# HBV Serology Tool

Select marker results to see educational possibilities and next-step questions to discuss with a clinician.

This tool is for health education only and does not provide a personal diagnosis or treatment advice. Please consult a qualified doctor for individual medical decisions.

- HBsAg: positive / negative / unknown; IU/mL or S/CO
- Anti-HBs: positive / negative / unknown; mIU/mL
- HBeAg: positive / negative / unknown; S/CO
- Anti-HBe: positive / negative / unknown; S/CO
- Anti-HBc: positive / negative / unknown; S/CO

Quantitative values are recorded only to preserve report context. Except for the commonly used post-vaccination Anti-HBs reference threshold of 10 mIU/mL, this tool does not replace the laboratory reference range, assay notes, or clinician judgment.

- HBsAg: Hepatitis B surface antigen. A positive result may suggest current HBV infection.
- Anti-HBs: Hepatitis B surface antibody. Positivity may be seen after vaccination or recovery from past infection.
- Anti-HBc: Hepatitis B core antibody. Positivity suggests past or current exposure to HBV; vaccination alone usually does not make it positive.
- HBeAg: Hepatitis B e antigen. Often used with HBV DNA to assess viral replication.
- Anti-HBe: Hepatitis B e antibody. Interpret together with HBeAg, HBV DNA, and liver tests.

### Pattern may suggest current HBV infection

HBsAg and anti-HBc positivity may be seen in current HBV infection, but this pattern cannot determine acute versus chronic infection by itself.

- This may suggest current HBV infection.
- Further testing and clinical history are needed before any conclusion.
- Discuss HBV DNA, ALT/AST, bilirubin, platelet count, liver ultrasound, and fibrosis assessment with a doctor.
- Ask a qualified clinician whether specialist liver or infectious disease care is appropriate.

It cannot determine acute versus chronic infection, infectiousness, whether treatment is needed, whether medicine can be stopped, or replace a clinician's assessment using history, full tests, and local guidance.

### Pattern may suggest current HBV infection with viral replication

HBsAg, anti-HBc, and HBeAg positivity may be seen when HBV is actively replicating. HBV DNA testing is needed to understand viral level.

- This may suggest current HBV infection.
- HBeAg positivity may suggest active viral replication.
- Seek medical evaluation and HBV DNA testing.
- Do not start, stop, or change antiviral medicine without a qualified clinician.

It cannot determine acute versus chronic infection, infectiousness, whether treatment is needed, whether medicine can be stopped, or replace a clinician's assessment using history, full tests, and local guidance.

### Pattern may suggest current HBV infection with HBeAg negativity

HBsAg and anti-HBc positivity may suggest current HBV infection. HBeAg negativity with anti-HBe positivity may be seen with lower replication or HBeAg-negative chronic hepatitis B, but HBV DNA and liver tests are still needed.

- This may suggest current HBV infection.
- HBeAg negativity does not mean there is no viral replication or no need for follow-up.
- Discuss HBV DNA, ALT/AST, liver ultrasound, and fibrosis assessment with a doctor.
- Follow medical advice for monitoring and do not change treatment on your own.

It cannot determine acute versus chronic infection, infectiousness, whether treatment is needed, whether medicine can be stopped, or replace a clinician's assessment using history, full tests, and local guidance.

### Pattern needs confirmation: HBsAg positive but anti-HBc negative

HBsAg positivity with anti-HBc negativity is uncommon and may be seen with very early infection, testing error, false positivity, or incomplete data.

- This is not enough for a clear interpretation by itself.
- The result and timing may need confirmation.
- Consider repeating HBsAg and anti-HBc total/IgM and adding HBV DNA.
- Review the full report with a clinician, especially after recent exposure or symptoms.

It cannot determine acute versus chronic infection, infectiousness, whether treatment is needed, whether medicine can be stopped, or replace a clinician's assessment using history, full tests, and local guidance.

### HBsAg positivity needs further evaluation

HBsAg positivity may suggest current HBV infection, but anti-HBc, HBV DNA, liver tests, and prior results are important for interpretation.

- This may suggest current HBV infection.
- The current inputs are not enough to determine stage or treatment need.
- Confirm anti-HBc, HBeAg, anti-HBe, HBV DNA, and ALT/AST.
- Ask a doctor to interpret results with history and local guidance.

It cannot determine acute versus chronic infection, infectiousness, whether treatment is needed, whether medicine can be stopped, or replace a clinician's assessment using history, full tests, and local guidance.

