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Interpretive Handbook

Test 9023 :
Chronic Hepatitis Profile (Type B)

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Hepatitis B virus (HBV) is a DNA virus that is endemic throughout the world. The infection is spread primarily through percutaneous contact with infected blood products, eg, blood transfusion, sharing of needles by drug addicts. The virus is also found in virtually every type of human body fluid and is known to be spread through oral and genital contact. HBV can be transmitted from mother to child during delivery through contact with blood and vaginal secretions; it is not commonly transmitted transplacentally.


After a course of acute illness, HBV persists in approximately 10% of patients. Some of these carriers are asymptomatic; others develop chronic liver disease including cirrhosis and hepatocellular carcinoma.


See HBV Infection–Diagnostic Approach and Management Algorithm and Viral Hepatitis Serologic Profile in Special Instructions.

Useful For Suggests clinical disorders or settings where the test may be helpful

Evaluating patients with suspected or confirmed chronic hepatitis B


Monitoring hepatitis B viral infectivity

Interpretation Provides information to assist in interpretation of the test results

Hepatitis B surface antigen (HBsAg) is the first serologic marker appearing in the serum 6 to 16 weeks following hepatitis B viral (HBV) infection. In acute cases, HBsAg usually disappears 1 to 2 months after the onset of symptoms. Persistence of HBsAg for more than 6 months indicates development of either chronic carrier state or chronic liver disease.


Hepatitis B surface antibody (anti-HBs) appears with the resolution of HBV infection after the disappearance of HBsAg. Anti-HBs also appears as the immune response following a course of inoculation with the hepatitis B vaccine.


Hepatitis B core antibody (anti-HBc) appears shortly after the onset of symptoms of HBV infection and may be the only serologic marker remaining years after exposure to hepatitis B.


The presence of hepatitis B envelope antigen (HBeAg) correlates with infectivity, the number of viral Dane particles, the presence of core antigen in the nucleus of the hepatocyte, and the presence of viral DNA polymerase in serum. Hepatitis B envelope antibody (anti-HBe) positivity in a carrier is often associated with chronic asymptomatic infection.


If the patient has a sudden exacerbation of disease, consider ordering hepatitis C virus antibody and hepatitis delta virus antibody (anti-HDV).


If HBsAg converts to negative and patient's condition warrants, consider testing for anti-HBs.


If HBsAg is positive, consider testing for anti-HDV.


See HBV Infection–Diagnostic Approach and Management Algorithm and Viral Hepatitis Serologic Profile in Special Instructions.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Positive hepatitis B surface antigen (HBsAg) test results should be reported by the attending physician to the State Department of Health, as required by law in some states.


Consider administration of hepatitis B immune globulin and hepatitis B vaccine to individuals exposed to the patient's blood and/or body fluids.


Performance characteristics of these assays have not been established in patients under the age of 2 or in populations of immunocompromised or immunosuppressed patients. These assays are not licensed by the FDA for testing cord blood samples or screening donors of blood, plasma, human cell, or tissue products.


Performance characteristics have not been established for the following specimen characteristics:

-Grossly icteric (total bilirubin level of >20 mg/dL)

-Grossly lipemic (triolein level of >3,000 mg/dL)

-Grossly hemolyzed (hemoglobin level of >61 mg/dL)

-Containing particulate matter

-Cadaveric specimen 

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.









Interpretation depends on clinical setting. See Viral Hepatitis Serologic Profiles in Special Instructions.

Clinical References Provides recommendations for further in-depth reading of a clinical nature

1. Mahoney FJ: Update on diagnosis, management, and prevention of hepatitis B virus infection. Clin Microbiol Rev 1999;12:351-366

2. Gane E: Chronic hepatitis B virus infection in south Auckland. N Z Med J 1998;111:120-123

3. Gitlin N: Hepatitis B: diagnosis, prevention, and treatment. Clin Chem 1997;43:1500-1506