1. CHRONIC HEPATITIS B SEROLOGY

2. 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

3. 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

4. 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

5. 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

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

8. 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

9. CLINICAL and laboratory FEATURES
CHRONIC HEPATITIS B
CLINICAL and laboratory FEATURES

10. 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

11. CHRONIC HEPATITIS B CLINICAL FEATURES Onset: insiduous
Incubation period: 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

12. 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

13. CHRONIC HEPATITIS B
LABORATORY FEATURES
Aminotransferase elevations tend to be modest but may fluctuate in the range of 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

14. 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

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