Can “small three positive” (HBeAg-negative chronic hepatitis B) revert to negativity and then relapse?
Mar 08, 2022
Source: Cainiu Health
Dr. Yu Yongqin
Introduction
“Minor three-positive” status turning negative: If it is confirmed that the hepatitis B surface antigen (HBsAg) has become negative and, simultaneously, the hepatitis B surface antibody (anti-HBs) has turned positive, this scenario is generally considered to represent complete eradication of the hepatitis B virus, with virtually no risk of recurrence. However, this outcome is relatively rare, as the vast majority of individuals with chronic hepatitis B infection remain HBsAg-positive for life. If such a serological conversion does occur, there is typically no need to worry about hepatitis B recurrence.
Although complete cure of hepatitis B “small three positives” (a serological pattern indicating chronic hepatitis B infection) is uncommon, sustained treatment can lead to seroconversion—namely, loss of hepatitis B surface antigen (HBsAg) and emergence of hepatitis B surface antibody (anti-HBs). Early detection of “small three positives” is often difficult; however, once diagnosed, prompt treatment is essential due to the infectious nature of the disease. So, will “small three positives” relapse after seroconversion? Let’s explore this further.
Will “Small Three Positives” Relapse After Seroconversion?
If seroconversion is confirmed—specifically, HBsAg becomes undetectable while anti-HBs becomes positive—this is generally considered a functional cure of chronic hepatitis B, with very low risk of recurrence. However, such outcomes are rare, as the majority of individuals with chronic hepatitis B remain lifelong carriers. If this favorable serological profile does occur, recurrence of hepatitis B is typically not a concern.
Nonetheless, maintaining healthy lifestyle habits remains critically important, as other etiologic factors may still cause liver disease. For instance, alcohol consumption should be avoided to prevent alcoholic liver disease. Weight management is essential to reduce the risk of non-alcoholic fatty liver disease (NAFLD). Additionally, precautions should be taken to avoid infection with other hepatotropic viruses—including hepatitis C virus (HCV), hepatitis A virus (HAV), and hepatitis E virus (HEV)—to prevent other forms of viral hepatitis.
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