What is considered a normal result for the five-item hepatitis B test?

Apr 24, 2025 Source: Cainiu Health

Dr. Gao Jun

Introduction

The five serological markers of hepatitis B include hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), hepatitis B e antigen (HBeAg), hepatitis B e antibody (HBeAb), and hepatitis B core antibody (HBcAb). The normal results generally fall into two categories: first, all markers are negative; second, only the hepatitis B surface antibody is positive, while the other four markers are negative. In daily life, it is important to maintain good personal hygiene habits.

Generally, the "five-item hepatitis B test" refers to a panel of five tests, including hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), hepatitis B e antigen (HBeAg), hepatitis B e antibody (HBeAb), and hepatitis B core antibody (HBcAb). Normally, there are usually two possible outcomes: either all five markers are negative, or only the hepatitis B surface antibody is positive with the other four being negative. The detailed interpretation is as follows:

The five-item hepatitis B test is a serological marker used to detect the presence of hepatitis B virus in the blood. The normal reference ranges of these markers are of significant clinical value in determining whether an individual has been infected with hepatitis B virus and in assessing the current status and progression of the infection.

Among the five tests, the hepatitis B surface antigen is the outer protein coat of the hepatitis B virus. A positive result indicates infection with hepatitis B virus, whereas a negative result suggests no infection has occurred.

The hepatitis B surface antibody is a protective antibody. A positive result indicates immunity to hepatitis B virus, which may result from successful vaccination or from a previous infection that has resolved and led to antibody production.

The hepatitis B e antigen is associated with active viral replication. A negative result generally indicates relatively low viral replication activity. The hepatitis B e antibody is produced in response to the e antigen. Its presence usually indicates reduced viral infectivity. The hepatitis B core antibody reflects the status of hepatitis B virus infection. If only this marker is positive, it may indicate a past infection. When all markers are negative, it suggests no prior exposure to hepatitis B virus and no immunity. If only the hepatitis B surface antibody is positive, it indicates protective immunity.

In daily life, it is important to maintain good personal hygiene practices, such as avoiding sharing personal items like toothbrushes and razors that may lead to blood contact. It is also advisable to avoid undergoing invasive procedures such as tattooing or ear piercing at unregulated establishments to reduce the risk of hepatitis B virus infection.

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What should you eat if you have mild hepatitis B (small three positives)?

In general, patients with "small three positives" (chronic hepatitis B with positive HBsAg, anti-HBe, and HBV DNA) should support liver health through diet while using medication to control the condition. Recommended foods typically include eggs, broccoli, sea bass, spinach, and oats. Commonly used medications include entecavir dispersible tablets, tenofovir disoproxil fumarate tablets, silybin capsules, compound glycyrrhizin tablets, and hepatoprotective tablets.

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How to determine normal results for the five hepatitis B tests

Under normal circumstances, the main results of the five hepatitis B tests include all negative, only hepatitis B surface antibody positive, and hepatitis B surface antigen negative with hepatitis B surface antibody positive. Additionally, determining whether the five hepatitis B test results are normal requires a comprehensive analysis of all indicators; a single result should not be viewed in isolation. If there are doubts about the test results or if the hepatitis B surface antigen is positive, further evaluation may be necessary.

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What is the difference between "big three positive" and "small three positive" in hepatitis B?

Under normal circumstances, the main differences between hepatitis B "big three positives" and "small three positives" include different viral markers, varying levels of viral replication activity, differing degrees of infectivity, different risks of liver damage, and distinct treatment strategies. In addition, patients with either hepatitis B "big three positives" or "small three positives" should undergo regular liver function tests and hepatitis B virus DNA testing.

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Can hepatitis B 'small three positives' be transmitted between spouses?

HBV small three positives refers to a situation in the five-serum marker test for hepatitis B where the hepatitis B surface antigen (HBsAg), hepatitis B e antibody (HBeAb), and hepatitis B core antibody (HBcAb) are positive, while the other two markers are negative. Generally, transmission between spouses may occur in such cases. The uninfected partner should regularly monitor their hepatitis B antibody levels and receive hepatitis B vaccination or booster shots if the antibody titer is insufficient. Protective measures can also be taken during sexual activity, according to a physician's recommendation.