From the Guidelines
In a patient with zero hepatitis B surface antibody, I recommend checking hepatitis B surface antigen (HBsAg) first to determine if they have active infection, and if HBsAg is positive, then order hepatitis B core total antibody to confirm infection, while hepatitis B core IgM antibody should be specifically requested if acute infection is clinically suspected 1. When evaluating a patient with zero hepatitis B surface antibody, it is essential to consider the clinical context and suspicion of acute or chronic infection.
- The presence of HBsAg indicates active infection, and ordering hepatitis B core total antibody can help confirm the diagnosis.
- Hepatitis B core IgM antibody is typically used to diagnose acute infection, as it appears early in the course of the disease and disappears within 6 months 1.
- A complete hepatitis B panel, including HBsAg, HBsAb, core total antibody, and sometimes e-antigen and e-antibody, provides a comprehensive assessment of infection status and helps distinguish between acute infection, chronic infection, resolved infection, or vaccination status.
- The absence of surface antibody alone could indicate susceptibility to infection, chronic infection, or waning immunity after vaccination, emphasizing the need for further testing and evaluation. Key points to consider when interpreting hepatitis B serologic test results include:
- HBsAg positivity indicates active infection
- HBsAb positivity indicates recovery from and immunity to HBV infection
- Hepatitis B core IgM antibody positivity indicates acute or recent HBV infection
- Hepatitis B core total antibody positivity indicates acute, recent, or previous HBV infection 1.
From the Research
HB Core IgM vs Total in Patients with Zero HB Surface Antibody
- In patients with zero HB surface antibody, the detection of hepatitis B core IgM antibody (anti-HBcIgM) is crucial for diagnosing acute hepatitis B virus infection after recent exposure 2.
- The presence of anti-HBcIgM indicates a recent infection, whereas the total hepatitis B core antibody (anti-HBc) can be present in both acute and chronic infections.
- In cases where the patient has a history of hepatitis B vaccination, the presence of isolated anti-HBc may indicate occult chronic HBV infection with undetectable HBsAg 3.
- The level of anti-HBc can also be used as a surrogate marker for host antiviral immunity in chronic hepatitis B virus infections 4.
- When to check HB core IgM vs total:
- Check anti-HBcIgM in patients with recent exposure to HBV and zero HB surface antibody to diagnose acute infection 2.
- Check total anti-HBc in patients with a history of HBV vaccination and zero HB surface antibody to detect potential occult chronic infection 3.
- Monitor anti-HBc levels in patients with chronic HBV infection to assess host antiviral immunity and treatment response 4.