From the Guidelines
Hepatitis B lab interpretation requires analysis of several serological markers to determine infection status and guide treatment decisions, with the key markers including hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), hepatitis B core antibody (anti-HBc), hepatitis B e antigen (HBeAg), and hepatitis B e antibody (anti-HBe), along with HBV DNA levels, as noted in the 2018 study by the Infectious Diseases Society of America and the American Society for Microology 1.
Key Markers for Hepatitis B Infection
- HBsAg: indicates current infection
- anti-HBs: indicates immunity due to vaccination or past infection
- anti-HBc: indicates past or current infection
- HBeAg: indicates high viral replication
- anti-HBe: indicates low viral replication
- HBV DNA: indicates viral load
Interpretation of Hepatitis B Labs
- Acute infection: positive HBsAg and IgM anti-HBc
- Chronic infection: persistent HBsAg for more than 6 months
- Treatment is typically indicated for chronic HBV with elevated ALT, detectable HBV DNA (>2000 IU/mL), and evidence of liver inflammation or fibrosis, as recommended by the AASLD and APASL guidelines 1
Treatment Goals
- HBeAg seroconversion (loss of HBeAg and development of anti-HBe)
- HBsAg loss
- HBV DNA suppression
- ALT normalization
- Prevention of cirrhosis and hepatocellular carcinoma
First-Line Treatments
- Entecavir 0.5mg daily
- Tenofovir disoproxil fumarate 300mg daily
- Tenofovir alafenamide 25mg daily
Monitoring and Follow-Up
Regular monitoring of HBV DNA levels, liver enzymes, and serological markers is essential to assess treatment response, with most patients requiring long-term or indefinite therapy to maintain viral suppression and prevent disease progression, as noted in the 2014 study by the Clinical Gastroenterology and Hepatology journal 1.
From the Research
Hepatitis B Lab Interpretation
Hepatitis B lab results are interpreted to determine infection status and guide treatment. The key markers used in this interpretation include:
- Hepatitis B surface antigen (HBsAg): indicates current infection 2
- Hepatitis B e antigen (HBeAg): indicates active viral replication and high infectivity 2
- Hepatitis B core antibody (HBcAb): appears after HBsAg and remains detectable for life 2
- Hepatitis B surface antibody (HBsAb): indicates immunity to hepatitis B, either from vaccination or past infection 2
Infection Status
The interpretation of hepatitis B labs can determine the following infection statuses:
- Acute hepatitis B: characterized by the presence of HBsAg and HBcAb IgM 3
- Chronic hepatitis B: characterized by the presence of HBsAg for more than 6 months 2
- Occult hepatitis B: characterized by the presence of HBV DNA in the absence of HBsAg 2
- Resolved hepatitis B: characterized by the presence of HBsAb and HBcAb, indicating past infection and immunity 3
Treatment Guidance
Hepatitis B lab results guide treatment decisions, including:
- Antiviral therapy: indicated for patients with high viral loads and active liver disease 2, 4
- Monitoring of liver disease progression: regular monitoring of liver function tests and HBV DNA levels is necessary to assess disease progression and treatment response 2, 5
- Prediction of treatment response: baseline HBcAb levels can predict HBeAg seroconversion in patients treated with nucleos(t)ide analogs 4
Special Cases
Some patients may have unusual patterns of hepatitis B serum markers, such as: