From the Guidelines
The serologic definition of a Hepatitis B (Hep B) carrier state is the persistent presence of hepatitis B surface antigen (HBsAg) in the blood for at least 6 months. This definition is based on the most recent and highest quality study available, which emphasizes the importance of HBsAg persistence in defining the carrier state 1. The carrier state is typically characterized by the absence of hepatitis B e antigen (HBeAg) and the presence of antibodies to HBeAg (anti-HBe), indicating chronic infection with hepatitis B virus (HBV) without active liver inflammation. Key features of the carrier state include:
- Persistence of HBsAg for at least 6 months
- Absence of HBeAg
- Presence of anti-HBe
- Lack of antibodies to HBsAg (anti-HBs), which would indicate immunity
- Presence of antibodies to hepatitis B core antigen (anti-HBc) This serologic profile reflects low-level viral replication in the liver, with viral particles being released into the bloodstream, but not at levels that cause significant liver damage 1. Carriers can still transmit the infection to others despite being asymptomatic, and regular monitoring of liver function tests and HBV DNA levels is recommended, as approximately 15-40% may develop progressive liver disease over time, including cirrhosis or hepatocellular carcinoma 1.
From the Research
Serologic Definition of Hepatitis B Carrier State
The serologic definition of a Hepatitis B (Hep B) carrier state is characterized by the presence of certain serological markers.
- Hepatitis B surface antigen (HBsAg) is the hallmark of HBV infection and is the first serological marker to appear in acute hepatitis B 2.
- Persistence of HBsAg for more than 6 months suggests chronic HBV infection, which is a key indicator of a carrier state 2.
- Other serological markers, such as hepatitis B e antigen (HBeAg) and anti-HBc, can also be present in individuals with chronic HBV infection 3.
- The presence of HBsAg, along with other serological markers, can be used to diagnose and monitor HBV infection, including the carrier state 4, 5, 6.
- A highly sensitive HBsAg (hs-HBsAg) assay can detect HBsAg levels as low as 0.5 mIU/ml, which can help identify individuals with a carrier state who may have undergone HBsAg seroclearance 5.
Key Serological Markers
- HBsAg: the hallmark of HBV infection and a key indicator of a carrier state 2, 5.
- HBeAg: indicates active HBV replication and risk of transmission of infection 2, 3.
- Anti-HBc: can be present in individuals with chronic HBV infection 3, 4.
- Anti-HBs: can be present in individuals who have undergone HBsAg seroclearance and may indicate a reduced risk of HBV transmission 5, 6.