Resolved Hepatitis B Infection

Interpretation of Serologic Pattern

The presence of anti-HBe alone, with negative HBsAg, negative HBV DNA, and normal liver enzymes, typically represents a person who has recovered from past HBV infection, according to the Centers for Disease Control and Prevention, as reported in MMWR Recommendations and Reports 1, 3
This pattern indicates that the person previously had HBV infection that included the HBeAg-positive phase, followed by seroconversion to anti-HBe, and eventual clearance of all other viral markers, as described in Hepatology 2, 3

Individuals with this pattern are generally considered to have resolved their HBV infection and are at low risk for liver disease progression, as stated by the American Association for the Study of Liver Diseases, in Hepatology 2, 3

To confirm resolved infection status, it would be helpful to test for anti-HBc, which would be expected to be positive in someone with past infection, as recommended by the Centers for Disease Control and Prevention, in MMWR Recommendations and Reports 1, 4
Normal ALT levels would further support the interpretation of resolved infection, according to Hepatology 2

Isolated anti-HBe positivity could potentially represent resolved HBV infection with loss of other serologic markers, as described in Hepatology 3
Isolated anti-HBe positivity could also potentially represent a false-positive anti-HBe test result, although this is rare, as noted in MMWR Recommendations and Reports 1

One-time testing for anti-HBc would be valuable to confirm past HBV infection, as recommended by the American Association for the Study of Liver Diseases, in Hepatology, and the Centers for Disease Control and Prevention, in MMWR Recommendations and Reports 1, 2
No specific treatment is needed for individuals with resolved HBV infection, as stated by the American Association for the Study of Liver Diseases, in Hepatology 3, 5
If the person will be receiving immunosuppressive therapy in the future, monitoring for potential HBV reactivation may be warranted, as recommended by the American Society of Clinical Oncology, in the Journal of Clinical Oncology 6

Do not confuse this pattern with the "inactive carrier state," which is characterized by positive HBsAg, negative HBeAg, positive anti-HBe, low HBV DNA, and normal ALT levels, as described in Hepatology 3, 7
Be aware that some individuals with resolved HBV infection may experience reactivation if they become immunosuppressed, as noted in the Journal of Clinical Oncology 6