What Does a Positive Hepatitis B e-Antibody Test Result Mean?

A positive hepatitis B e-antibody (HBeAb) test result indicates that the body has been exposed to the hepatitis B virus (HBV). It's important to understand that this antibody is not a protective one, but rather a marker of past or ongoing infection. Compared to a positive e-antigen (HBeAg) result, a positive HBe antibody typically suggests lower viral activity, reduced viral load in the blood, and decreased contagiousness.

However, interpreting the HBe antibody alone is not sufficient. To gain a comprehensive understanding, it should be evaluated alongside other components of the hepatitis B panel. Below are some common scenarios associated with a positive HBe antibody:

1. Chronic Hepatitis B in a Stable Phase

When the hepatitis B surface antigen (HBsAg), HBe antibody, and core antibody (anti-HBc) are all positive, this is commonly referred to as "small three positives" or "little three Yang" in clinical practice. This pattern usually indicates a lower level of HBV replication and a relatively stable condition with minimal liver damage and low infectivity.

2. Past Infection with Immunity Developed

If the hepatitis B surface antibody (anti-HBs), HBe antibody, and core antibody are all positive, it generally indicates a past infection from which the individual has recovered. In this case, the immune system has successfully cleared the virus and developed protective immunity against future HBV infections.

3. Occurrence of HBeAg-Negative Chronic Hepatitis B

In some cases, a positive HBe antibody may be accompanied by a positive HBV DNA test and elevated liver enzymes such as ALT and AST. This can indicate a more active form of chronic hepatitis B caused by a mutation in the e-antigen gene, which prevents the production of HBeAg. Despite a positive HBe antibody result, this situation often requires prompt antiviral treatment to prevent progressive liver damage.

In conclusion, a positive HBe antibody result must be interpreted carefully in the context of the full hepatitis B serological profile. It does not, on its own, indicate immunity or clearance of the virus. Consulting with a healthcare provider for accurate diagnosis and appropriate management is essential.