Interpretation of Hepatitis b serologic Test Results

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Interpretation of Hepatitis B Serologic Test Results

Hepatitis B serologic testing involves measurement of several hepatitis B 

virus (HBV)-specifi c antigens and antibodies. Different serologic “markers” 

or combinations of markers are used to identify different phases of HBV 

infection and to determine whether a patient has acute or chronic HBV 

infection, is immune to HBV as a result of prior infection or vaccination, or 

is susceptible to infection.

Hepatitis B surface 

antigen (HBsAg):  

A protein on the surface 

of hepatitis B virus; it can 

be detected in high levels 

in serum during acute or 

chronic hepatitis B virus 

infection. The presence of 

HBsAg indicates that the 

person is infectious. The 

body normally produces 

antibodies to HBsAg as 

part of the normal immune 

response to infection. 

HBsAg is the antigen used 

to make hepatitis B vaccine.

Hepatitis B surface 

antibody (anti-HBs):  

The presence of anti-HBs 

is generally interpreted as 

indicating recovery and 

immunity from hepatitis B 

virus infection. Anti-HBs 

also develops in a person 

who has been successfully 

vaccinated against 

hepatitis B. 

Total hepatitis B core 

antibody (anti-HBc):  

Appears at the onset 

of symptoms in acute 

hepatitis B and persists 

for life. The presence of 

anti-HBc indicates previous 

or ongoing infection with 

hepatitis B virus in an 

undefi ned time frame. 

IgM antibody to hepatitis B 

core antigen (IgM anti-HBc):  

Positivity indicates recent 

infection with hepatitis B 

virus (<6 mos). Its presence 

indicates acute infection. 

Tests

Results

Interpretation

HBsAg

negative

Susceptible

anti-HBc

negative

anti-HBs

negative

HBsAg

negative

Immune due to natural infection

anti-HBc

positive

anti-HBs

positive

HBsAg

negative

Immune due to hepatitis B vaccination

anti-HBc

negative

anti-HBs

positive

HBsAg

positive

Acutely infected

anti-HBc

positive

IgM anti-HBc

positive

anti-HBs

negative

HBsAg

positive

Chronically infected

anti-HBc

positive

IgM anti-HBc

negative

anti-HBs

negative

HBsAg

negative

Interpretation unclear; four possibilities:

anti-HBc

positive

1.  Resolved infection (most common)

anti-HBs

negative

2.  False-positive anti-HBc, thus susceptible

3.  “Low level” chronic infection

4.  Resolving acute infection

Adapted from:  A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B 

Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization 

Practices.  Part I: Immunization of Infants, Children, and Adolescents.  MMWR 2005;54(No. RR-16).

DEPARTMENT OF HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

Division of Viral Hepatitis

www.cdc.gov/hepatitis