negative

The following was noted under the Hep B Surface AB:

A negative Hepatitis B Surface Antibody is indicative of:
1) no prior exposure to HBV,
2) lack of antibody response to an acute or chronic HBV infection,
3) lack of antibody response to HBV vaccination, or,
4) loss of immunity that followed either vaccination or infection.

Would someone please tell me what this result means?  The Red Cross has never told me I have an issue.  My AST/ALT levels are in the teens.

My doctor hasn't returned any of my phone calls or contact attempts regarding the test result.  The office told me they would contact me with any issues if they popped up on my bloodwork.  Since the office and doctor have not contacted me, I'm not sure what I'm looking at when I read the results.

Any insight would be greatly appreciative.  Thanks!
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Avatar_m_tn
Hepatitis B is one type of viral hepatitis. Hepatitis means inflammation of the liver. It can be caused by the Hepatitis A, B, C, D, or E viruses. So I would not rely on further advice from the nurse.

The whole issue arises from the fact that you tested positive for HBcAb (everything else is negative). By testing positive to the Hepatitis B Core antibody, it means you have a current or past (but resolved)  Hepatitis B infection. But because you tested negative to the HBsAg, we rule out that you have a current infection. So we think you had a past but resolved infection. But as the doctor said, if you had a previous, but resolved Hepatitis B infection, you should have developed immunity, i.e., you should test positive to HBsAb, but your test is negative. But as Rome70 pointed out, if your previous resolved infection was old, you may have lost the HBsAb from your blood (even though the immune memory is there) and that is why he suggested that you may consider getting vaccination to regain that immunity. See point 4 of the explanation from the blood bank.

Finally, I am intrigued by why the specialist is interested in your travel to China, Japan and Israel. China is endemic for Hepatitis B. But Hepatitis B is not transmitted by casual contact, it is by blood to blood contact, by sex and vertically from your mother. So it is not where you have been, but whether you have the risk factors for infection.

To ease your mind, I am sure the specialist will order a repeated test and if he/she is a specialist, he/she will give you the right answer.

BTW, what country do you live in?
25 Comments Post a Comment
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Avatar_m_tn
It looks like you had HBV long ago, that was successfuly resolved and now you also lost HBS antibodies ( 20 years) so you should be revaccinated now. But I would redo the tests in another lab, and test also IgM, antiHBS quant.
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Avatar_f_tn
I heard from the doctor today who seemed quite concerned about my results.  I was told that I've had/continue to have hep B and I am not building antibodies so I would likely be considered chronic.  She also noted that I would be highly likely to develop cancer.  All of this has caught me off guard.  I've been referred to a heptologist.  I may have spelled that incorrectly.  

Is the internal specialist doctor over-reacting???
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Avatar_m_tn
Not only is she over-reacting but she obviously do es not know much about Hepatitis B.

After all, you tested NEGATIVE to HBsAg, so how could she conclude you continue to have Hep B? Highly likely to develop cancer - base on what?

At the very worst, you may have what they call occult Hep B. But this rare and even if you do, the clinical significance is not known. To rule out that possibility, you have to see whether you have hbvdna in your blood. Nowadays, some blood banks will do a nucleic acid test to rule that out.
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Avatar_f_tn
Thank you for the additional information.  I really appreciate it!  

The specialist's office called to schedule my intake and appt.  They seem to be interested in my travels to China, Japan, and Israel.  I was also asked if my family has a history of liver disease.  

A family member is a nurse and suggested it could be viral hepatitis.  Is that a possibility?  I'm not sure I understand the difference between viral and B.

As for the doctor that suggested that I must still have an active Hep B virus--she said if I had developed immunity to the virus I would've tested positive in one of the two places I tested negative.  Since I hadn't--it was still likely active and she mentioned I'd be contagious.
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Avatar_m_tn
Hepatitis B is one type of viral hepatitis. Hepatitis means inflammation of the liver. It can be caused by the Hepatitis A, B, C, D, or E viruses. So I would not rely on further advice from the nurse.

The whole issue arises from the fact that you tested positive for HBcAb (everything else is negative). By testing positive to the Hepatitis B Core antibody, it means you have a current or past (but resolved)  Hepatitis B infection. But because you tested negative to the HBsAg, we rule out that you have a current infection. So we think you had a past but resolved infection. But as the doctor said, if you had a previous, but resolved Hepatitis B infection, you should have developed immunity, i.e., you should test positive to HBsAb, but your test is negative. But as Rome70 pointed out, if your previous resolved infection was old, you may have lost the HBsAb from your blood (even though the immune memory is there) and that is why he suggested that you may consider getting vaccination to regain that immunity. See point 4 of the explanation from the blood bank.

