HBV Serology Interpreter

Interpret Hepatitis B serological markers to determine infection phase and clinical status. Includes HBsAg, HBeAg, IgM/IgG Anti-HBc, Anti-HBs, Anti-HBe, HBV DNA level, and ALT status.

Interactive Pattern Matcher

Select the result for each marker to identify the infection phase:

HBsAg

HBeAg

IgM Anti-HBc

Anti-HBs

Anti-HBe

Susceptible

Never infected, not vaccinated

Phase: No Infection

HBsAg-

HBeAg-

IgM Anti-HBc-

IgG Anti-HBc-

Anti-HBs-

Anti-HBe-

HBV DNA:-

ALT:Normal

Vaccinated / Immune

Immunity from vaccination only

Phase: Immunity

HBsAg-

HBeAg-

IgM Anti-HBc-

IgG Anti-HBc-

Anti-HBs+

Anti-HBe-

HBV DNA:-

ALT:Normal

Acute HBV — Early Phase

Active acute infection, high replication

Phase: Early

HBsAg+

HBeAg+

IgM Anti-HBc+

IgG Anti-HBc±

Anti-HBs-

Anti-HBe-

HBV DNA:+++ (High)

ALT:Increased

Acute HBV — Window Period

HBsAg cleared, Anti-HBs not yet appeared

Phase: Window

HBsAg-

HBeAg-

IgM Anti-HBc+

IgG Anti-HBc±

Anti-HBs-

Anti-HBe-

HBV DNA:+

ALT:Increased

Acute HBV — Recovery

Natural immunity from resolved acute infection

Phase: Recovery

HBsAg-

HBeAg-

IgM Anti-HBc-

IgG Anti-HBc+

Anti-HBs+

Anti-HBe+

HBV DNA:±

ALT:Normal

Chronic HBV — Immune Tolerant

High replication, minimal liver damage (HBsAg >6 months)

Phase: Immune Tolerant

HBsAg+

HBeAg+

IgM Anti-HBc-

IgG Anti-HBc+

Anti-HBs-

Anti-HBe-

HBV DNA:+++ (High)

ALT:Normal / Slightly Increased

Chronic HBV — Immune Active (HBeAg+)

Active replication with liver inflammation

Phase: Immune Active (HBeAg Positive)

HBsAg+

HBeAg+

IgM Anti-HBc-

IgG Anti-HBc+

Anti-HBs-

Anti-HBe-

HBV DNA:+++ (High)

ALT:Increased

Chronic HBV — Immune Active (HBeAg−)

Pre-core/core mutant — replication without HBeAg

Phase: Immune Active (HBeAg Negative)

HBsAg+

HBeAg-

IgM Anti-HBc-

IgG Anti-HBc+

Anti-HBs-

Anti-HBe+

HBV DNA:++ (Moderate)

ALT:Increased

Chronic HBV — Inactive Carrier

Low/no replication, minimal disease activity

Phase: Inactive Chronic

HBsAg+

HBeAg-

IgM Anti-HBc-

IgG Anti-HBc+

Anti-HBs-

Anti-HBe+

HBV DNA:− to ++ (Low)

ALT:Normal / Slightly Increased

Occult HBV Infection

HBsAg negative, DNA detectable in liver (± serum)

Phase: Occult

HBsAg-

HBeAg-

IgM Anti-HBc-

IgG Anti-HBc±

Anti-HBs±

Anti-HBe±

HBV DNA:± (serum), + in liver

ALT:Normal

Key Clinical Pearls

Window Period

IgM Anti-HBc is the ONLY detectable marker during the window period. HBsAg has cleared but Anti-HBs has not yet appeared. HBV DNA may still be positive.

Vaccine vs Natural Immunity

Vaccination: Anti-HBs ONLY. Natural recovery: Anti-HBs + IgG Anti-HBc + Anti-HBe (all positive). The presence of Anti-HBc differentiates them.

HBeAg-Negative Hepatitis

Pre-core mutant: HBeAg negative but HBV DNA moderate (++) with elevated ALT. Differentiate from inactive carrier by checking ALT and DNA levels. Requires long-term therapy.

Immune Tolerant vs Immune Active

Both have HBeAg+ and high DNA (+++). The KEY differentiator is ALT: Normal in immune tolerant, Elevated in immune active. Elevated ALT triggers treatment.

Occult HBV

HBsAg negative with HBV DNA detectable in liver (± serum). Other markers variably positive. Screen before immunosuppression — risk of fatal reactivation.

Chronic = HBsAg >6 Months

Chronic HBV is defined as HBsAg persistence for >6 months. IgG Anti-HBc replaces IgM Anti-HBc. The phase depends on HBeAg status, DNA level, and ALT.

Quick Reference Summary Table

Phase	HBsAg	HBeAg	IgM	IgG	Anti-HBs	Anti-HBe	DNA	ALT
No Infection	-	-	-	-	-	-	-	Normal
Immunity	-	-	-	-	+	-	-	Normal
Early	+	+	+	±	-	-	+++ (High)	Increased
Window	-	-	+	±	-	-	+	Increased
Recovery	-	-	-	+	+	+	±	Normal
Immune Tolerant	+	+	-	+	-	-	+++ (High)	Normal / Slightly Increased
Immune Active (HBeAg Positive)	+	+	-	+	-	-	+++ (High)	Increased
Immune Active (HBeAg Negative)	+	-	-	+	-	+	++ (Moderate)	Increased
Inactive Chronic	+	-	-	+	-	+	− to ++ (Low)	Normal / Slightly Increased
Occult	-	-	-	±	±	±	± (serum), + in liver	Normal