Interpreting Negative Hepatitis B Test Findings and Following Up Measures
Hepatitis B, a type of liver infection caused by the hepatitis B virus (HBV), can be confusing when it comes to understanding test results. One such test result that might raise questions is a nonreactive Hepatitis B surface antibody (HBsAb) test result.
A nonreactive HBsAb test result means that there is no detectable antibody to hepatitis B surface antigen in the blood, indicating that the person has not developed immunity to hepatitis B through vaccination or previous infection.
However, the interpretation of a nonreactive HBsAb depends on the results of other tests, specifically the hepatitis B core antibody (HBcAb) and hepatitis B surface antigen (HBsAg) tests.
- If HBcAb is negative and HBsAg is negative, this suggests the person has never been exposed to hepatitis B and has no immunity. The individual is susceptible to infection and may need hepatitis B vaccination.
- If HBcAb is positive and HBsAg is negative, this indicates past exposure to hepatitis B virus with resolved infection but no detectable surface antibody. This can occur in some people after natural infection where anti-HBs is not produced or has declined over time. They are typically not infectious and have immunity from prior infection, but immunity status may be uncertain.
- If HBsAg is positive regardless of HBsAb, this indicates current active infection with hepatitis B virus, whether or not antibodies are present.
In summary, a nonreactive HBsAb result alone cannot confirm immunity status; it needs to be interpreted alongside HBcAb and HBsAg tests. This combined testing distinguishes between susceptible individuals, those with past resolved infection, and those with current infection.
The Centers for Disease Control and Prevention (CDC) recommends that all adults, infants, and pregnant people undergo screening for HBV infection. Additionally, healthcare professionals are advised to periodically test people with ongoing risk of exposure to HBV, and all adults should receive vaccination against HBV.
People with hepatitis B should avoid sharing bodily fluids, donating blood, semen, organs, or tissue, sharing drug needles, and sharing personal items like toothbrushes, razors, or nail clippers to prevent transmission. If someone has received nonreactive results for the HBsAb, HBcAb, and HBsAg tests, they do not have a current HBV infection but are susceptible to the virus and should schedule a vaccination with their doctor.
[3] Hepatitis B Foundation. (2021). Hepatitis B Testing. Retrieved from https://www.hepatitistest.org/hepatitis-b-testing/
[5] American Liver Foundation. (2021). Hepatitis B: Diagnosis and Testing. Retrieved from https://www.liverfoundation.org/for-patients/about-the-liver/diseases-of-the-liver/hepatitis-b/diagnosis-and-testing/
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