Serologic and Virologic Markers of Hepatitis B Virus Infection

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David H. Spach, MD Jo Hofmann, MD

Last updated: March 21, 2013

A 27-year-old woman presents to the urgent care clinic with the new onset of nausea and jaundice. During the past 3 years, she has experienced major problems with drug addiction and has been regularly injecting crystal methamphetamine. She almost always uses clean needles, but 6 weeks ago she shared needles with a man whom she later found out has hepatitis B virus infection. She has never received HBV vaccine. Two years ago, she had negative antibody tests for hepatitis A, B, and C, but did not return for follow-up and vaccinations. Her physical examination is normal except for track marks on her arms and visible jaundice. Laboratory studies show a total bilirubin of 6.8 mg/dl, aspartate aminotransferase (AST) level of 1906 U/L, and an alanine aminotransferase (ALT) level of 2086 U/L. Serology tests for hepatitis A, B, and C viruses are ordered. The panel ordered for hepatitis B includes hepatitis B surface antigen (HBsAg), antibody to hepatitis B surface antigen (anti-HBs), total hepatitis B core antibody (total anti-HBc), hepatitis e antigen (HBeAg), and antibody to hepatitis B e antigen (anti-HBe).

Which of the following serologic profiles would be most consistent with acute HBV infection?

A HBsAg (-), anti-HBs (+), Total anti-HBc (+), HBeAg (-), anti-HBe (+).
B HBsAg (+), anti-HBs (-), Total anti-HBc (-), HBeAg (-), anti-HBe (+).
C HBsAg (+), anti-HBs (-), Total anti-HBc (+), HBeAg (+), anti-HBe (-).
D HBsAg (-), anti-HBs (+), Total anti-HBc (-), HBeAg (-), anti-HBe (-).