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HBsAg Positive: Results of a Hepatitis B Blood Test

An HBsAg test is done to check for active or chronic hepatitis B

Hepatitis B surface antigen (HBsAg) is a protein that appears in the blood when you have a hepatitis B infection. A HBsAg blood test can detect this antigen. Hiv Gp120 Antigen

HBsAg Positive: Results of a Hepatitis B Blood Test

A positive HBsAg result means you have an active hepatitis B virus (HBV) infection and are contagious. HBV is spread through contact with infected body fluids, such as blood and semen.

This article discusses the HBsAg test and other tests used to confirm hepatitis B infections. It also explains how hepatitis B infections are treated and provides prevention tips.

HBsAg test is a blood test that detects hepatitis B surface antigen (HBsAg). HBsAb is a protein on the surface of the hepatitis B virus. High levels of HBsAg typically indicate an active hepatitis B virus infection.

HBsAg is a part of the outer layer of a hepatitis B virus cell. The center of the cell contains the viral DNA, the genes it uses to replicate. Surrounding the DNA is a protein called hepatitis B core antigen (HBcAg).

HBsAg surrounds HBcAg and is part of the "envelope" that protects the virus from attack by the body's immune system. However, the immune system is good at getting through this envelope in order to kill the virus. When it does, remnants of surface antigen protein are left in the blood-like debris, which lab tests can detect.

The HBsAg test is used in conjunction with other tests blood tests to identify an HBV infection. Other serologic markers for hepatitis B include:  

Your body can produce antibodies to any of these antigens once you are exposed to the virus. These antibodies develop at different stages of the infection.

As of 2023, the Centers for Disease Control and Prevention recommends all adults should be tested for hepatitis B at least once in their life.

Your blood may be screened for HBV for many different reasons. HBV screenings are used to diagnose an active or chronic hepatitis B infection and identify individuals who may benefit from vaccination.

Routine HBV screenings are performed:

Hepatitis B screening is used to identify acute or chronic hepatitis B infections and those who would benefit from vaccination.

A HBsAg test is performed by a phlebotomist using a venous blood draw. Blood is usually taken by inserting a needle into a vein at the inside of the elbow or back of the hand. The blood is collected into an airtight tube and sent to a lab to be analyzed.

No special preparation is needed prior to the test. You do not need to fast prior to the test, so it can be taken at any time of the day. It is always a good idea to drink water prior to getting blood drawn to ensure you are well hydrated. 

The HBsAg test focuses on the presence or absence of this biomarker. If HBsAg is detected, the test is positive. If no HBsAg is detected, the test is negative.

In most instances, a positive HBsAg means a person has an active or recent hepatitis B infection. The body produces antibodies to HBsAg as part of the immune response to infection.

HBsAg can be detected in the blood during both acute infections (infections that come on suddenly) and chronic infections (infections that last for longer than six months).

A recent hepatitis B vaccination (HepB) can also cause a positive HBsAg test result. If you received a dose of the HepB vaccine within 30 days of your test, your healthcare provider may recommend waiting another month before retesting.

Most labs identify a range between 0.05 and 250 international units per milliliter (IU/ml). The precise level correlates to your status as someone who's not exposed, who has been vaccinated or is in a recovery stage of an infection, or who is in a currently active state of infection.

While it is most important to know if you are HBsAg positive or negative, there are certain situations that may cause this test to be falsely negative or falsely positive.

There is no specific treatment for an acute HBV infection. The hepatitis B virus is usually self-limiting (naturally resolving without treatment) and will clear up on its own within four to six months.

Infections that last longer than six months are considered chronic. The World Health Organization recommends treating chronic HBV infections with antiviral medication. Viread (tenofovir) or Baraclude (entecavir) are considered the strongest oral antiviral drugs used for hepatitis B infections.  

Hepatitis B can be prevented through education, vaccination, and testing.

Hepatitis B is spread through contact with blood, semen, and other body fluids from an infected person. Hepatitis B exposure can occur through sex, childbirth, or sharing needles, razors, or medical equipment (like a glucose monitor).

Hepatitis B cannot be passed through kissing, sharing eating utensils, sneezing, coughing, hugging, breastfeeding, or through food or water.

Hep B vaccination can help prevent the spread of hepatitis B. The vaccine is routinely given to all infants within 24 hours of birth. Follow-up doses are required throughout childhood and adulthood.

HBsAg testing is routinely performed during pregnancy. This is to identify and treat infants at risk for contracting hepatitis B during vaginal or C-section delivery.

Prompt treatment in the first 12 hours of life can prevent hepatitis B transmission from mother to child. This includes two shots: hepatitis B immune globulin (HBIG) and the first dose of the hep B vaccine.

Hepatitis B prevention strategies in medical settings include screening blood products, sterilizing needles, syringes, and other equipment, and wearing sterile gloves.

Other ways to prevent the spread of hepatitis B include:

Centers for Disease Control and Prevention. Interpretation of hepatitis B serologic test results.

Conners EE, Panagiotakopoulos L, Hofmeister MG, et al. Screening and testing for hepatitis B virus infection: CDC recommendations—United States, 2023. MMWR Recomm Rep. 2023;72(1):1-25. doi:10.15585/mmwr.rr7201a1

Wilkins T, Sams R, Carpenter M. Hepatitis B: screening, prevention, diagnosis, and treatment. Am Fam Physician. 2019;99(5):314-323.

U.S. National Library of Medicine: MedlinePlus. Hepatitis virus panel.

Karra VK, Chowdhury SJ, Ruttala R, Polipalli SK, Kar P. Clinical Significance of Quantitative HBsAg Titres and its Correlation With HBV DNA Levels in the Natural History of Hepatitis B Virus Infection. J Clin Exp Hepatol. 2016 Sep;6(3):209-215. doi:10.1016/j.jceh.2016.07.002.

World Health Organization. Hepatitis B.

Centers for Disease Control and Prevention. Viral hepatitis: frequently asked questions for the public.

Screening for hepatitis b virus infection in pregnant women: recommendation statement. AFP. 2020;101(2):112-114.

Centers for Disease Control and Prevention. Protect your baby for life: when a pregnant woman has hepatitis B.

Chang MH, Chen DS. Prevention of hepatitis B. Cold Spring Harb Perspect Med. 2015;5(3):a021493. doi:10.1101/cshperspect.a021493 

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Centers for Disease Control and Prevention. Hepatitis B FAQs for health professionals.

By Charles Daniel  Charles Daniel, MPH, CHES is an infectious disease epidemiologist, specializing in hepatitis.

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HBsAg Positive: Results of a Hepatitis B Blood Test

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