DOI: 10.12890/2025_006007

Unusual concurrent HBsAg and anti-HBs positivity in chronic hepatitis B with compensated cirrhosis

Authors

  • Bui Thai Huy Nguyen Department of Infectious Diseases, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam 0009-0003-6881-7578
  • Hoang Phuong Tran Department of Infectious Diseases, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam 0009-0006-3340-3414
  • Nguyen Tra Uyen Ho Department of Infectious Diseases, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam 0009-0002-4192-5811
  • Thai Nguyen Ma Department of Infectious Diseases, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam 0009-0003-7890-7606
  • Tin Nghia Tran Department of Biochemistry, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam 0000-0003-1485-2813
  • Thi Thao Linh Nguyen Department of Parasitology, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam 0009-0009-0670-8230
  • Duy Linh Nguyen Department of Surgery, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam 0000-0001-8283-9237

ndlinh@ctump.edu.vn

Keywords

Chronic hepatitis B, HBsAg and anti-HBs coexistence, serological paradox, immune escape variants, cirrhosis

Abstract

Background: The simultaneous positivity of hepatitis B surface antigen (HBsAg) and its corresponding antibody (anti-HBs) is a rare serological paradox in chronic hepatitis B. Its pathogenesis is not fully understood but may involve hepatitis B virus (HBV) S gene mutations leading to immune escape or complex host immune dysfunction. Recognizing this pattern is clinically important, as it may indicate advanced liver disease.
Case report: A 54-year-old man with no history of alcohol abuse or liver disease presented with persistent bloating and dyspepsia. Laboratory tests revealed concurrent positivity for HBsAg (1438.5 S/Co) and anti-HBs (136.6 mIU/ml), hepatitis B e antigen (HbeAg) positivity, and a high HBV deoxyribonucleic acid (DNA) viral load (4.3 ×106 copies/ml). Transaminases were mildly elevated, platelet count was reduced, and liver elastography indicated cirrhosis (F4). The patient was diagnosed active chronic hepatitis B with concurrent HBsAg and anti-HBs positivity, complicated by compensated cirrhosis and started on tenofovir 300 mg daily. After 4 months of treatment, the patient showed clinical improvement, with marked reductions in liver enzyme levels and HBV DNA viral load.
Conclusion: The concurrent positivity of HBsAg and anti-HBs is a rare serological finding that may reflect a complex HBV infection with a higher risk of progressive liver disease. This case illustrates that this unusual serological pattern can be associated with a high viral load and cirrhosis, highlighting the need for close monitoring of liver function, HBV DNA levels, and antiviral treatment response.

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References

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Published

2025-12-23

Issue

Vol. 13 No. 1 (2026)

Categories

How to Cite

1.
Nguyen BTH, Tran HP, Ho NTU, Ma TN, Tran TN, Nguyen TTL, et al. Unusual concurrent HBsAg and anti-HBs positivity in chronic hepatitis B with compensated cirrhosis. EJCRIM [Internet]. 2025 Dec. 23 [cited 2026 Nov. 3];13(1). Available from: https://ejcrim.com/index.php/ejcrim/article/view/6007