Finally, I am intrigued by why the specialist is interested in your travel to China, Japan and Israel. China is endemic for Hepatitis B. But Hepatitis B is not transmitted by casual contact, it is by blood to blood contact, by sex and vertically from your mother. So it is not where you have been, but whether you have the risk factors for infection.

To ease your mind, I am sure the specialist will order a repeated test and if he/she is a specialist, he/she will give you the right answer.

BTW, what country do you live in?
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Avatar_f_tn
Thank you Stephen.  I appreciate your responses.  I am from the US.  It wasn't the blood bank that gave me results,  It was a hospital.  I had a previous bought of nausea/vomiting/pale stools for almost 3 weeks that required IV's and medication. At that time my AST level went to 50 from 11. My ALT was normal.  My AST is now 11 again.  Preceeding that was a very bad sore throat and headcold. Then I went back for what I thought was strep throat.  The doctor thought CMV or Mono but ordered a few extra tests as well.  She was just as surprised as I was because she was convinved it was CMV.  I was on a medication that was stopped because it has a rare side effect of hepatitis.  My parents weren't very good about keeping records of my vaccinations--we moved a lot.  They thought I had been vaccinated for Hepatitis A & B in the past.  

I'm not sure what to expect at the specialist appt. I was told there would be an intake and then I'd see the doctor.  Perhaps more blood work.

Thanks again for your insights.
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Avatar_f_tn
Hi Stephen.

Saw the specialist yesterday.  He didn't appear to be concerned.  Like you noted in your response, he felt I likely had a prior infection and lost immunity but he also said there was a chance of being chronic.  I was given the 1st of the 3 booster shots for Hep A & B in the hopes that it could give me immunity.  He mentioned I have an 85% chance of it working if I fall into the category he felt I did.  The lab took 11 viles of blood for various tests and I was told some would be in for review in 2 weeks and the rest in 4.  Today they started posting.  Beyond my cholesteral dropping 106 points to go back into normal range, I can see that I'm seriously vitamin D deficient and iron anemic.  Unlike my previous Hep test which had the 3 negatives and 1 positive--this test only lists 1.  It says, "Hep B Core AB, IgM - Negative" and notes normal result is negative.  I was pumped with so much info yesterday I've found my notes confusing.  Is this a retest that would mean I'm a false positive?  Or does this suggest that I'm chronic?  My notes point to chronic...  Any thoughts would be appreciative.  This weekend is going to drive me insane with wondering where I stand.  
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Avatar_m_tn
Hep B core AB, IgM is usually positive when you are having acute Hepatitis B. By testing negative, it just ruled out that you are in the middle of acute Hepatitis. If there is no test result concerning HbsAg, it means they have ruled out the acute Hepatitis B as well and you are where you were: a prior infection, fully recovered, but lost the immunity that usually came with a full recovery (no antibodies).
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Avatar_f_tn
Hi Stephen!  

Thanks for the response!  I'm truly grateful for this community and your willingness to respond.  Additional results posted today--Hep Be Ab:Negative.  I'm guessing this also adds to the idea that a prior infection resolved and lost the immunity?  Although, I don't really understand how you lose immunity when you had it...  

Anyhow, I realized I hadn't told you why the specialist wanted my detailed travel info (and their interest in my time in specific areas).  Mostly it seemed like they were trying to do preventative work.  For example, if I was infected during one of my travel trips, the time stamp would be important to evaluate if I had contracted other diseases at the same time that were prevelant in that region.  I think I explained that correctly.  After the appointment, I was referred to Infectious Diseases so that I could get the recommended vaccinations for the places I travel most.  Doc wants to protect my liver at all costs!

Thanks again for your help.  I wish I could give you a hug!  This news has been a unexpected and a bit scary.  I'm mostly on my own since my family is in another state and my boyfriend seems to have jumped ship (I think the news was just too much for him).  

Have a great day!  Off to do some research on my own to better understand what's happening in my body.
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Avatar_m_tn

i am so surprised at how doctors can be ignorant!there is no ending to their ignorance and many patients will be damaged by such ***** around

hbsab can be lost by the years without loss of immunity against hbv, we know from quite sometime that:

low or und hbsab means you complitely resolved hbv and cccdna
hbsab is not the most potent antibody on hbv, infact hbv vaccine is badly designed and has poor response and even fails!hbcab is the main hbv antibody together with hbsab

partners of hbv carriers are sometimes found immune with no hbsab
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Avatar_f_tn
Hi Stef!

Thanks for responding.  Okay.  I got more tests in and I'm super confused.  Doc won't talk to me until everything is in...but I have no clue how much is left.  

