What does a positive Hepatitis B e-antibody (HBeAb) with all other Hepatitis B (HBV) labs negative indicate?

Positive Hepatitis B e-Antibody with All Other HBV Labs Negative

A positive Hepatitis B e-antibody (anti-HBe) with all other Hepatitis B virus (HBV) labs negative most likely indicates resolved hepatitis B infection with clearance of the virus. 1

Interpretation of Serologic Pattern

• The presence of anti-HBe alone (with negative HBsAg, negative HBV DNA, and normal liver enzymes) typically represents a person who has recovered from past HBV infection 1
• This pattern indicates that the person previously had HBV infection that included the HBeAg-positive phase, followed by seroconversion to anti-HBe, and eventual clearance of all other viral markers 1
• Anti-HBe can persist for years after complete viral clearance, serving as a serologic "footprint" of previous infection 2

Clinical Significance

• This serologic pattern is consistent with the fourth stage of the natural history of HBV infection, where patients become negative for HBeAg and HBsAg but remain positive for anti-HBe 2
• In this stage, HBV DNA is typically undetectable in serum, though it may remain integrated in liver tissue at very low levels 2
• Individuals with this pattern are generally considered to have resolved their HBV infection and are at low risk for liver disease progression 1

Important Considerations

• To confirm resolved infection status, it would be helpful to test for anti-HBc (hepatitis B core antibody), which would be expected to be positive in someone with past infection 1
• Anti-HBs (antibody to hepatitis B surface antigen) may or may not be present in someone with resolved infection 1
• Normal ALT levels would further support the interpretation of resolved infection 1

Differential Diagnosis

• Isolated anti-HBe positivity could potentially represent:
  • Resolved HBV infection with loss of other serologic markers 1
  • False-positive anti-HBe test result (rare) 1
  • Very early recovery phase of acute HBV infection (though other markers would typically still be present) 1

Recommendations

• One-time testing for anti-HBc would be valuable to confirm past HBV infection 1
• No specific treatment is needed for individuals with resolved HBV infection 1
• Routine monitoring is generally not required for those with resolved infection 1
• If the person will be receiving immunosuppressive therapy in the future, monitoring for potential HBV reactivation may be warranted 1

Potential Pitfalls

• Do not confuse this pattern with the "inactive carrier state," which is characterized by positive HBsAg, negative HBeAg, positive anti-HBe, low HBV DNA, and normal ALT levels 1
• Be aware that some individuals with resolved HBV infection may experience reactivation if they become immunosuppressed 1, 2
• Isolated anti-HBe without other HBV markers is uncommon, so consider confirming the result with repeat testing if clinically indicated 1