Hepatitis B e-Antibody Negative: What Does It Mean?

When a patient with hepatitis B is found to have a negative e-antibody result, it often indicates that the e-antigen is positive. In some cases, both the e-antigen and e-antibody may be negative. Below are common scenarios associated with a negative hepatitis B e-antibody result:

1. "Big Three Positives" (HBeAg-Positive Chronic Hepatitis B)

A "big three positives" diagnosis refers to a positive surface antigen, positive e-antigen, and positive core antibody. This pattern typically indicates high viral replication and a larger viral load, which may lead to more significant long-term health risks. Patients with this profile should undergo regular monitoring through tests such as HBV-DNA quantification, liver function tests, and abdominal ultrasound to assess disease progression and determine the need for treatment intervention.

2. "One and Five Positive" (HBeAg-Negative Chronic Infection)

In some cases, both the e-antigen and e-antibody are negative, resulting in a "one and five positive" pattern — meaning only the surface antigen and core antibody are positive. This condition is similar in significance to the "small three positives" pattern and often suggests a long-standing hepatitis B infection. Patients should take this result seriously and continue regular follow-ups, including HBV-DNA testing, standard liver function assessments, liver ultrasound, and possibly other imaging studies. These evaluations are crucial for tracking changes in liver health and guiding necessary treatment adjustments.