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Difficulty: MediumGastroenterology and Hepatology

Match each Hepatitis B virus (HBV) serologic profile to its most accurate clinical interpretation.

  • HBsAg (+), Anti-HBc IgM (+), HBeAg (+), Anti-HBs (-)Acute Hepatitis B infection
  • HBsAg (-), Anti-HBc IgG (+), HBeAg (-), Anti-HBs (+)Resolved past Hepatitis B infection (natural immunity)
  • HBsAg (-), Anti-HBc (-), HBeAg (-), Anti-HBs (+)Immunity secondary to Hepatitis B vaccination
  • HBsAg (+), Anti-HBc IgG (+), HBeAg (-), Anti-HBs (-)Chronic Hepatitis B infection (inactive phase)

Answer

Profile 1 matches Acute Hepatitis B; Profile 2 matches Resolved past infection; Profile 3 matches Vaccine-induced immunity; Profile 4 matches Chronic Hepatitis B.
Hepatitis B serology requires sequential interpretation. HBsAg determines active versus absent infection. Core antibodies (Anti-HBc IgM vs IgG) distinguish acute from chronic/past exposure. Surface antibodies (Anti-HBs) determine immunity. HBeAg correlates with infectivity.

Step-by-Step Solution

1
Evaluate the presence of HBsAg.
Profiles 1 and 4 have positive HBsAg, indicating active infection (acute or chronic). Profiles 2 and 3 have negative HBsAg, indicating absence of active infection.
HBsAg is the primary marker of active HBV infection.
2
Differentiate the active infections (Profiles 1 and 4) using Anti-HBc.
Profile 1 has Anti-HBc IgM (acute). Profile 4 has Anti-HBc IgG (chronic).
IgM antibodies against the core antigen indicate recent, acute exposure, whereas IgG indicates past or ongoing chronic exposure.
3
Differentiate the non-active/immune profiles (Profiles 2 and 3) using Anti-HBc.
Profile 2 has Anti-HBc IgG, meaning the patient was exposed to the actual virus (resolved natural infection). Profile 3 is negative for all core antibodies.
The HBV vaccine only contains surface antigen. Therefore, vaccinated individuals will only develop Anti-HBs, never Anti-HBc.

Key Concept

Interpretation of Hepatitis B Serologic Panels
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Topics

Gastroenterology and Hepatology

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