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Difficulty: HardGastroenterology and Hepatology

Match each Hepatitis B (HBV) serologic and virologic profile to its corresponding clinical disease state.

  • HBsAg (+), HBeAg (-), Anti-HBc IgG (+), Anti-HBs (-), HBV DNA = 250,000 IU/mL, ALT = 150 U/LHBeAg-negative chronic active hepatitis B
  • HBsAg (-), HBeAg (-), Anti-HBc IgM (+), Anti-HBs (-), HBV DNA = Undetectable, ALT = 400 U/LAcute hepatitis B window period
  • HBsAg (+), HBeAg (-), Anti-HBc IgG (+), Anti-HBs (-), HBV DNA = 450 IU/mL, ALT = 22 U/LInactive hepatitis B carrier state
  • HBsAg (-), HBeAg (-), Anti-HBc IgG (+), Anti-HBs (+), HBV DNA = Undetectable, ALT = 18 U/LResolved past hepatitis B infection
  • HBsAg (+), HBeAg (+), Anti-HBc IgG (+), Anti-HBs (-), HBV DNA = 5,000,000 IU/mL, ALT = 25 U/LChronic hepatitis B immune-tolerant phase

Answer

The serologic patterns map specifically to phases of HBV infection based on the interplay of surface/core antigens, antibodies, and viral replication activity indicated by HBV DNA and ALT levels.
Each profile uniquely identifies a specific phase of Hepatitis B infection. Accurate matching requires recognizing the virological significance of precore mutations (HBeAg-negative but highly active), the window period (isolated core IgM), immune tolerance (high DNA, low ALT), inactive carriage (low DNA, low ALT), and resolved infection (core IgG and surface antibodies).

Step-by-Step Solution

1
Analyze HBsAg and Anti-HBs status.
Determines active infection versus clearance/immunity.
HBsAg implies current virus presence; Anti-HBs implies clearance and acquired immunity.
2
Evaluate Anti-HBc class (IgM vs. IgG).
Differentiates acute from chronic or resolved infections.
IgM is positive during early/acute infection and the window period; IgG persists for life after initial exposure.
3
Assess viral replication and liver injury markers (HBeAg, HBV DNA, ALT) in chronic cases.
Identifies immune-tolerant, active, and inactive states.
High DNA with normal ALT indicates tolerance; High DNA with high ALT indicates active hepatitis; Low DNA with normal ALT indicates an inactive carrier.

Key Concept

Hepatitis B Serology and Disease Phases
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Topics

Gastroenterology and Hepatology

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