When a patient has HBV infection they can present in varying stages like the acute stage or the

resolution
phase. Serology is particularly useful for classifying these variant stages.

 Principle 1:
Hepatitis B surface antigen (HBsAG), is the key marker for infection. It’s the first serologic marker to
rise during the acute phase, & when a patients resolves the acute phase i.e. resolves the infection it
disappears, & if it’s present for greater than 6 months then this defines the chronic stage.

 Principle 2:
- Key marker to acute battle is IgM against the core “the way to think about this is that the core,
is the core of the matter, at least serologically”. Here you have Hepatitis B Core Antibody
(HBcAB), you can see that during the acute battle for the first 6 months, it’s the major antibody
that you use to try to defeat the virus.

- What happens during the acute phase is you producing IgM & it hammers the way at the virus
until it eventually knocks away the virus creating something called the windows phase, & the
only thing that will be positive during the window phase is IgM & then towards the end of that
battle IgG will be produced, if you have permanently destroyed the surface antigen & other
markers of the virus, then you’ll call that a resolved infection. However, again if surface antigens
are present for more than 6 months that would indicate that the patient now has chronic
disease.

 Principle 3:
- The sign of victory is the presence of IgG against the surface, & so here you have Hepatitis B
Surface Antibody (HBsAB), you get IgG only if the infection resolves, & if you go into the chronic
stage you won’t develop IgG against the surface, & so again the presence of IgG vs the surface
indicates that you have won the battle.

- Now there’s one more way to win the battle, & that would be to give immunization, remember
that in immunization, we simply give the surface antigen to the patient with nothing else, & they
will produce an IgG against the surface antigen, & then will be protected against the virus.
 Principle 4:
Whenever you have IgG against the surface it also protects you.

N.B. The envelope antigen (HBeAG) indicates infectivity, it is present during the acute phase, maybe
during the chronic phase but whenever it’s present it indicates that virus can be transmitted.