Definition and interpretation of serological tests for hepatitis B virus
| Markers | Clinical interpretation |
| HBsAg | Hallmark of infection; positive during early phase of acute infection, persistently positive in chronic infection |
| Anti-HBs | Recovery from acute infection (or chronic); immunity following vaccination |
| HBeAg | eAg positivity associated with high replicative state; presence of inflammation and/or fibrosis determines disease phase; eAg negativity reflects a change in disease phase and is usually associated with the emergence of anti-HBe; viral mutations in precore and basal core promoter regions result in eAg-negative hepatitis |
| Anti-HBe | Marker of eAg seroconversion associated with immune control in low viraemic states |
| Anti-HBc (IgM) | Positive in acute infection; may be positive during reactivation of HBV |
| Anti-HBc (IgG) | Exposure to infection and present in association with HBsAg in chronic infection; HBsAg-negative, anti-HBc-positive serology usually indicative of past exposure to virus; anti-HBs may /may not be positive; if anti-HBs negative, a false positive anti-HBc should be considered (eg after IVIG infusion); HBV DNA must be checked to exclude occult infection |
| Tests | Clinical interpretation |
| HBsAg (–) | Indicative of past infection and clinically relevant in the context of immune suppression |
| Total anti-HBc (+) | |
| Anti-HBs (+) | |
| HBsAg (–) | Indicative of prior hepatitis B vaccination |
| Total anti-HBc (–) | |
| Anti-HBs (+) | |
| HBsAg (+) | Indicative of acute HBV infection |
| Total anti-HBc (+) | |
| Anti-HBc IgM (+) | |
| Anti-HBs (–) | |
| HBsAg (+) | HBsAg positivity is the hallmark of chronic HBV infection |
| Total anti-HBc (+) | |
| Anti-HBc IgM (–) | |
| Anti-HBs (–) | |
| HBsAg (–) | Number of potential clinical interpretations: (i) past HBV infection (ii) false-positive anti-HBc (iii) occult chronic hepatitis B if HBV DNA detectable (iv) resolving acute infection |
| Total anti-HBc (+) | |
| Anti-HBs (–) |
Anti-HBs = hepatitis B surface antibody; anti-HBe = hepatitis B ‘e’ antibody; anti-HBc = hepatitis B core antibody; HBeAg = hepatitis B ‘e’ antigen; HBsAg = hepatitis B surface antigen; HBV = hepatitis B virus; IVIG = intravenous immunoglobulin