HEPATITIS B SERODIAGNOSIS ESSENTIALS

A supplement to IVMS-Hepatitis and HBV Interactive Tutorial

|http://www.slideshare.net/drimhotep/hepatitis-and-hbv-tutorial|

From: Cecil Essentials of Medicine Andreoli and Carpenter's 8th.Ed

Serologic testing in HBV|

Also see HBV Antibody-Viral Test 1. HBsAgThe appearance of HBsAg in serum is the first evidence of infection, appearing before biochemical evidence of liver disease, and persists throughout the clinical illness. Persistence of HBsAg more than 6 months after the acute illness signifies chronic hepatitis B. 2. Anti-HBsSpecific antibody to HBsAg (anti-HBs) appears in most individuals after clearance of HBsAg and after successful vaccination against hepatitis B. Disappearance of HBsAg and the appearance of anti-HBs signal recovery from HBV infection, noninfectivity, and immunity. 3. Anti-HBcIgM anti-HBc appears shortly after HBsAg is detected. (HBcAg alone does not appear in serum.) In the setting of acute hepatitis, IgM anti-HBc indicates a diagnosis of acute hepatitis B, and it fills the serologic gap in rare patients who have cleared HBsAg but do not yet have detectable anti-HBs. IgM anti-HBc can persist for 36 months or longer. IgM anti-HBc may also reappear during flares of previously inactive
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chronic hepatitis B (see later). IgG anti-HBc also appears during acute hepatitis B but persists indefinitely, whether the patient recovers (with the appearance of anti-HBs in serum) or chronic hepatitis B develops (with persistence of HBsAg). In asymptomatic blood donors, an isolated anti-HBc with no other positive HBV serologic results may represent a falsely positive result or latent infection in which HBV DNA is detectable in serum only by polymerase chain reaction testing 4. HBeAgHBeAg is a secretory form of HBcAg that appears in serum during the incubation period shortly after the detection of HBsAg. HBeAg indicates viral replication and infectivity. Persistence of HBeAg beyond 3 months indicates an increased likelihood of chronic hepatitis B. Its disappearance is often followed by the appearance of anti-HBe, generally signifying diminished viral replication and decreased infectivity. 5. HBV DNAThe presence of HBV DNA in serum generally parallels the presence of HBeAg, although HBV DNA is a more sensitive and precise marker of viral replication and infectivity. Very low levels of HBV DNA, detectable only by polymerase chain reaction testing, may persist in serum and liver long after a patient has recovered from acute hepatitis B, but the HBV DNA in serum is bound to IgG and is rarely infectious. In some patients with chronic hepatitis B, HBV DNA is present at high levels without HBeAg in serum because of development of a mutation in the core promoter or precore region of the gene that codes HBcAg; these mutations prevent synthesis of HBeAg in infected hepato-cytes. When additional mutations in the core gene are present, the precore mutant enhances the severity of HBV infection and increases the risk of cirrhosis (see later).

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Table from: Cecil Essentials of Medicine Andreoli and Carpenter's 8th.Ed

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