Synonym

• Hepatitis B virus markers
• HBV markers
• Hepatitis B surface antigen
• HbsAg
• Hepatitis associate antigen
• Australia antigen
• Hepatitis B surface antibody
• Anti-HBs
• HbsAb
• Hepatitis B envelope antigen
• HbeAg
• Hepatitis B envelope antibody
• Anti-HBe
• HbeAb
• Hepatitis B core antibody
• Anti-HBc
• IgM Anti-HBc
• Core Antibody
• HBcAb
• Hepatitis B core antibody immunoglobulin M-specific

Tubes

• Red or tiger top tube
• Lavender or green top tube may be acceptable at some laboratories
• 5-7 mL of venous blood

Additional information

• Handle sample gently to prevent hemolysis
• Send the sample to lab within 2-4 hrs

Info

• Hepatitis B antibodies-antigens test detects the presence of antibodies or parts (antigens) specific to hepatitis B virus in the blood
• This test detects presence of current of past infection
• The hepatitis B virus (HBV) is a double stranded DNA retrovirus of the Hepadnaviridae family
• Hepatitis B is the most common form of viral hepatitis worldwide
• The panel of Hepatitis B virus (HBV) markers include:
• Surface antibody (HBsAb)
• Surface antigen (HBsAg)
• Core antibody (HBcAb IgG & IgM)
• Envelope antibody (HBeAb)
• Envelope antigen (HBeAg)

Clinical

• The indications for Hepatitis B testing includes:
• Evaluation of a person with signs and symptoms of viral hepatitis or suspected HBV infection
• Screening individuals at high risk such as:
• Persons with multiple sex partners or diagnosis of a sexually transmitted disease (STD)
• Sex contacts of infected persons
• Homosexuals
• Injection drug users
• Family members of chronically infected persons
• Infants born to infected mothers
• Infants/children of immigrants from areas with high rates of HBV infection
• Health care and public safety workers
• Hemodialysis patients
• Recipients of blood or plasma derived products
• As a routine screening test in pregnant women
• Detection of possible carrier status
• To assess the infectivity of a patient by measurement of HBsAg/HBeAg
• To monitor the therapeutic efficacy of interferon alpha therapy in persons with chronic hepatitis (HBeAg)
• Evaluate the immune status of individuals following immunization (HBsAb)
• Quantitation of HBsAb levels to predict the time interval for a booster dose of vaccination
• As a screening test in blood donors for HBV and the donated blood before transfusion (HbcAb, HbsAg)
• The primary modes of transmission of HBV infection are parenteral, perinatal, and sexual. Exposure to most body fluids, including saliva, semen, and cervical secretions can result in infection
• HBV has a prevalence rate of 0.35% in United States and 5% worldwide
• HBV infection has an incubation period of 6 weeks to 6 months, and can lead to acute and chronic liver disease
• The clinical presentation ranges from subclinical hepatitis to symptomatic hepatitis, and rarely, fulminant hepatitis (0.1-0.5%)
• Perinatal or childhood infection is associated with few or no symptoms. Clinical symptoms occur in only ~10% of children aged 5-15 yrs. However, this age group is at increased risk of developing a chronic carrier state
• Children (>15 yrs) and adults are symptomatic in 33-50% of infections, with fulminant hepatitis in 1-2% (with a 75% fatality rate)
• Long-term complications include cirrhosis and hepatocellular carcinoma
• Acute HBV infection often presents with some of the following:
• Fatigue/Malaise
• Fever
• Loss of appetite
• Nausea & vomiting
• Arthralgias and myalgias
• Headache and photophobia
• Pharyngitis, cough, coryza
• Jaundice
• Urticarial rashes
• Abdominal pain
• Hepatomegaly
• Urine that is dark brown
• Clay-colored stools
• Serologic profiles of HBV infection vary with the clinical spectrum of the disease, which includes asymptomatic infection, acute/resolved infection, coinfection, and chronic carrier state
• Hepatitis B surface antigen (HBsAg):
• It is the first marker in the serum to appear after infection, detectable 8-12 weeks after exposure and often precedes symptoms
• The level becomes undetectable within 6 months after exposure
• In the event HBsAg is detectable later than 6 months following exposure, the person is probably a chronic carrier and should never donate blood
• HbsAg may have a false positive in patients (>5%) with certain diseases other than hepatitis such as hemophilia, Hodgkin's disease, and leukemia
• Hepatitis B surface antibody (HBsAb):
• HBsAb appears ~5 months post HBV exposure and 2-16 weeks after HBsAg disappears
• HBsAb may decline or even disappear with time
• Appearance of HBsAb indicates previous hepatitis B infection, successful HBV vaccination, clinical recovery, and/or immunity to the virus
• HBsAb positive patients may become infected, or a latent infection reactivated due to viral (HIV) or drug induced immunosuppression
• Hepatitis B core antibody immunoglobulin M-specific (HBcAb IgM):
• This appears 6 to 14 weeks after exposure and is a useful marker for HBV infection in the window period (the time HBsAg disappears and HBsAb appears)
• It is indicative of current or previous infection and also referred to as the 'core window'
• Hepatitis B core antibody immunoglobulin G-specific> (HBcAb IgG):
• It appears at the onset of symptoms in acute hepatitis B and persists indefinitely
• It indicates previous hepatitis B infection
• Hepatitis B envelop antigen (HBeAg):
• HBeAg is a secreted product of the nucleocapsid gene of HBV, and appears 10-12 weeks after exposure, and usually is present for 2-6 weeks, but may be detected in both acute and chronic HBV infection
• Presence of HBeAg is indicative of active viral replication (high levels of HBV) and infectivity as HBeAg appears at the same time as the viral DNA polymerase in the blood
• Persistence of HBeAg beyond 8-10 weeks following acute infection, indicates a development of a chronic carrier state
• Hepatitis B envelope antibody (HBeAb):
• HBeAb appears ~14 weeks after exposure and is suggestive of resolution of infection and diminished risk of ability to transmit infection (lower levels of HBV)
• Spontaneous seroconversion from HbeAg to HBeAb is a predictor of long term clearance of HBV in patients undergoing antiviral therapy
• Interpretation of the hepatitis B panel (CDC):

