Digestive Diseases and Sciences

, Volume 31, Issue 6, pp 620–624

Clinical significance of concurrent hepatitis B surface antigen and antibody positivity

  • Tat-Kin Tsang
  • Andres T. Blei
  • Daniel J. O'Reilly
  • Richard Decker
Original Articles

Abstract

Over a period of 30 months, 64 patients with concurrently positive hepatitis B surface antigen (HBsAg) and antibody (anti-HB5) were identified at two institutions. When all assays were considered, 23.9% of HBsAg-positive individuals exhibited anti-HBs. Both persistent HBsAg/anti-HBs positivity and variable changes in antigen or antibody status were observed among the 36 patients with follow-up beyond six months. When compared to a control group, these patients did not exhibit differences in risk factors for acquiring hepatitis B or in clinical and histological diagnoses. Concurrent HBsAg and anti-HBs was present at detection in 25 patients, while antibody appeared in the remaining 11 subjects. Subsequently, it was undetectable in seven of these 36 patients; no clinical changes occurred at the time of acquisition or loss of the antibody. The titer of the antibody was below 10 mIU/ml in 75% of these individuals. In 10 patients, the subtype of HBsAg was ad, while the anti-HBs was anti-y. Concurrent HBsAg and anti-HBs is a pattern frequently observed throughout the spectrum of hepatitis B-related events. The heterotypic antibody in these patients is of a low titer, and its appearance or disappearance is not associated with changes in the clinical course; simultaneous HBsAg/anti-HBs positivity does not appear to reflect a distinct clinical entity.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Hoofnagle JH: Serologic markers of hepatitis B virus infection. Ann Rev Med 32:1–11, 1981.Google Scholar
  2. 2.
    Seeff LB, Wright EC, Zimmerman JH, Alter HJ, Dietz AA, Felsher BF, Finkelstein JD, Garcia-Pont P, Gerin JL, Greenlee HB, Hamilton J, Holland PV, Kaplan PM, Kiernan T, Koff RS, Leevy CM, McAuliffe VJ, Nath N, Purcell RH, Schiff ER, Schwartz CC, Tamburro CH, Vlahcevic Z, Zemel R, Zimmon DS: Type B hepatitis after needle-stick exposure: Prevention with hepatitis B immune globulin. Ann Intern Med 88:285–293, 1978.Google Scholar
  3. 3.
    Le Bouvier GL, Capper RA, Williams AE, Pelletier M, Katz AJ: Concurrently circulating hepatitis B surface antigen and heterotypic anti-HBs antibody. J Immunol 117:2262–2264, 1976.Google Scholar
  4. 4.
    Sasaki T, Okhubo Y, Yamashita Y, Imai M, Miyakawa Y, Mayumi M: Cooccurrence of hepatitis B surface antigen of a particular subtype and antibody to a heterologous subtypic specificity in the same serum. J Immunol 117:2258–2259, 1976Google Scholar
  5. 5.
    Koziol DE, Alter HJ, Kirchner JP, Holland PV: The development of HBsAg positive hepatitis despite the previous existence of antibody to HBsAg. J Immunol 117:2260–2262, 1976.Google Scholar
  6. 6.
    Tabor E, Gerety RJ, Smallwood LA, Barker LF: Coincident hepatitis B surface antigen and antibodies of different subtypes in human serum. J Immunol 118:369–370, 1977Google Scholar
  7. 7.
    Courouce-Pauty A, Drouet J, Kleinknecht D: Simultaneous occurrence in the same serum of hepatitis B surface antigen and antibody to hepatitis B surface antigen of different subtypes. J Infect Dis 140:975–978, 1979Google Scholar
  8. 8.
    Brandt KH, Kathcaki JN, Bronkhorst IB, Meinders AE: Cooccurrence of hepatitis B surface antigen and heterotypic anti-HBs in the same serum. Neth J Med 23:233–236, 1980Google Scholar
  9. 9.
    Foutch PG, Carey WD, Tabor E, Cianflocco AJ, Nakamoto S, Smallwood LA, Gerety RJ: Concomitant hepatitis B surface antigen and antibody in thirteen patients. Ann Intern Med 99:460–463, 1983Google Scholar
  10. 10.
    Tabor E, Gerety RJ, Smallwood LA, Barker LF: Induction of antibody to the “y” determinant of HBsAg in a chimpanzee carrier of HBsAg subtype “adw”. J Immunol 117: 2038–2040, 1976Google Scholar
  11. 11.
    Heijtink RA, Hattum JV, Schalm SW, Masurel N: Cooccurrence of HBsAg and anti-HBs: Two consecutive infections or a sign of advanced chronic liver disease? J Med Virol 10:83–90, 1982Google Scholar
  12. 12.
    Hollinger FB, Adam E, Heiberg D, Melnick JL: Response to hepatitis B vaccine in a young adult population.In Viral Hepatitis, 1981 Symposium. W. Szmuness, HG Alter, JE Maynard (eds). Philadelphia, Franklin Institute Press, 1982, pp 455–456Google Scholar
  13. 13.
    Snedecor GW, Cochran WG: Statistical Methods, 6th ed. Ames, Iowa, Iowa State University Press, 1967Google Scholar
  14. 14.
    Swenson PD, Escobar MR, Carithers RL Jr, Sobieski TJ: Failure of preexisting antibody against hepatitis B surface antigen to prevent subsequent hepatitis B infection. J Clin Microbiol 18:305–309, 1983Google Scholar
  15. 15.
    Szmuness W, Stevens CE, Harley EJ, Zang EA, Alter JH, Taylor PE, DeVera A, Chen GTS, Kellner A, Dialysis Vaccine Trial Study Group. Hepatitis B vaccine in medical staff of hemodialysis units: Efficacy and subtype crossprotection. N Engl J Med 307:1481–1486, 1982Google Scholar
  16. 16.
    Heijtink RA, Masurel N, Weimar W, Schalm SW: Influenza vaccination in HBsAg positive chronic active hepatitis patients treated with interferon. Med Microbiol Immunol 169:31–38, 1980Google Scholar
  17. 17.
    Schlicht I, Gadow J, Ortmans H, Jorno L, Gentz H-D, Wolter G, Hoppe I: Deficiency of antibody formation to HBsAg in the pathogenesis of chronic hepatitis and cirrhosis? Acta Hepato-Gastroenterol 26:450–456, 1979Google Scholar
  18. 18.
    Sheretz RJ, Spindel E, Hoofnagle J: Antibody to hepatitis B surface antigen may not always indicate immunity to hepatitis B virus infection. N Engl J Med 309:1519, 1983 (letter)Google Scholar
  19. 19.
    Tabor E, Gerety RJ, Foutch PG, Carey WD: Specificity of tests for antibody to hepatitis B surface antigen in patients with concomitant antibody and antigen. Ann Intern Med 101:277, 1984 (letter)Google Scholar

Copyright information

© Plenum Publishing Corporation 1986

Authors and Affiliations

  • Tat-Kin Tsang
    • 1
    • 2
    • 3
  • Andres T. Blei
    • 1
    • 2
    • 3
  • Daniel J. O'Reilly
    • 1
    • 2
    • 3
  • Richard Decker
    • 1
    • 2
    • 3
  1. 1.Department of MedicineVeterans Administration Lakeside Medical CenterChicago
  2. 2.Northwestern UniversityChicago
  3. 3.Abbott LaboratoriesNorth Chicago

Personalised recommendations