Hepatitis B Serology

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Contents 1 More Specific Terms 2 Introduction 3 More General Terms 4 Additional Terms 5 References

More Specific Terms

• hepatitis B e antibody (HBeAb)
• hepatitis B e antigen in serum (HBeAg)
• hepatitis B surface antibody (HBsAb)
• hepatitis B surface antigen in serum (HBsAg)
• IgM hepatitis B core antibody (HBcAb)
• total hepatitis B core antibody (HBcAb total)

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   total 
*                       HBcAb  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.

More General Terms

• serology
• microbiology panel

Additional Terms

• hepatitis B infection
• hepatitis B virus (HBV)

References

1. Laboratory Medicine: Test Selection & Interpretation. Howanitz & Howanitz (eds), Churchill Livingstone, NY, 1991, pg 818-19
2. Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009

hepatitis B virus (HBV) serology