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During the course of a typical case of acute hepatitis B viral (HBV) infection, IgM antibodies to hepatitis B core antigen (anti-HBc IgM) are present in the serum shortly before clinical symptoms appear. Anti-HBc total is detectable during the prodromal, acute, and early convalescent phases when it exists as immunoglobulin M (IgM) anti-HBc. Anti-HBc IgM rises in level and is present during the core window period, ie, after hepatitis B surface antigen disappears and before antibodies to hepatitis B surface antigen appear. Anti-HBc total may be the only serologic marker remaining years after exposure to HBV.
Detection and differentiation between recent and past/resolved or chronic hepatitis B viral (HBV) infection
Diagnosis of recent HBV infection during the "window period" when both hepatitis B surface antigen and antibodies to hepatitis B surface antigen are negative
A positive, antibodies to hepatitis B core antigen (anti-HBc) total result may indicate, either, recent, past/resolved, or chronic hepatitis B viral (HBV) infection.
Testing for anti-HBc IgM (HBIM / Hepatitis B Core Antibody, IgM, Serum) is necessary to confirm the presence of acute or recent hepatitis B. A positive anti-HBc total result with a negative anti-HBc IgM result indicates past or chronic HBV infection. Differentiation between past/resolved and chronic hepatitis B can be based on the presence of hepatitis B surface antigen in the latter condition.
Negative anti-HBc total results indicate the absence of recent, past/resolved, or chronic hepatitis B.
Positive antibodies to hepatitis B core antigen (anti-HBc) total results with negative anti-HBc IgM results in infants <18 months old may be due to passively acquired maternal IgG antibodies. Additional testing, such as hepatitis B surface antigen, anti-HBc IgM, and hepatitis Be antigen, are necessary to confirm a diagnosis of acute or recent hepatitis B in these infants.
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 >500 mg/dL)
-Containing particulate matter
Interpretation depends on clinical setting.
See Viral Hepatitis Serologic Profiles in Special Instructions.
1. Badur S, Akgun A: Diagnosis of hepatitis B infections and monitoring of treatment. J Clin Virol 2001;21(3):229-237
2. Servoss JC, Friedman LS: Serologic and molecular diagnosis of hepatitis B virus. Clin Liver Dis 2004;8(2):67-281