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

HBsAg	HBeAg	IgM anti-HBc	IgG anti-HBc	Anti- HBs	Anti- HBe	HBV DNA	Interpretation
Acute HBV infection
+	+	+				+++	Early phase
		+				+	Window phase
			+	+	+	±	Recovery phase
Chronic HBV infection
+	+		+			+++	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: Resolved infection (most common) False-positive anti-HBc, thus susceptible “Low level” chronic infection Resolving acute infection	negative	positive	negative

 

 

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.