Antigen positive but antibody negative

[Kate__0__0]

  My fiance and I have recently been tested for HIV, Hep B etc. I am negative for the former and immunised against the latter (I am a health care worker). He is HIV negative but his Hepatitis B tests show he is antigen positive although he has no antibodies (surface or core). What might this mean?? He is African and the doctor out there said it meant that he was a carrier and that no action was needed. Is this so?? Is he likely to be chronically infected as well?? If he comes to live in the west could he have treatment??
  Many thanks for your help.

[HFHSM.D.-D.M.]

Dear Kate:
I appreciate your concerns about your fiancee and I’ll try to give you some information that hopefully will be helpful to you.  Hepatitis B can be very confusing to physicians as well as to non-physicians.  My understanding is that you boyfriend is hepatitis B surface antigen (HBsAg) positive and that he is negative for hepatitis B surface antibodies (HBsAb).  
The fact that your fiancee is HBsAg is positive means that he is infected with hepatitis B and can give it to others.  In terms of his health, the critical thing is to determine whether he has an active, replicating virus or a quiescent form.  We use two major markers to look for evidence of viral replication and the Hepatitis B DNA (HBV DNA) level and the hepatitis e antigen (HBeAg).  Both these tests are considered “markers of active viral replication” and they are very important in determining how active a hepatitis B infection is.  If these tests are positive, it certainly means your fiancee is a candidate for treatment and I see no reason why he could not be evaluated and treated in the U.S.  
If his markers for viral replication are negative, he and patients like him are often referred to as carriers.  Some, but not all, of these patients will eventually lose their virus over time.  In theory, these patients should not have on-going liver damage from the hepatitis B though they are at some risk for developing liver cancer and should periodically be screened for this.  These patients typically do not respond to treatment, they typically do not need treatment and we typically do not treat them.  
I hope this information is helpful.  At some point your fiancee should be tested for markers of viral replication (HBV DNA and HBeAg) if he has not already.  I am pleased that you have been vaccinated though you may want to make sure you have protective titers given your fiancee’s status.  
I would invite you to contact us again with additional concerns or questions.   If you are near Detroit,  we would be happy to see you here at Henry Ford.   We have an active group of liver specialists with experience with hepatitis B.   You can always contact us directly at [phone].
This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question pertaining to your health.  

[doctort]

A related discussion, HbAg +ve was started.