Interpretation of Hepatitis B Serologic Test Results

 Hepatitis B serologic testing involves measurement of several hepatitis B virus (HBV)-specific antigens and antibodies. See this blog post

Different serologic “markers” or combinations of markers are used to identify different phases of Hepatitis B Virus (HBV infection) and to determine whether a patient has acute or chronic HBV infection, is immune to HBV as a result of prior infection or vaccination, or is susceptible to infection.

Antigen/Antibody tested	Test result	Inference
HBsAg anti-HBc anti-HBs	Negative Negative Negative	Susceptible
HBsAg anti-HBc anti-HBs	Negative Positive Positive	Immune due to natural infection
HBsAg anti-HBc anti-HBs	Negative Negative Positive	Immune due to hepatitis B vaccination
HBsAg anti-HBc IgM anti-HBc anti-HBs	Positive Positive Positive Negative	Acutely infected
HBsAg anti-HBc IgM anti-HBc anti-HBs	Positive Positive Negative Negative	Chronically infected
HBsAg anti-HBc anti-HBs	Negative Positive Negative	Interpreatation unclear; four possibilities: 1.       Resolved infection (most common) 2.       False-positive anti-HBc, thus susceptible 3.       "Low level" chronic infection 4.       Resolving acute infection

Hepatitis B surface antigen (HBsAg): A protein on the surface of hepatitis B virus; it can be detected in high levels in serum during acute or chronic hepatitis B virus infection. The presence of HBsAg indicates that the person is infectious. The body normally produces antibodies to HBsAg as part of the normal immune response to infection. HBsAg is the antigen used to make hepatitis B vaccine.

Hepatitis B surface antibody (anti-HBs): The presence of anti-HBs is generally interpreted as indicating recovery and immunity from hepatitis B virus infection. Anti-HBs also develops in a person who has been successfully vaccinated against hepatitis B.

Total hepatitis B core antibody (anti-HBc): Appears at the onset of symptoms in acute hepatitis B and persists for life. The presence of anti-HBc indicates previous or ongoing infection with hepatitis B virus in an undefined time frame.

IgM antibody to hepatitis B core antigen (IgM anti-HBc): Positivity indicates recent infection with hepatitis B virus. Its presence indicates acute infection.

Source: DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Disease Control and Prevention Division of Viral Hepatitis