hepatitis B virus (HBV) serology

Introduction

Serodiagnosis of hepatitis B virus (HBV).

• IgM anti hepatitis B core antigen (HBcAb IgM)
  • the presence of HBcAb IgM indicates acute hepatitis B infection (2 weeks to 6 months after exposure)
  • HBcAb IgM disappears after the acute infection has resolved (regardless of whether or not the patient develops chronic hepatitis B)
• total hepatitis B core antibody (HBcAb total)
  • HBcAb total rises with HBcAb IgM, but remains elevated (regardless of whether or not the patient develops chronic hepatitis B)
  • HBcAb often remain elevated for life although titers of HBcAb may decline or disappear
• hepatitis B e antigen (HBeAg)
  • HBeAg indicates a stage of disease in which there is ongoing viral replication
  • HBeAg(+) patients are more infective than HBsAg(+) chronic hepatitis B carriers who are HBeAg-
  • HBeAg disappears during the acute phase of hepatitis B with development of immunity
  • HBeAg persists in chronic hepatitis B
• hepatitis B e antibody (HBeAb)
  • earliest indication of developing immunity to HBV
  • corresponds to disappearance of HBeAg
• hepatitis B surface antigen (HBsAg)
  • rises with HBeAg, but declines later
  • HBsAg indicates HBV infection, acute or chronic
  • with development of immunity HBsAg disappears prior to disappearance of HBcAb IgM
• hepatitis B surface antibody (HBsAb)
  • presence of HBsAb indicates immunity
  • rises with disappearance of HBcAg IgM with development of immunity
  • lags behind disappearance of HBsAg
  • does not appear in chronic hepatitis B
  • a quantitative value of > 10 mIU/mL implies immunity

Table of hepatitis B serologies in various clinical states

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

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

More general terms

• serology for infectious agent
• microbiology panel

More specific terms

• 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

Additional terms

• hepatitis B infection
• hepatitis B virus (HBV)

Patient information

hepatitis B serology patient information