Hepatitis B Serologic Test Results Interpretation

Hepatitis B Surface Antigen (HBsAg)  is the most important serological marker for identifying infection with Hepatitis B Virus.
HBsAg is present early in acute infection, disappears with resolution of infection and persists in chronic infection.
IgM anti-HBc (IgM class antibody, against Hepatitis B Core Antigen) is essential for the diagnosis of acute infection, but is also seen occasionally in very active chronic hepatitis. Anti-HBc antibodies develop and persist after all HBV infections.
The loss of HBsAg and development of anti-HBc signals resolution of acute infection.

Anti-HBs also occurs post vaccination, but anti-HBc will not be present in such cases. Chronic infection is manifested by persistent HBsAg.
Markers of viral replication such as HBeAg and HBV-DNA (non-PCR method) are detectable during the early high replication phase, but are not detectable during the later quiescent low replication phase. HBeAg is not a reliable marker of HBV replication when a precore variant is responsible for the infection. Such cases will be HBeAg negative, anti-HBe positive, but HBV-DNA (by a non-PCR method) positive.

Antigen/Antibody tested	Test result	Inference
HBsAg anti-HBc anti-HBs	Negative Negative Negative	Susceptible
HBsAg anti-HBc anti-HBs	Negative Positive Positive	Immune due to natural infection
HBsAg anti-HBc anti-HBs	Negative Negative Positive	Immune due to hepatitis B vaccination
HBsAg anti-HBc IgM anti-HBc anti-HBs	Positive Positive Positive Negative	Acutely infected
HBsAg anti-HBc IgM anti-HBc anti-HBs	Positive Positive Negative Negative	Chronically infected
HBsAg anti-HBc anti-HBs	Negative Positive Negative	Interpreatation unclear; four possibilities: 1.       Resolved infection (most common) 2.       False-positive anti-HBc, thus susceptible 3.       “Low level” chronic infection 4.       Resolving acute infection

Hepatitis B surface antigen (HBsAg): A protein on the surface of hepatitis B virus; it can be detected in high levels in serum during acute or chronic hepatitis B virus infection. The presence of HBsAg indicates that the person is infectious. The body normally produces antibodies to HBsAg as part of the normal immune response to infection. HBsAg is the antigen used to make hepatitis B vaccine.

Hepatitis B surface antibody (anti-HBs): The presence of anti-HBs is generally interpreted as indicating recovery and immunity from hepatitis B virus infection. Anti-HBs also develops in a person who has been successfully vaccinated against hepatitis B.

Total hepatitis B core antibody (anti-HBc): Appears at the onset of symptoms in acute hepatitis B and persists for life. The presence of anti-HBc indicates previous or ongoing infection with hepatitis B virus in an undefined time frame.