TABLE 5-2 Interpretation of Hepatitis B Serologic Diagnostic Test Results

Antigen or Antibody Test

Result

Interpretation

HBsAg

Anti-HBc

Anti-HBs

All negative

Susceptible

HBsAg

Anti-HBc

Anti-HBs

Negative

Positive

Positive

Immune because of natural infection

HBsAg

Anti-HBc

Anti-HBs

Negative

Negative

Positive

Immune because of hepatitis B vaccination

HBsAg

Anti-HBc

IgM anti-HBc

Anti-HBs

Positive

Positive

Positive

Negative

Acutely infected

HBsAg

Anti-HBc

IgM anti-HBc

Anti-HBs

Positive

Positive

Negative

Negative

Chronically infected

HBsAg

Anti-HBc

Anti-HBs

Negative

Positive

Negative

Interpretation unclear; could be due to

  • Resolved infection

  • False-positive anti-HBc test

  • Low-level chronic infection

  • Resolving acute infection

Abbreviations: HBsAg, hepatitis B surface antigen; anti-HBc, total hepatitis B core antibody; anti-HBs, hepatitis B surface antibody; IgM anti-HBc, IgM antibody to hepatitis B core antigen.

SOURCE: CDC, 2009c.

Clinicians also may not know which tests to order to test for chronic vs acute viral HBV infection. Table 5-2 provides guidance on the interpretation of hepatitis B serologic test results.

Cost-effectiveness data on the use of laboratory testing in particular at-risk populations are available. As mentioned above, people born in foreign countries that have high rates of HBV (2% or more) are at the highest risk for chronic HBV infection and constitute the largest pool of undiagnosed persons (see Box 3-1). Laboratory testing of adult Asian and Pacific Islanders for HBV infection (10% prevalence of chronic HBV infection), monitoring and treating people who are found to be chronically infected, and



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