### Pattern may suggest immunity from vaccination

HBsAg negativity with anti-HBs positivity and anti-HBc negativity may be seen after successful hepatitis B vaccination.

- This may suggest vaccine-derived immunity.
- Clinical context and exact lab thresholds still matter.
- Keep a copy of vaccination and lab records.
- Ask a clinician if booster or repeat testing is needed for your situation.

It cannot determine acute versus chronic infection, infectiousness, whether treatment is needed, whether medicine can be stopped, or replace a clinician's assessment using history, full tests, and local guidance.

### Pattern may suggest past infection and recovery

HBsAg negativity with anti-HBs and anti-HBc positivity may be seen after past HBV infection and recovery.

- This may suggest past HBV exposure with recovery.
- Some people need follow-up in special situations such as immunosuppression.
- Discuss the result with a doctor, especially before chemotherapy, immune-suppressing treatment, or pregnancy.
- Ask whether HBV DNA or liver tests are needed.

It cannot determine acute versus chronic infection, infectiousness, whether treatment is needed, whether medicine can be stopped, or replace a clinician's assessment using history, full tests, and local guidance.

### Pattern may suggest no evidence of infection or immunity

When HBsAg, anti-HBs, and anti-HBc are all negative, the pattern may suggest no current infection and no detectable immunity.

- This may suggest susceptibility to HBV.
- Vaccination may be appropriate depending on age, risk, and local guidance.
- Discuss hepatitis B vaccination with a clinician.
- Consider repeat or confirmatory testing if exposure was recent.

It cannot determine acute versus chronic infection, infectiousness, whether treatment is needed, whether medicine can be stopped, or replace a clinician's assessment using history, full tests, and local guidance.

### Pattern may suggest isolated anti-HBc positivity

HBsAg negative, anti-HBs negative, and anti-HBc positive is often called isolated core antibody positivity. It may be seen after past infection with waning antibody, false positivity, window period, or rarely occult infection.

- This may suggest prior HBV exposure.
- False positivity or recent infection window period may need to be considered.
- Discuss repeat anti-HBc, anti-HBs, and possible HBV DNA testing with a clinician.
- Tell a doctor before chemotherapy, immune-suppressing treatment, or transplant evaluation.

It cannot determine acute versus chronic infection, infectiousness, whether treatment is needed, whether medicine can be stopped, or replace a clinician's assessment using history, full tests, and local guidance.

### Pattern may suggest antibody protection, but source is unclear

HBsAg negativity with anti-HBs positivity may suggest immunity, but when anti-HBc is unknown or the pattern is incomplete, the source of immunity cannot be determined.

- This may suggest detectable anti-HBs antibody.
- Whether immunity came from vaccination or past infection depends on anti-HBc and history.
- Review quantitative anti-HBs and anti-HBc results.
- Consult a clinician if immunosuppression, pregnancy, or recent exposure is relevant.

It cannot determine acute versus chronic infection, infectiousness, whether treatment is needed, whether medicine can be stopped, or replace a clinician's assessment using history, full tests, and local guidance.

### Pattern needs clinical context

This combination is incomplete or less specific. HBV serology interpretation depends on complete testing, timing, symptoms, vaccination history, and local lab thresholds.

- This may require repeat or additional testing.
- A definitive diagnosis cannot be made from this tool.
- Review the full lab report with a qualified doctor.
- Ask whether HBV DNA, ALT/AST, and repeat serology are needed.

It cannot determine acute versus chronic infection, infectiousness, whether treatment is needed, whether medicine can be stopped, or replace a clinician's assessment using history, full tests, and local guidance.

## Evidence sources

- [CDC Hepatitis B Prevention and Control](https://openhbv.com/sources/cdc-hepatitis-b-prevention-and-control.md?locale=en) — https://www.cdc.gov/hepatitis-b/prevention/index.html
- [CDC Hepatitis B Testing and Diagnosis](https://openhbv.com/sources/cdc-hepatitis-b-testing-and-diagnosis.md?locale=en) — https://www.cdc.gov/hepatitis-b/hcp/diagnosis-testing/index.html
- [CDC Hepatitis B Vaccine Administration](https://openhbv.com/sources/cdc-hepatitis-b-vaccine-administration.md?locale=en) — https://www.cdc.gov/hepatitis-b/hcp/vaccine-administration/index.html
- [WHO Hepatitis B Fact Sheet](https://openhbv.com/sources/who-hepatitis-b-fact-sheet.md?locale=en) — https://www.who.int/news-room/fact-sheets/detail/hepatitis-b