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Interpretation of the hepatitis B serologic panel

Interpretation of the hepatitis B serologic panel
Tests Results Interpretation
HBsAg Negative Susceptible
anti-HBc Negative
anti-HBs Negative
HBsAg Negative Prior infection (inactive)
anti-HBc Positive
anti-HBs Positive
HBsAg Negative Immune due to hepatitis B vaccination*
anti-HBc Negative
anti-HBs Positive
HBsAg Positive Acutely infected
anti-HBc Positive
IgM anti-HBc Positive
anti-HBs Negative
HBsAg Positive Chronically infected
anti-HBc Positive
IgM anti-HBc Negative
anti-HBs Negative
HBsAg Negative Isolated anti-HBc+. Four interpretations possible.
anti-HBc Positive
anti-HBs Negative

anti-HBc: hepatitis B core antibody; anti-HBs: hepatitis B surface antibody; HBsAg: hepatitis B surface antigen; HBV: hepatitis B virus; IgM: immunoglobulin M.

* Antibody response (anti-HBs) can be measured quantitatively or qualitatively. A protective antibody response is reported quantitatively as 10 or more milli-international units (≥10 mIU/mL) or qualitatively as positive. Postvaccination testing should be completed one to two months after the third vaccine dose for results to be meaningful.

¶ Four interpretations:
  1. Might be recovering from acute HBV infection; IgM anti-HBc should be positive.
  2. Might have had recovered from prior infection and test not sensitive enough to detect very low level of anti-HBs in serum.
  3. Might be susceptible with a false positive anti-HBc, rare.
  4. Might have occult HBV infection with undetectable HBsAg and generally undetectable or low level serum HBV DNA; such patients may experience HBV reactivation during potent immunosuppressive therapy.
Centers for Disease Control and Prevention, Hepatitis B information for health professionals: Interpretation of hepatitis B serologic test results. Available from the CDC website.
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