Interpretation of Hepatitis-B Results

July 29,2021
2 Min Read

HBsAg	Anti-HBs	Anti-HBc (Total)	Anti-HBc (IgM)	HBV DNA	Possible Interpretations(1–4)
Negative	Negative	Negative	Negative	-	No active or prior infection; not immune and hence susceptible — may be good candidate for vaccine; Possibly in the incubation stage
Negative	Positive	Negative	Negative	-	Immunity due to Hepatitis B vaccination. Passive transfer after hepatitis B immune globulin administration
Negative	Negative	Positive	Negative	-	Inconclusive*: False-positive (i.e., susceptible), past infection, “low-level” chronic infection, or passive transfer of anti-HBc to infant born to HBsAg-positive mother
Negative	Positive	Positive	Negative	-	Immune due to natural infection.
Positive	Negative	Positive	Positive	Detected	Acute infection, usually with symptoms; could also be flare of chronic infection
Positive	Negative	Positive	Positive	Not Detected	Acute infection is resolving (convalescent)
Positive	Negative	Positive	Positive** / Negative	Detected	Chronic infection (Active) – liver damage likely
Positive	Negative	Positive	Negative	Not Detected	Chronic infection (Carrier state) – low risk of liver damage

*Persons positive only for anti-HBc are unlikely to be infectious except under unusual circumstances in which they are the source of direct percutaneous exposure of susceptible recipients to large quantities of virus (e.g., blood transfusion or organ transplant).(1)

**May be positive in 10%-15% patients with reactivation of infection.(2)

Note: HBeAg and Anti-HBe are not included, because there are some strains of HBV without the e-antigen. In areas where these strains of HBV are common (in the Middle East and Asia), testing for HBeAg is not very useful. In these cases, a negative HBeAg result does not necessarily mean that the person is not infectious; it may be that the person is infected with a strain without the e-antigen.(3)

References

1. Mast EE, Weinbaum CM, Fiore AE, Alter MJ, Bell BP, Finelli L, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: immunization of adults. MMWR Recomm Rep Morb Mortal Wkly Rep Recomm Rep. 2006 Dec 8;55(RR-16):1–33; quiz CE1-4.

2. Hepatitis B Test: Reference Range, Interpretation, Collection and Panels. 2020 Mar 22 [cited 2020 Jul 26]; Available from: https://emedicine.medscape.com/article/2109144-overview#a2

3. AACC. Hepatitis B Testing | Lab Tests Online [Internet]. [cited 2020 Jul 26]. Available from: https://labtestsonline.org/tests/hepatitis-b-testing

4. Centers for Disease Control and Prevention (CDC). Interpretation of Hepatitis B Serologic Test Results [Internet]. Available from: https://www.cdc.gov/hepatitis/HBV/PDFs/SerologicChartv8.pdf