[Question #8786] Followup about Hep B testing from a question I asked Dr. Handsfield

39 months ago

I have severe OCD that is getting treated and I am doing okay with it, until recently. I have had a terrible patch the last two weeks as I continue to fear somehow I may have Hep B. Here is my situation in 2001 I had a routine screen for Hep B and I had the following results:

HBsAG (surface antigen) (-)

HBsAB (surface antibody) (-)

HBcAB (core antigen) (+)

My doctor at the time said it was a false positive, so I moved on. Then in 2013 I read an article that told me that the results above were inconclusive so I got another test with the following results:

HBsAG (surface antigen) (-)

HBsAB (surface antibody) (-)

HBcAB (core antigen) (-) This test was a total HBcAB test which looked for both IgM and IgG

I I have read so many conflicting things about HBV and have become terrified of occult HBV infection worried I could be a low level carrier where the IgM and IgG burned out and yet I still have HBV. Dr. Handsfield told me 4 months ago not to worry I was negative, my doctor tells me this - two online doctors as well. But I can't seem to move on. My questions are these:

(1) is the test I had in 2013 definitive, am I truly Hep B free, and there is no chance I am a low level carrier because everything is negative and the total HBcAB was both negative for IgM or IgC.

(2) That my first test was a false positive and I never even had Hep B.

(3) If I was ever exposed to Hep B that my HBcAB IgG would have been positive for life - that it couldn't burn out or change like the IgM which then turns into a positive IgG in the normal course of a HBV infection.

Thanks for all that you do.

H. Hunter Handsfield, MD

39 months ago

Thanks for your continued confidence in the forum and for your thanks in advance. However, I really have nothing more to say. Your obsession with hepatitis B in spite of both minimal if any risk 20+ years ago, and the reliability of your tests since then, was addressed in detail in 4 months ago (thread #8437). And your more general obsession with resolved or "dormant" STIs has been discussed directly or indirectly in all your previous threads. And of course asking the same questions in different words will not change the replies.

There is no such thing as antibody to HBV becoming "burned out". All three of your numbered statements are correct.

As you have been advised previously, you need to stop looking at this forum as a resource to deal with your OCD, even when the specific issues on your mind are STI related. Unless and until truly new issues arise -- e.g. if you have new high risk exposures or new symptoms typical for STIs -- this will have to be your last question on the forum; repeated anxiety driven questions are subject to deletion without reply, and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers, and because experience shows that continued answers tend to simply prolong such anxieties (or OCD in general) when the real answers are only likely with professional care for the underlying psychological issues. Finally, such questions have little educational value for other users, one of the forum's main purposes.

Thank you for your understanding. Best wishes and stay safe-- HHH, MD

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39 months ago

when you wrote antibody would never burn out - you meant core antigen correct as that is what I asked about. I appreciate your candor and will not bother you all again. I really do appreciate what you have done for me. Thanks

H. Hunter Handsfield, MD

39 months ago

I meant antibody. I am unaware of existence of a hepatitis B core antigen test. The shorthand you report (HBcAb) is an antibody test (Ab = antibody, Ag = antigen).---
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39 months ago

Thank you so much dr. handsfield - this will be the last thing I ever ask you - if I was a chronic carrier of Hep B that core antibody anti-HBc (HBcAB) would be + as would my HBsAG also (+) from 2001 to 2013 - with those being negative in 2013, I am Hep B free - I just want to make sure I understand your answer now and from the past thread and I promise I won't ask anything else ever again and your answer will give me the reassurance I need to move on - I am in therapy and I appreciate so much what you wrote below and the compassion you have shown me - if you could just answer this last question I will be forever grateful. Thank you so much.

H. Hunter Handsfield, MD

39 months ago

Taken together, your test results indicate you have never had HBV. Having never had it, you cannot possibly be a carrier. (The only test that addresses carrier status per se is HBsAg. That negative result would mean you aren't a carrier, even if your other tests had shown you had a past HBV infection. But they do not, so it's a moot point.)

Be clear, there's nothing personal in the forum's exclusion of repeated reassurance questions, as my comment above also says ("compassion not criticism"). Still I'm glad you understand and hope your discussions over the years have been helpful. Good luck and best wishes.

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