Here's the recap:

Hep B Core Ab, Total          Positive
HBsAB (anti-HBs)                Negative
Hep B Surface AB, Qual      Negative
Hep Be Ag                           Negative
Hep Be Ab                           Negative
Hep B Core Ab, IgM            Negative
Hep A Ab, Total                   Negative
Hep C Antibody IA               Negative

The doctor said the tests he was going to run were going to prove that I had a previous Hep B infection, gained immunity, and then lost it.  Is that what you see?  What I see doesn't make sense.  From what I've read up on, it looks as though its a false positive or a HBeAg-negative hepatitis B which would suggest chronic.  How long does it normally take to make a diagnosis?  (I mean other than the very first test that I tested positive for)

Thanks!
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Avatar_m_tn
You are getting exactly the same resuts as before and therefore the same interpretation : a resolved previous infection.

It is not a false positive because you tested positive twice. It is not chronic HBeAg negative hepatitis because your HBsAg is NEGATIVE.
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Avatar_f_tn
Hi Stephen!

Thank you for responding.  I just lumped all the test results together for easy review because I thought they said something different.  

My first test was:

Hep B Core Ab, Total          Positive
Hep C Antibody IA               Negative
HBsAG                                Negative
Hep B Surface AB, Qual      Negative

My second test was:

HBsAB (anti-HBs)                Negative
Hep Be Ag                           Negative
Hep Be Ab                           Negative
Hep B Core Ab, IgM            Negative
Hep A Ab, Total                   Negative

So let me understand correctly--which two test are the same??  I didn't realize I had a repeat.  Apparently I don't understand the abbreviations.  I thought I did.

Thanks.
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Avatar_f_tn
And really...I just don't understand how I've been a long time regular blood donor and never contacted that I have Hep B.  

I've never been asked to stop donating.  I've never been turned away from donating.  In fact, I just got a call today asking me to come in--its time for me to give again.  I realize you're all very knowledgeable and experts on this disease...but I'm still trying to catch-up here.  

I asked my doctor to confirm my original diagnosis.  No where in the 2nd round of tests does it give me a positive, reactive, or abnormal result.  What am I missing here??
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Avatar_m_tn
My apology, it was a "recap", not latest results.  Your second test results:

HBsAB (anti-HBs)   Negative - a repeat of Hep B Surface AB,    Qual      Negative
Hep Be Ag                           Negative - Cannot indicate HepB
Hep Be Ab                           Negative - cannot indicate HepB
Hep B Core Ab, IgM            Negative   - Rule out acute
Hep A Ab, Total                   Negative  - You have not been exposed to Hepatitis A

I bet your next results will include hbvdna (viral load). This is an expensive test.
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Avatar_f_tn
Another test result posted this morning:

Alpha 1 Antitrypsin Quant     129

*The Reference Range listed was 83 to 199 and the Unit: mg/dL

Alpha 1 Antitry Phen              PI*MM

*There was a note, "90% of normal individuals have the MM phenotype, with normal quantitative AAT levels."

I have no clue what any of this means.  Any ideas?  I looked for the HBVdna notes in all of the tests but didn't see anything so it appears I haven't had that test yet or its still pending out in lab work la-la-land.

Thanks!
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Avatar_f_tn
Last test in today:

HBV DNA Ultra

Negative for HBVDNA by PCR
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Avatar_m_tn
Congratulations! You don't have Hepatitis B.
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Avatar_f_tn
hi, my  husband applying abroad in his medical he is hepa b reactive, then we consult another doctor but the test is Non-reactive, My husband brought the result to the clinic where he is Hepa B reactive, the medtech said it was only screening, the equipment they used is high tech, was it possible that the screening is non-reactive but in their equipment is Reactive?, i don't know the equipment called, i'm so confused. please help understand.
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Avatar_m_tn
Equipment is operated by technicians who can make mistake. Almost all tests for Hepatitis B are for screening purpose, i.e., to test a person for the presence of a disease, as most people do not have symptoms. If you have symptoms and your doctor wants to confirm a diagnosis, then you have diagnostic tests. So the medtech is talking nonsense when he said it is only screening.
All tests, whether they are screening or diagnostic, should be accurate.

I am not a lab technician, but I would think, if a test is positive, the lab should test again to confirm the positive result.

Labs can make mistakes, so you will just have to accept results from a reputable lab such as those in a hospital or Red Cross, or have the results confirmed by another lab as your doctor has done.

Just my opinion.
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Avatar_f_tn
me and my husband are both healthy living, though my husband drink occasionally, we don't have any symptoms, but thanks for reply, soon we will go to hospital to have diagnos and to know the quantity if we really have that virus. thank you.
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Avatar_f_tn
Hi iv tested neg for hept core igm  and neg for surface antigen but positive for surface antibody. What dose this mean???
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Avatar_m_tn
You were vaccinated against HBV previously.
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Avatar_m_tn
She could also have seroconverted from actual infection. An Igg anti core test is needed to clarify if she is at risk with future chemotherapy or other immunsuppressive therapy..
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Avatar_m_tn
Thank you for the correction. You are absolutely right. I mis-read the result as HBcAb negative.
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