Additional information

• Exacerbations of chronic HBV infection are more often seen in men than in women
• An estimated 200,000 to 300,000 persons become infected with HBV each year in US alone. Worldwide, countries are classified on the basis of endemic rates of HBV infection:
• Low endemic rates (<2% of the general population has the antibody to the hepatitis B surface antigen [HBsAg])
• Intermediate endemic rates (2-8% positive for HBsAg)
• High endemic rates (>8% positive for HbsAg)
• African Americans have a higher prevalence of hepatitis B than persons of Hispanic or White heritage
• Persons with chronic HBV infection are predisposed to chronic liver disease and have a >200-fold increased risk of hepatocellular carcinoma
• Transfusion acquired hepatitis B infection may not show any symptoms for up to 6 months following transfusion
• Immunization of susceptible persons exposed to hepatitis B should be done as soon as possible, utilizing both hepatitis B immunoglobulin and HBV vaccine. These injections should be administered within 24 hrs of skin-break contact and within 14 days sexual contact
• HBeAg positive mothers will infect over 90% of their newborns, and the majority of them will become chronic carriers. Hepatitis B immunoglobulins should be administered to all newborns of HBeAg positive mothers and a standard course of Hepatitis B immunizations administered
• Hepatitis B immunization is recommended for all children, with the first injection being immediately after delivery
• False positive results for HbsAg are seen in transfused individuals and hemophiliacs receiving plasma components
• Drugs that may decrease HBeAb and HBsAb levels include interferon
• Related laboratory tests include:
• -Glutamyltranspeptidase
• Alanine aminotransferase
• Alkaline phosphatase
• Aspartate aminotransferase
• Bilirubin
• HBV DNA for viral load
• HBV genotype by polymerase chain reactions (PCR)
• Hepatitis A testing
• Human immunodeficiency virus serology
• Liver biopsy
• Syphilis serology

Nl Result

Consult your laboratory for their normal ranges as these may vary somewhat from the ones listed below.

