{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T18:30:53Z","timestamp":1767983453165,"version":"3.49.0"},"reference-count":10,"publisher":"SMC Media","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0The 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:\u00a0A 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 \u00d7106\u00a0copies\/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:\u00a0The 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.<\/jats:p>","DOI":"10.12890\/2025_006007","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T09:41:32Z","timestamp":1767778892000},"source":"Crossref","is-referenced-by-count":0,"title":["Unusual concurrent HBsAg and anti-HBs positivity in chronic hepatitis B with compensated cirrhosis"],"prefix":"10.12890","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6881-7578","authenticated-orcid":false,"given":"Bui Thai Huy","family":"Nguyen","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3340-3414","authenticated-orcid":false,"given":"Hoang Phuong","family":"Tran","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4192-5811","authenticated-orcid":false,"given":"Nguyen Tra Uyen","family":"Ho","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7890-7606","authenticated-orcid":false,"given":"Thai Nguyen","family":"Ma","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1485-2813","authenticated-orcid":false,"given":"Tin Nghia","family":"Tran","sequence":"first","affiliation":[{"name":"Department of Biochemistry, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0670-8230","authenticated-orcid":false,"given":"Thi Thao Linh","family":"Nguyen","sequence":"first","affiliation":[{"name":"Department of Parasitology, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8283-9237","authenticated-orcid":false,"given":"Duy Linh","family":"Nguyen","sequence":"first","affiliation":[{"name":"Department of Surgery, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10397","published-online":{"date-parts":[[2025,12,23]]},"reference":[{"key":"10.12890\/2025_006007_ref1","unstructured":"World Health Organization. Guidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection. 2024 [cited 2025 Nov 23]; Available from: https:\/\/www.who.int\/publications\/i\/item\/9789240090903"},{"key":"10.12890\/2025_006007_ref2","unstructured":"Pham VL, Trinh THC, Tran ND, Duong TL, Nguyen TBH, Le CH, et al. The prevalence and risk of hepatitis B and C virus infection in Can Tho City. 2017 [cited 2025 Nov 23];Available from: https:\/\/sti.vista.gov.vn\/projects\/kqnv\/nguyen-cuu-tinh-hinh-nhiem-nguy-co-lay-nhiem-virus-viem-gan-b-va-c-tai-thanh-pho-can-tho-117911.html"},{"key":"10.12890\/2025_006007_ref3","doi-asserted-by":"crossref","unstructured":"Pu Z, Ji Z, Su H, Fu T, Shao Z, Yan Y. HBsAg and anti-HBs coexistence in patients with HBV in acute and chronic phases. Virus Res 2025;355:199567. doi: 10.1016\/j.virusres.2025.199567","DOI":"10.1016\/j.virusres.2025.199567"},{"key":"10.12890\/2025_006007_ref4","doi-asserted-by":"crossref","unstructured":"Jiang X, Chang L, Yan Y, Wang L. Paradoxical HBsAg and anti-HBs coexistence among chronic HBV infections: causes and consequences. Int J Biol Sci 2021;17:1125\u201337. doi: 10.7150\/ijbs.55724","DOI":"10.7150\/ijbs.55724"},{"key":"10.12890\/2025_006007_ref5","doi-asserted-by":"crossref","unstructured":"Jin ZZ, Jin FF, Liu X, Liu N, Wen F, Lou JL. Coexistence of low levels of HBsAg and high levels of anti-HBs may increase risk of hepatocellular carcinoma in chronic hepatitis B patients with high HBV load. Braz J Infect Dis 2019;23:343\u2013351. doi: 10.1016\/j.bjid.2019.08.007","DOI":"10.1016\/j.bjid.2019.08.007"},{"key":"10.12890\/2025_006007_ref6","doi-asserted-by":"crossref","unstructured":"Kwak MS, Chung GE, Yang JI, Yim JY. 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