Step I HBV serology question

[HiddenTruth]

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Couple of q's:

1. During the convolescent phase, or "window" period, are BOTH Anti-HBc and Anti HBe present, or only Anti-HBc?

2. So, I am a bit confused about Anti-HBc. Are there two titers of Anti-HBc, IgM being the initial one (lasting 3-5 months) followed by IgG a couple of weeks after IgM appears, which persists for life? Or, does the IgM CONVERT to IgG 3-5 months ater it first appears, and then IgG persisting for life (or how many ever years)?

3. Is there anything else abnormal other than the persistence of HBs Ag (with HbeAg or Anti-HBe) beyond 6 mos to have chronic hepatitis? (I guess what I am asking is, whether there is any change or shifts in Anti-HBc titers in acute hepatitis that is resolved vs. chronic).

4. Is there a criteria, like number of years, or something before you develop hepatocellular carcinoma with chronic hepatitis?

5. I should know these time changes that correlate with different titiers really well, eh? Gosh, I always forget this stuff. 😎

Thanks.

 

[smgilles]

Couple of q's:

1. During the convolescent phase, or "window" period, are BOTH Anti-HBc and Anti HBe present, or only Anti-HBc?

2. So, I am a bit confused about Anti-HBc. Are there two titers of Anti-HBc, IgM being the initial one (lasting 3-5 months) followed by IgG a couple of weeks after IgM appears, which persists for life? Or, does the IgM CONVERT to IgG 3-5 months ater it first appears, and then IgG persisting for life (or how many ever years)?

3. Is there anything else abnormal other than the persistence of HBs Ag (with HbeAg or Anti-HBe) beyond 6 mos to have chronic hepatitis? (I guess what I am asking is, whether there is any change or shifts in Anti-HBc titers in acute hepatitis that is resolved vs. chronic).

4. Is there a criteria, like number of years, or something before you develop hepatocellular carcinoma with chronic hepatitis?

5. I should know these time changes that correlate with different titiers really well, eh? Gosh, I always forget this stuff. 😎

Thanks.

1. Only Anti-HBc is present during the "window" period because antibodies to HBeAg and HBsAg are obscured since the antibody is complexed w/antigen in the serum. The best way to diagnose a recent acute infection, is to measure IgM anti-HBc, especially during the "window" period.

2. I imagine if the infection hasn't cleared you get isotype switching of IgM anti-HBc to IgG anti-HBc, but the best way to establish chronic infection is by the continued finding of HBeAg, HBsAg, or both and lack of detectable antibody to these antigens.

3. The continued finding (>6months) of HBsAg and HBeAg is what distinguishes chronic infection. HBcAg role is to provide informtion pertaining to a recent acute infection of HBV.

4. Only 5-10% w/HBV go chronic and about 80% of those are attributed to Primary Hepatocellular Carcinoma. The latency period b/w HBV infection and PHC is 9-35 years.

Hope this helps.

 

[HiddenTruth]

3. The continued finding (>6months) of HBsAg and HBeAg is what distinguishes chronic infection. HBcAg role is to provide informtion pertaining to a recent acute infection of HBV.

Cool, thanks for the clarification.

I do think that you can have chronic hepatitis with HBs ag (>6 mos) and negative HBe ag/HBV DNA. I think this state is classified as "healthy carrier", in which the risk of transmission of virus is very low(e.g vertical transmission btwn mother and child). And, likewise a person with positive HBs Ag (> 6 mos), and positive HBe ag/HBV DNA is considered an "infective carrier", in whom the risk of transmission and infectivity is extremely high.

I don't think you need to be positive for BOTH HBs ag and HBe ag (only HBs ag for > 6 mos is the criteria) to be considered as being a chronic carrier/state. Someone correct me if I am wrong. Thanks.

 

[smgilles]

Cool, thanks for the clarification.

I do think that you can have chronic hepatitis with HBs ag (>6 mos) and negative HBe ag/HBV DNA. I think this state is classified as "healthy carrier", in which the risk of transmission of virus is very low(e.g vertical transmission btwn mother and child). And, likewise a person with positive HBs Ag (> 6 mos), and positive HBe ag/HBV DNA is considered an "infective carrier", in whom the risk of transmission and infectivity is extremely high.

I don't think you need to be positive for BOTH HBs ag and HBe ag (only HBs ag for > 6 mos is the criteria) to be considered as being a chronic carrier/state. Someone correct me if I am wrong. Thanks.

You are correct in your statements here. I should have clarified better.