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hepatitis B virus (HBV) serology
Serodiagnosis of hepatitis B virus (HBV).
1) IgM anti hepatitis B core antigen (HBcAb IgM)
a) the presence of HBcAb IgM indicates acute hepatitis B infection (2 weeks to 6 months after exposure)
b) HBcAb IgM disappears after the acute infection has resolved (regardless of whether or not the patient develops chronic hepatitis B)
2) total hepatitis B core antibody (HBcAb total)
a) HBcAb total rises with HBcAb IgM, but remains elevated (regardless of whether or not the patient develops chronic hepatitis B)
b) HBcAb often remain elevated for life although titers of HBcAb may decline or disappear
3) hepatitis B e antigen (HBeAg)
a) HBeAg indicates a stage of disease in which there is ongoing viral replication
b) HBeAg(+) patients are more infective than HBsAg(+) chronic hepatitis B carriers who are HBeAg-
c) HBeAg disappears during the acute phase of hepatitis B with development of immunity
d) HBeAg persists in chronic hepatitis B
4) hepatitis B e antibody (HBeAb)
a) earliest indication of developing immunity to HBV
b) corresponds to disappearance of HBeAg
5) hepatitis B surface antigen (HBsAg)
a) rises with HBeAg, but declines later
b) HBsAg indicates HBV infection, acute or chronic
c) with development of immunity HBsAg disappears prior to disappearance of HBcAb IgM
6) hepatitis B surface antibody (HBsAb)
a) presence of HBsAb indicates immunity
b) rises with disappearance of HBcAg IgM with development of immunity
c) lags behind disappearance of HBsAg
d) does not appear in chronic hepatitis B
e) a quantitative value of > 10 mIU/mL implies immunity
Table of hepatitis B serologies in various clinical states [3]
IgM HBcAb total HBcAb HBeAg HBeAb HBsAg HBsAb
uninfected {1} - - - - - -
vaccine immunity - - - - - +
natural immunity - + - +/- - +
early infection - - + - + -
acute infection {2} + + +/- +/- + -
core window period {3} + + - + - -
resolving infection + + - + - +
chronic infection - + +/- +/- + -
{1} uninfected, but not immune
{2} HBeAg is present early during acute hepatitis B, but disappears during the acute phase with appearance of HBeAb when development of immunity follows
{3} Period during acute HBV infection when HBsAg is negative & HBcAb IgM is still positive. Immunity & HBsAb will develop.
Phases of chronic hepatitis B by serologies[3]
HBV DNA total HBcAb HBeAg HBeAb HBsAg HBsAb
chronic infection - + +/- +/- + -
immune tolerant {1} >1 million + + - + -
immune active {2} >20,000/2000 + +/- +/- + -
immune control {3} <2000 + - + + -
reactivation {4} increase + +/- +/- + -
{1} < 30 years, no inflammation or fibrosis, vertically transmitted
{2} HBV DNA > 20,000 if HBeAg+, > 2000 is HBeAg-, inflammation & fibrosis, serum ALT abnormal
{3} normal serum ALT, chronic inactive HBV carrier, no inflammation, variable fibrosis
{4} loss of immune control in persons recieving immunosuppressive therapy
Related
hepatitis B infection
hepatitis B virus (HBV)
Specific
hepatitis B core antibody (HBcAb total) in serum
hepatitis B core antibody in body fluid
hepatitis B core IgM (HBcIgM) in serum
hepatitis B e antibody (HBeAb)
hepatitis B e antigen in serum (HBeAg)
hepatitis B surface antibody (HBsAb)
hepatitis B surface antibody (HBsAb) in serum
hepatitis B surface antigen in serum (HBsAg)
hepatitis B virus antibody + hepatitis D virus antibody
General
serology for infectious agent
microbiology panel
References
- Laboratory Medicine: Test Selection & Interpretation.
Howanitz & Howanitz (eds), Churchill Livingstone, NY,
1991, pg 818-19
- Medical Knowledge Self Assessment Program (MKSAP) 15, 19
American College of Physicians, Philadelphia 2009, 2021
- Interpretation of Hepatitis B Serologic Test Results.
https://www.cdc.gov/hepatitis/HBV/PDFs/SerologicChartv8.pdf