Odd Hep B Test Results

What do my lab results mean?
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Hi all - I’m hoping someone might be able to help me navigate these weird test results. Results are at the bottom.

For background, I’ve been a regular blood donor for over a decade and have never had any travel outside the US. I don’t have any “notable” instances where I could have contracted Hep B nor has my partner (who also very recently tested negative for Hep B across the board). My mother also does not have Hep B. I was vaccinated as a child for Hep B as well.

I feel like this is leaning towards a false positive, however my current hepatologist is stating I do have Hep B and is suggesting long-term monitoring (regular bloodwork, ultrasounds, fibroscans). My understanding is I would also no longer be able to donate blood, which has been something I am really passionate about.

I’m considering a second opinion outside of this medical network, however I’d really like to see if others here have ever seen a similar situation. I’m far from an expert, but diagnosing off a single positive Surface Antigen result does not seem to be the norm. I’ve had a hard time even finding charts where only the surface antigen is positive that indicate true infection over multiple tests (other than very early infection or vaccine related positive tests).

I have no symptoms, etc. The test was just part of normal bloodwork back in January. My doctor also seems to be under the impression that additional testing isn’t available or useful to confirm if it’s a false positive all while admitting my case is unusual. All three of the surface antigen tests were performed at the same lab as well. My doctor also does not seem to be interested in (or aware that it’s even possible to) sending to a different lab or testing on a different platform.

I just feel stuck in a situation where I’m being diagnosed with something I might not actually have. I can accept if I truly have Hep B, but I can’t seem to find resources pointing that way.

Test Results Timeline:

Blood Donation: 10 days before Test 1, cleared all markers as normal.

NOTE: All Surface Antigen tests were done at the same lab and presumably the same platform

Test 1:
Surface Antigen - Positive, not confirmable
Surface Antibody - Positive (vaccinated a long time ago), Quantitative 90.3 mIU/mL

Test 2 (10 days after test 1)
Surface Antigen - Positive, not confirmable (lab noted on this one it was most likely a false positive)
BE Antibody - Nonreactive
BE Antigen - Nonreactive
IGG / IGM - Negative, IGM-only test - Negative

Test 3 (~20 days after first test):
Hep B DNA (Quantitative, Real-time PCR): Not detected
AFP - 1.8

Abdominal Ultrasound (~45 days after first test) - Liver normal

Test 4 (~60 days after first test):
Surface Antigen - Positive, confirmed (This is the test my hepatologist is pointing at for diagnosis)
BE Antigen - Nonreactive
BE Antibody - Nonreactive
Hep B DNA (Quantitative, Real-time PCR) - Not detected
Surface Antibody - Positive, Quantitative 105 mIU/mL
Core IGG / IGM - Negative

Any help or guidance would be greatly appreciated here!

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Yes, you are right that this is very odd. It’s not at all typical for surface antigen and surface antibody to both be positive at the same time. 90 mIU/mL should give you strong protection from hep B. It also doesn’t make sense why you wouldn’t have any core antibody (IgM or IgG). Maybe some @HealthExperts could help?

2 Likes
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Hi @Launch8469,
Welcome to the community. I am sorry to hear about your current situation. I agree with your assessment and that of @et5656 that something is not adding up here. You have enough antibodies to protect you against hepatitis B. The only possibility could be that you received the vaccine recently and took these tests immediately afterwards. However, I doubt that is the case here. A false positive is possible here, since you have antibodies and no detected HBV DNA/viral load.

I can’t imagine how frustrating this has been for you. I will recommend a new test with a different lab to see what those results could be. Take it easy if you can, as you try to understand this situation.

Keep us posted. Bansah1

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Thank you both for your responses! Glad that I’m not the only one thinking these are odd results!

You’re correct on the vaccine assumption - my last Hep B vaccine was nearly 20 years ago at this point.

My doctor’s lead also agreed with him which is frustrating. However he is also checking with the department head I guess to get their thoughts. I’m pushing for a test at a different lab as well but he didn’t seem to think it would matter.

I’ve scheduled an initial appointment outside their network for a second opinion as well. Hopefully a fresh set of eyes can clear this up.

Will try to post updates as I get them as well!

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You are welcome. We have some hepatologist on the platform so let’s hope we can help figure this out. I also hope that the second place can offer some better answers to this puzzle.

Best. Bansah1

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Wanted to provide a quick update - the doctor my current doctor reached out to is suggesting a quantitative test for the surface antigen and is leaning towards a potential cross contamination or other related issue.

Hoping that this test provides a clearer picture. At least more is being done to confirm what’s actually going on now!

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Great, I do think that a quantitative test might provide more clarity. Crossing my fingers for you that you don’t have HBV!

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I would agree that it is more likely to be a false positive for HBsAg, particularly with the high levels of protective antibody and the negative anti-HBc test. Indeed quantitative HBsAg testing might help. Please keep us informed about how it goes!

Cheers,

Thomas

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Another update here - after consulting with the senior physician, it seems like they’ve come to the conclusion that I do not have Hep B! They spoke with the lab and had something done to review the latest positive and confirmable result.

Afterwards, the result was changed to positive but not confirmable. Based on my understanding and what my doctor explained, this result is basically now showing that there’s something initially triggering the positive result that’s most likely not Hep B.

Still waiting on some additional information, but generally think this should be my last update here. Appreciate all the replies here after my initial post! Really appreciate this community being out here, even if I only needed it briefly!

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Frustrating but good news.