Hepatitis B Laboratory Testing Panel
The standard hepatitis B laboratory panel should include HBsAg, anti-HBs, and anti-HBc as the core tests to properly assess hepatitis B infection status. 1
Core Hepatitis B Testing Panel
The basic hepatitis B testing panel consists of three essential serologic markers:
- Hepatitis B surface antigen (HBsAg): Indicates current HBV infection
- Antibody to hepatitis B surface antigen (anti-HBs): Indicates immunity to HBV
- Total antibody to hepatitis B core antigen (anti-HBc): Indicates previous or ongoing exposure to HBV
These three tests together provide a comprehensive assessment of a person's hepatitis B status and are recommended by clinical guidelines as the standard panel 2, 1.
Interpretation of Test Results
The combination of these three markers allows for accurate classification of HBV status:
| Test Results | Interpretation |
|---|---|
| HBsAg+, anti-HBc+, anti-HBs- | Current HBV infection |
| HBsAg-, anti-HBc+, anti-HBs+ | Resolved HBV infection with immunity |
| HBsAg-, anti-HBc-, anti-HBs+ | Vaccine-induced immunity |
| HBsAg-, anti-HBc-, anti-HBs- | Susceptible to HBV infection |
| HBsAg-, anti-HBc+, anti-HBs- | Possible interpretations: 1) Resolved infection with waning anti-HBs, 2) "Window period" of acute infection, or 3) Occult HBV infection |
Additional Tests for Comprehensive Evaluation
For patients with positive HBsAg (indicating current infection), additional tests are recommended:
- HBeAg and anti-HBe: To assess viral replication status and infectivity 2
- HBV DNA quantification: To determine viral load and guide treatment decisions 2
- Liver function tests: ALT, AST, bilirubin, albumin, and prothrombin time 2
Special Considerations
- IgM anti-HBc: Should be ordered when acute infection is suspected, as it distinguishes between acute and chronic infection 2
- Hepatitis A immunity testing (anti-HAV): Recommended for all patients with chronic HBV infection, as HAV superinfection can increase mortality risk 5.6-29 fold 2
- Tests for coinfections: Anti-HCV, anti-HDV, and anti-HIV should be considered in high-risk individuals 2
Common Pitfalls to Avoid
- Incomplete testing: Testing only for HBsAg without anti-HBs and anti-HBc can miss patients in the "window period" or with occult hepatitis B 1
- Misinterpreting isolated anti-HBc: This pattern requires careful evaluation and may necessitate HBV DNA testing to rule out occult hepatitis B 1
- Failing to test for hepatitis A immunity: All patients with chronic HBV should be tested for HAV immunity and vaccinated if negative 2
Recommendations for Specific Populations
- High-risk individuals: Those from regions with HBsAg prevalence >2%, men who have sex with men, injection drug users, and household contacts of HBV-infected persons should be screened 2
- Immunocompromised patients: May require more frequent monitoring of antibody levels 1
- Patients receiving immunosuppressive therapy: Should be screened for HBV before initiating therapy to prevent reactivation 2
By following this comprehensive testing approach, clinicians can accurately diagnose hepatitis B infection status, guide appropriate management, and prevent complications related to HBV infection.