How to determine normal results for the five hepatitis B tests

Sep 04, 2025 Source: Cainiu Health

Dr. Gao Jun

Introduction

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.

Under normal circumstances, the main normal results of the five-item hepatitis B test include all negative, only hepatitis B surface antibody positive, and hepatitis B surface antigen negative with hepatitis B surface antibody positive. Detailed analysis is as follows:

1. All Negative

The five-item hepatitis B test includes hepatitis B surface antigen, hepatitis B surface antibody, hepatitis B e antigen, hepatitis B e antibody, and hepatitis B core antibody. If all five indicators test negative, it indicates no infection with the hepatitis B virus and no protective antibodies have been produced. This group lacks immunity against the hepatitis B virus and belongs to the susceptible population. It is recommended to receive the hepatitis B vaccine promptly to generate hepatitis B surface antibodies through active immunization and reduce the risk of hepatitis B virus infection.

2. Only Hepatitis B Surface Antibody Positive

If only the hepatitis B surface antibody is positive in the five-item hepatitis B test, and the remaining four are negative, this is considered a normal result. The hepatitis B surface antibody is a protective antibody; a positive result indicates sufficient antibodies exist in the body to resist hepatitis B virus infection. This result typically appears after successful hepatitis B vaccination or in individuals who have previously been infected with the hepatitis B virus but have recovered and developed protective antibodies, indicating good immune protection against the hepatitis B virus.

3. Hepatitis B Surface Antigen Negative and Hepatitis B Surface Antibody Positive

If the hepatitis B surface antigen is negative and the hepatitis B surface antibody is positive, with either the hepatitis B e antibody or hepatitis B core antibody positive among the remaining three indicators, and others negative, this also indicates a normal condition. A negative hepatitis B surface antigen indicates no current infection with the hepatitis B virus; a positive hepatitis B surface antibody indicates the presence of protective antibodies in the body; a positive hepatitis B e antibody may indicate previous infection with the hepatitis B virus with suppressed viral replication; a positive hepatitis B core antibody only indicates previous infection with the hepatitis B virus and does not reflect the current infection status. Overall, such results suggest previous hepatitis B virus infection with recovery and development of protective antibodies in the body. No special treatment is required, and regular follow-up examinations are sufficient.

In addition, determining whether the five-item hepatitis B test results are normal requires comprehensive analysis based on all indicators rather than considering any single result alone. If there are doubts about the results after testing or if the hepatitis B surface antigen is positive, timely consultation with a specialist is advised to further complete relevant examinations, clarify health status, and follow medical guidance for appropriate actions.

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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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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.

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Is fasting required for the hepatitis B surface antigen (HBsAg) and antibody tests?

In general, fasting is not required for the hepatitis B surface antigen test (HBsAg) and related tests. It is recommended to maintain a normal routine the day before the test, avoid staying up late or drinking alcohol, and reduce the impact of physical abnormalities on the overall health assessment. However, if other tests such as liver function, blood glucose, or lipid profile that require fasting are also being performed, you should fast as required to avoid affecting the results of those tests.