[Question #2129] Questions About HBV

47 months ago
Greetings Dr. Handsfield and Dr. Hook, I hope that all is well and that your weekend is off to a great start. Thank you for all that you do! I know your time is valuable so I will try to be brief and to the point. :)

I recently discovered that I was not successfully vaccinated with the original HBV series I received when I was younger. I am getting revaccinated, and have received two shots with the next scheduled for next month (6/17). However, last week (5/5/17) I engaged in receptive anal intercourse (we used condoms) with a partner I believed was negative via our prior discussions. However a subsequent conversation has led me to believe something different. 

My PCP wants me to finish my final shot to be vaccinated and agreed to do a full STD screen in 6 months (11/4/17) including Hep. B Surface Antibody and Hep. B Total Core Antibody. 

1. If I am successfully vaccinated against HBV, will it be possible to still test positive for the HBV Surface Antigen and the HBV Total Core Antibody? 
2. If I am successfully vaccinated and I do test negative for both the HBV Surface Antigen and the HBV Total Core Antibody, does this in fact mean that I was not previously exposed to the HBV virus. (I ask this questions because prior to being able to clean up and change clothing someone close to me made contact with my potentially contaminated clothes via hug and I am worried about transmission to them via this route.) If I am in fact negative for the HBV Surface Antigen and the HBV Total Core Antibody, can I be certain that I could not have passed the virus along to someone in this way. 
3. Will a successful vaccination cause me to test negative for HBV, but still have possibly transmitted it to someone via non-sexual exposure prior to receiving the final shot (as in the example above)? I ask because I will complete the vaccination series a good 5 months prior to potentially seroconverting to detectable levels on HBV tests. 

Thank you doctors!
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago
Welcome to the Forum.  I'll be glad to comment.  Hopefully you were not exposed but your questions are good ones and address an important issue.  A small proportion of persons who received hepatitis B vaccine do not respond.  Of these some respond to a second round of vaccination, often using the higher vaccine dose such as that used for dialysis patients.  Let's try to address your questions:

1.  If your respond to the vaccine you will have antibodies only to the hepatitis B surface antigen (HBsAg).  You should not test positive for either hepatitis B surface antigen or for hepatitis B core antibody, either of which would indicate the presence of infection either at present or in the past.  Persons who respond to hepatitis B vaccine have only hepatitis B surface antibodies  in their blood, not antibodies to hepatitis B core antigen or detectable hepatitis B surface antigen..

2.  I am not sure I follow your question.  Hepatitis B would not be passed by a hug.  See my comment above about the surface antigen and Core antibody

3.  No, you would test positive for hepatitis B core antibody or hepatitis B surface antigen if you were going to have transmitted hepatitis B to someone else.

I hope these replies are helpful.  If not, please re-state the question and we can try to clarify things.  EWH
47 months ago

Happy Sunday Dr. Hook,

I thank you for your speedy response. I am trying to stay calm and focused but this is a bit un-nerving (6 months is a long time to wait).

I looked over your responses and think I have a better understanding, but please allow me to summarize so that I know I have correctly understood.

If I was infected during my sexual encounter, when I receive my final HBV vaccination next month, the HBV vaccination will not act as “a cure” of sorts and suppress HBV virus to levels that will test negative on the HBV Surface Antigen or the HBV Total Core Antibody. If I test negative for either of these test, which detect infections that are past or present, then I can be sure that there has to that point in time been no infection with HBV? For me to be able to transmit HBV to someone, I MUST test positive for either the HBV Surface Antigen or the HBV Total Core Antibody. If I test negative on both of these test, then I have had no virus to transmit and can rest assured I have not passed HBV to others either sexually or non-sexually (I read this is rare, but want to be sure). I would not want to expose someone to this.

One last questions, when do people seroconvert on average? I will have the STD panel in 6 months (November), but will have an HBV panel in 3 months through Quest Laboratories to get a potential indicator to how I will test at 6 months.

Thank you again sincerely for all you and Dr. Handsfield do on MedHelp. I look forward to your response.

Best regards.

Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago
Your summary is almost entirely correct.  I believe there may be one misunderstanding however.  Most people get over hepatitis B and, in fact, many people acquire the infection and get over it without even know that they have hepatitis B.   Early in the naturally acquired infection, when the virus is in the blood the hepatitis B surface antigen (HBsAg) is positive.  As the person recovers from the infection and the infection becomes non-infectious, the HBsAg is no longer detectable.  At that time the indications that the person has been infected in the past is indicated by the presence of antibodies to the surface and core antigens- HBsAB and HBcAB respectively.  Thus if you respond to the vaccine you will only be HBsAB positive and negative for both HBsAg and HBcAB.  If you were to get infected, you could have some combination of positive tests for either antibody (HBsAB  and/or HBcAB) and/or HBsAg.  I hope this information helps rather than confuses things more. 

As far as your question about seroconversion, most people have seroconverted at 2-3 months following the beginning of vaccination.  A smaller proportion do not seroconvert until more than 3 months after the vaccination process has begin.  I do not know the precise number and I do not know whether the pattern of seroconversion is different among persons who failed to seroconvert following the initial vaccine series as you did  EWH
47 months ago

Hello again Dr. Hook,

I think I am getting it. Please allow me one more summary of my understanding before the thread closes.

It seems the HBsAG behaves like the p24 antigen in HIV infections, which becomes undetectable with the arrival of antibodies to the p24 antigen. So to, the HBsAG becomes undetectable with the arrival of it’s own antibodies (HBsAB and/or HBcAB), with HBsAB indicating reception to the vaccine, and HBcAB indicating antibodies to a present/ past infection.

At six months, assuming my body receives the second vaccinations, my test results will hopefully read positive for the HBsAB (meaning I took to the vaccine), and negative for the HBsAG and HBcAB, which will allow me to safely and conclusively know that I was not infected with HBV during my encounter. A negative HBsAB, HBsAG and HBcAB will mean the same, but also that I did not respond to the vaccine.

If I test positive for either/ both the HBsAG or HBcAB then I was infected during this encounter.

I am thinking on screening at the 2, 4, and 6 month markers to keep a closer eye on the HBsAG and hope it stays negative throughout the wait period. My 6 month test my PCP ordered will test for the HBsAB and the HBcAB, so it seems the HBcAB will play the defining role in my HBV status, in addition to a series of hopefully negative HBsAG results.

Thank you again Dr. Hook, I feel that I have a better grasp on the road ahead of me and what I should be looking for.


Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
Your summary is superb and on target regarding a rather complex situation.  No changes or amendments.  I am confident that your testing downstream will not be HBcAB or HBsAg positive and sincerely hope you will see HBsABs. 

As you know, this is my third response and I think we have addressed your questions.  the thread will be closed going forward later today EWH