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Hepatitis B - Management
How do I interpret hepatitis B serology tests?

  • Hepatitis B surface antigen (HBsAg) is the first biochemical marker to rise in people with hepatitis B.
    • It rises during the incubation period, and may be cleared early in the course of the disease. It is undetectable in 10% of people by the time the test is performed.
    • Chronic hepatitis B occurs when HBsAg persists in the serum for 6 months or longer.
  • Hepatitis B e-antigen (HBeAg) and hepatitis B virus-DNA (HBV-DNA) are detectable around the same time as, or shortly after, HBsAg.
    • Disappearance of HBeAg, development of antibodies to HBeAg (anti-HBe), and a decline in HBV-DNA indicates control of viral replication and predicts resolution of acute hepatitis B.
    • Persistence of HBsAg, HBeAg, and HBV-DNA indicates possible progression to chronic hepatitis B.
    • People with chronic hepatitis B tend to be more infectious if HBeAg is also detected. If HBeAg has been cleared, anti-HBe is usually detected, and infectivity is lower.
    • High levels of HBV-DNA may indicate a greater risk of progression to cirrhosis and hepatocellular cancer.
  • Immunoglobulin M (IgM) antibody to hepatitis B core antigen (anti-HBc) is the first antibody to arise after infection.
    • IgM anti-HBc indicates infection within the last 6 months.
    • It usually appears within 1 month of HBsAg, and 1–2 weeks before the increase in alanine transaminase (ALT).
    • Its presence generally distinguishes acute disease from an exacerbation.
    • It is usually replaced gradually by immunoglobulin G (IgG) anti-HBc.
  • IgG anti-HBc generally persists for life and indicates infection at some time in the past.
  • Antibody to HBsAg (anti-HBs) develops during convalescence following the disappearance of HBsAg.
    • Anti-HBs indicates recovery from hepatitis B. However, complex interactions may allow coexistence of HBsAg and anti-HBs in up to 25% of inactive HBsAg carriers.
    • Anti-HBs persists for life.
  • Anti-HBs without anti-HBc is a marker of immunization.
  • For a summary of this information in table format, see Interpretation of hepatitis B serology tests (table).

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