Interpreting Hepatitis B Serology in 5 Easy steps

Hepatitis B surface antigen (HBsAg)

  • Appears during incubation period (1-6 months), 2-7 weeks prior to symptoms.
  • Peaks when the patient is most ill.
  • Becomes undetectable in 3-6 months.
  • Indicates infection – recent or chronic.

Hepatitis B surface antibody (anti-HBs or HBsAb)

  • Arises once the acute disease has resolved.
  • Sometimes, not detectable unless until weeks or months after HBsAg has disappeared. This gap is called “window” period.
  • Indicates, immunity (by vaccination or infection).

Hepatitis B core antibody (anti-HBc or HBcAb)

  • Anti-HBc IgM and elevated serum transaminases also appear shortly before the symptom onset.
  • Over the next few months, anti-HBc IgM is replaced with an IgG component.
  • IgM = Recent (Acute) infection
  • IgG = Chronic infection

Hepatitis B e-antigen (HBeAg)

  • Shortly after HBsAg appears, HBeAg and HBV DNA can be detected in the serum and are markers of the acute viral replication.
  • Predictor of infectivity.

Hepatitis B e-antibody (anti-HBe or HBeAb)

  • Anti-HBe appears shortly after HBeAg vanishes and indicates subsiding viral activity.
  • Predictor of low infectivity.
hepatitis b serology
Acute Hepatitis B infection – serologic course

chronic hepatitis b infection - serologic course
chronic hepatitis b infection – serologic course
Never infected (susceptible)
Incubation period+ (1st to appear)IgM (shortly before symptom onset)+
Prodrome, Acute disease+IgM++/-
Window periodIgM+/-+/-
Convalescence (Recovery)+IgG+/-
Chronic active hepatitis B+IgG+
Chronic non-active hepatitis B+IgG+
Immune due to Vaccination+
Immune due to Natural infection+IgG+/-
False positive or infection in remote pastIgG

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