CHRONIC HEPATITIS B SEROLOGY

Antigens HBsAg Found on the surface of the intact virus and in serum as unattached particles Earliest detectable marker in serum indicates current Hepatitis B infection HBcAg Found within the core of the intact virus Not detectable in serum Reference: 17th Ed. Harrison’s Principles of Internal Medicine p.1933-1934

Antigens HBeAg Readily detectable serologic marker of HBV infection Appears shortly after HBsAg Coincides w/high levels of virus replication Indicates highly infective stage of HBV Reference: 17th Ed. Harrison’s Principles of Internal Medicine p.1935

Antibodies Anti-HBs Antibody to HBsAg Becomes detectable in serum after HBsAg disappears indicates immunity to Hepatitis B infection “protective antibody” Anti-HBc Total antibody to HBcAg Only serologic evidence of recent HBV infection during the “window period” May indicate acute or chronic infection Reference: 17th Ed. Harrison’s Principles of Internal Medicine p.1933-1934

Antibodies Anti-HBc IgM IGM antibody to HBcAg Seen in the 1st 6 months after acute infection indicates recent acute Hepatitis B infection Anti-Hbc IgG -IgG antibody to HBcAg -predominates beyond 6 months - Seen in chronic HBV infection Reference: 17th Ed. Harrison’s Principles of Internal Medicine p.1934-1935

Antibodies Anti-HBe - Antibody to HBeAg - Signifies low infectivity Reference: 17th Ed. Harrison’s Principles of Internal Medicine p.1935

Chronic Hepatitis B Serologic Patterns HBs Ag Anti-HBs Anti-HBc HBeAg Anti-HBe Interpretation + - IgG Chronic Hepatitis B, High infectivity Low infectivity Reference: 17th Ed. Harrison’s Principles of Internal Medicine p.1943

CLINICAL and laboratory FEATURES CHRONIC HEPATITIS B CLINICAL and laboratory FEATURES

Progression of acute hepatitis to chronic hepatitis: Clinical and Laboratory features: lack of complete resolution of clinical symptoms of anorexia, weight loss, and fatigue and the persistence of hepatomegaly; 2. the presence of bridging or multilobular hepatic necrosis on liver biopsy during protracted, severe acute viral hepatitis; failure of the serum aminotransferase, bilirubin, and globulin levels to return to normal within 6 to 12 months after the acute illness; and 4. the persistence of HBeAg beyond 3 months or HBsAg beyond 6 months after acute hepatitis. Reference: Braunwald, et al, Harrison’s Principles of Internal Medicine 17th Ed., pp.1945

CHRONIC HEPATITIS B CLINICAL FEATURES Onset: insiduous Incubation period: 30-180 days (mean, 8-12 weeks) Fatigue is a common symptom Low grade fever between 38° and 39°C (100° - 102°F) when heralded with serum-sickness syndrome Reference: Braunwald, et al, Harrison’s Principles of Internal Medicine 17th Ed., pp.1941-1942

CHRONIC HEPATITIS B Persistent or Intermittent jaundice is a common feature in severe or advanced cases. It may lead to progressive liver injury and in cases with superimposed cirrhosis --- hepatic decompensation. Reference: Braunwald, et al, Harrison’s Principles of Internal Medicine 17th Ed., p. 1957

CHRONIC HEPATITIS B LABORATORY FEATURES Aminotransferase elevations tend to be modest but may fluctuate in the range of 100-1000 units. Alanine aminotransferase (ALT) tends to be more elevated than aspartate aminotransferase (AST) When cirrhosis is established, AST tends to exceed ALT. Levels of alkaline phosphatase activity tend to be normal or only marginally elevated. Reference: Braunwald, et al, Harrison’s Principles of Internal Medicine 17th Ed., p. 1957

CHRONIC HEPATITIS B In severe cases, moderate elevations in serum bilirubin [51.3 to 171 µmol/L (3 to 10 mg/dL)] occur. Hypoalbuminemia and prolongation of the prothrombin time occur in severe or end-stage cases. Hyperglobulinemia and detectable circulating autoantibodies are distinctly absent in chronic hepatitis B (in contrast to autoimmune hepatitis). Reference: Braunwald, et al, Harrison’s Principles of Internal Medicine 17th Ed., p. 1957

Reference: Braunwald, et al, Harrison’s Principles of Internal Medicine 16th Ed., p. 1844