Serologic Testing for the Diagnosis of Hepatitis B Virus (HBV) Infection

The antigens and antibodies associated with HBV infection include HBsAg (Australia antigen) and antibody to HBsAg (anti-HBs), hepatitis B core antigen (HBcAg) and antibody to HBcAg (anti-HBc), and hepatitis B e antigen (HBeAg) and antibody to HBeAg (anti-HBe). At least one serologic marker is present during the different phases of HBV infection.

Serologic markers for the different phases of acute and chronic hepatitis B virus infection

Acute HBV infection

HBsAg HBeAg IgM anti-HBc IgG anti-HBc Anti- HBs Anti- HBe HBV DNA Interpretation
+ + + +++ Early phase
+ + Window phase
+ + + ± Recovery phase

 

Chronic HBV infection

HBsAg HBeAg IgM anti-HBc IgG anti-HBc Anti- HBs Anti- HBe HBV DNA Interpretation
+ + + +++ Replicative phase
+ + + ± Low, nonreplicative phase
+ ± + + + Flare of chronic HBV
+ + + ++ Precore/core promoter mutants

 

 

Interpretation of the Hepatitis B Panel

Interpretation HBsAg anti-HBc anti-HBs IgM anti-HBc
Susceptible negative negative negative
Immune due to natural infection negative positive positive
Immune due to hepatitis B vaccination negative negative positive
Acutely infected positive positive negative positive
Chronically infected positive positive negative negative
Interpretation unclear; four possibilities:

  1. Resolved infection (most common)
  2. False-positive anti-HBc, thus susceptible
  3. “Low level” chronic infection
  4. Resolving acute infection
negative positive negative

Hepatitis B Profile

 

 

References:

  1. Lledó JL, Fernández C, Gutiérrez ML, Ocaña S. Management of occult hepatitis B virus infection: an update for the clinician. World J Gastroenterol. 2011 Mar 28;17(12):1563-8. [Medline]
  2. Kao JH. Diagnosis of hepatitis B virus infection through serological and virological markers. Expert Rev Gastroenterol Hepatol. 2008 Aug;2(4):553-62. [Medline]
  3. Fagan EA, Williams R. Serological responses to HBV infection. Gut. 1986 Jul;27(7):858-67. [Medline]
  4. Mast EE, Margolis HS, Fiore AE, Brink EW, Goldstein ST, Wang SA, Moyer LA, Bell BP, Alter MJ; Advisory Committee on Immunization Practices (ACIP). A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) part 1: immunization of infants, children, and adolescents.MMWR Recomm Rep. 2005 Dec 23;54(RR-16):1-31. [Medline]

Created: Nov 21, 2011.

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