Precore/core mutation relatedness to viral reactivation in patients undergoing targeted therapy for hepatitis B virus-related hepatocellular carcinoma

Table 1 Hepatitis B serologic testing involves measurement of several hepatitis B virus-specific antigens and antibodies. Different serologic markers or combinations of markers are used to identify different phases of hepatitis B virus infection and to determine whether a patient has acute or chronic hepatitis B virus infection, is immune to hepatitis B virus as a result of prior infection or vaccination, or is susceptible to infection

Test profile	HbsAg	Anti-HBs	Anti-HBc (total)	Anti-HBc (IgM only)	HBeAg	Anti- HBe	Interpretation
Acute, non-enteric or type unknown	-			-			Acute hepatitis A
	+			+			Acute hepatitis B1
	-			-			Acute or chronic hepatitis C with co-existing acute illness of other etiology2
	-			-			Consider early hepatitis C or hepatitis E, CMV, or EBV2
Chronic, type B screen	+		+		+	-	Chronic hepatitis B, active replicating virus1,3
	+		+		-	+	Chronic hepatitis B, non-replicating virus1,3
Chronic, type unknown	+	-	+	-			Chronic hepatitis B1,3
	-	-	-	NT			Chronic hepatitis C4
	-	-	-	NT			Consider non-viral causes of chronic hepatitis
	+	-	+	-			Chronic HBV and HCV co-infection1,3,4
	-	+	+	+	-		Chronic hepatitis C4 and exposure to HBV with recovery/immunity
HBV immunity screen		+					Immune to HBV
HAV immunity screen							Immune to HAV
Previous hepatitis exposure screen	-	-	-				Exposure to HAV with recovery/immunity
	-	-	-				Recent hepatitis A
	-	-	-				Exposure to HCV with recovery or chronicity
	+	-	-				Exposure to HBV, early infection, asymptomatic
	+	-	+	-			Hepatitis B, chronic or carrier state
	+	-	+	+			Acute hepatitis B1
	-	+/-	+	-			Exposure to HBV with recovery/immunity
	-	-	+	+			Early acute hepatitis B (core window)
	-	-	-				Consider non-viral causes of previous hepatitis

¹Consider hepatitis delta virus (delta) co-infection.

²Consider hepatitis E immunoglobulin M Ab test.

³Consider hepatitis B virus DNA test.

⁴Consider hepatitis C virus RNA test.

The presence of hepatitis B surface antigen (HBsAg) indicates that the person is infectious. The body normally produces antibodies to HBsAg as part of the normal immune response to infection. HBsAg is the antigen used to make hepatitis B vaccine. The presence of hepatitis B surface antibody is generally indicating recovery and immunity from hepatitis B virus (HBV) infection. Anti-hepatitis B surface also develops in a person who has been successfully vaccinated against hepatitis B. Total hepatitis B core antibody (anti-HBc): Appears at the onset of symptoms in acute hepatitis B and persists for life. The presence of anti-HBc indicates previous or ongoing infection with HBV in an undefined time frame. Immunoglobulin M antibody to hepatitis B core antigen (immunoglobulin M anti-HBc): Positivity indicates recent infection with HBV (< 6 months). Its presence indicates acute infection. HBsAg: Hepatitis B surface antigen, it can be detected in high levels in serum during acute or chronic hepatitis B virus infections; Anti-HBs: Hepatitis B surface antibody; Anti-HBc: Hepatitis B core antibody; IgM: Immunoglobulin M; HBeAg: Hepatitis B e antigen; Anti HBe: Hepatitis B e antibody; CMV: Cytomegalovirus; EBV: Epstein-Barr virus; NT: Not tested; HBV: Hepatitis B virus; HCV: Hepatitis C virus; HAV: Hepatitis A virus.