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Difficulty: MediumGastroenterology and Hepatology

Match each Hepatitis B virus (HBV) serologic profile to the most accurate corresponding clinical status.

  • HBsAg (+), Anti-HBc IgM (+), HBeAg (+), Anti-HBs (-)Acute Hepatitis B infection
  • HBsAg (+), Anti-HBc IgG (+), HBeAg (-), Anti-HBs (-)Chronic Hepatitis B infection (inactive carrier state)
  • HBsAg (-), Anti-HBc IgG (+), Anti-HBs (+)Resolved past Hepatitis B infection
  • HBsAg (-), Anti-HBc (-), Anti-HBs (+)Immunity secondary to vaccination
  • HBsAg (-), Anti-HBc IgM (+), Anti-HBs (-)Acute HBV infection in the window period

Answer

1. Acute infection corresponds to positive HBsAg and Anti-HBc IgM. 2. Chronic infection corresponds to positive HBsAg and Anti-HBc IgG. 3. Resolved infection corresponds to positive Anti-HBc IgG and Anti-HBs. 4. Vaccination immunity corresponds to isolated Anti-HBs positivity. 5. The window period corresponds to isolated Anti-HBc IgM positivity.
Each serologic panel uniquely identifies a specific phase of Hepatitis B exposure. Combining the surface antigen/antibody status with the core antibody class (IgM vs IgG) allows for definitive categorization of the patient's clinical state.

Step-by-Step Solution

1
Evaluate the presence of HBsAg and Anti-HBs to determine current infection versus immunity.
HBsAg positivity means the virus is currently present (acute or chronic). Anti-HBs positivity means the patient has immunity (resolved or vaccinated).
Surface antigen is the hallmark of active viral presence, whereas surface antibody is the neutralizing antibody conferring long-term immunity.
2
Analyze the core antibody (Anti-HBc) status to differentiate the source of immunity or the duration of infection.
IgM implies acute/recent exposure, while IgG implies chronic or past exposure. The absence of any core antibody in an immune patient indicates vaccination.
The hepatitis B vaccine contains only recombinant surface antigen. Therefore, vaccinated individuals never develop core antibodies.
3
Identify the 'window period' profile where neither surface antigen nor surface antibody is detectable.
The profile with only Anti-HBc IgM positive represents the window period.
There is a gap of several weeks between the disappearance of HBsAg and the appearance of Anti-HBs. During this time, Anti-HBc IgM is the sole diagnostic marker of recent acute infection.

Key Concept

Interpretation of Hepatitis B Serologic Panels
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Topics

Gastroenterology and Hepatology

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