• The normal result depends upon the clinical scenario.
• Patients with no exposure to hepatitis B and no immunization should be negative on all markers.
• Patients with immunization should be negative on all markers, except HBsAb should be positive.

Any other results are abnormal and are consistent with either prior, current or chronic infection with hepatitis B (see table below).

High Result

A high result (e.g. one or more of the markers is positive) must be interpreted within the clinical scenario. Results can be interpreted as follows:

Low Result

A low result; or all markers negative is consistent with no prior infection and inadequate response to, or waning immunity to vaccination

References

• ARUP Laboratories®. Hepatitis B Virus Surface Antibody. [Homepage on the internet]©2006. Last updated in September 2006. Last accessed on January 29, 2007. Available at URL: http://www.aruplab.com/guides/ug/tests/0020090.jsp
• ARUP Laboratories®. Hepatitis B Virus Antibody. [Homepage on the internet]©2006. Last updated in September 2006. Last accessed on January 29, 2007. Available at URL: http://www.aruplab.com/guides/ug/tests/0020095.jsp
• Behzad-Behbahani A et al. Anti-HBc & HBV-DNA detection in blood donors negative for hepatitis B virus surface antigen in reducing risk of transfusion associated HBV infection. Indian J Med Res. 2006 Jan;123(1):37-42.
• Centers for Disease Control: A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States. MMWR 12/23/05, 54(RR16);1-23 [Homepage on the Internet. Last reviewed on December 12, 2005. Last accessed on January 29, 2007. Available at URL: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5416a1.htm?s_cid=rr5416a1_e
• Chu CM. Natural history of chronic hepatitis B virus infection in adults with emphasis on the occurrence of cirrhosis and hepatocellular carcinoma. J Gastroenterol Hepatol. 2000 May;15 Suppl:E25-30.
• eMedicine from WebMD®. Hepatitis B. [Homepage on the Internet] ©1996-2006. Last updated on July 11, 2006. Last accessed on January 29, 2007. Available at URL: http://www.emedicine.com/PED/topic978.htm
• Laboratory Corporation of America. Hepatitis B Surface Antibody. [Homepage on the internet]© 2001. Last updated on August 28, 2006. Last accessed on January 29, 2007. Available at URL: http://www.labcorp.com/datasets/labcorp/html/chapter/mono/hc000800.htm
• LabTestsOnline®. Hepatitis B. [Homepage on the Internet]© 2001-2006. Last reviewed on February 25, 2005. Last accessed on January 29, 2007. Available at URL: http://www.labtestsonline.org/understanding/analytes/hepatitis_b/test.html
• Oommen PT et al. Relationship between viral load and genotypes of hepatitis B virus in children with chronic hepatitis B. J Pediatr Gastroenterol Nutr. 2006 Sep;43(3):342-7.
• Thakur V et al. Prevalence of hepatitis B infection within family contacts of chronic liver disease patients--does HBeAg positivity really matter? J Assoc Physians India. 2002 Nov;50:1386-94.
• UTMB Laboratory Survival Guide®. HEPATITIS B SURFACE ANTIGEN. [Homepage on the Internet]© 2006. Last reviewed on March 6, 2003. Last accessed on January 29, 2007. Available at URL: http://www.utmb.edu/lsg/LabSurvivalGuide/Micro/HEPATITIS%20B%20SURFACE%20ANTIGEN.html
• UTMB Laboratory Survival Guide®. HEPATITIS B VIRUS CORE ANTIBODY (Total). [Homepage on the Internet]© 2006. Last reviewed on March 6, 2003. Last accessed on January 29, 2007. Available at URL: http://www.utmb.edu/lsg/LabSurvivalGuide/Micro/HEPATITIS%20B%20CORE%20ANTIBODY.html
• UTMB Laboratory Survival Guide®. HEPATITIS B VIRUS CORE ANTIBODY IgM. [Homepage on the Internet]© 2006. Last reviewed on March 6, 2003. Last accessed on January 29, 2007. Available at URL: http://www.utmb.edu/lsg/LabSurvivalGuide/Micro/HEPATITIS%20B%20CORE%20ANTIBODY%20IgM.html