Hepatitis B, chronic

B18.1

• Description
• Diagnostic criteria
• Referral

DESCRIPTION

Persistently elevated transaminases after hepatitis B infection.

DIAGNOSTIC CRITERIA

• Transaminases are double upper limit of normal.
• Liver biopsy is characteristic.
• Hepatitis B serology positive.
  Interpretation of Hepatitis B Serological Test Results
• Susceptible:
  HBsAg negative
  Anti-HBc negative
  anti-HBs negative
  IgM anti-HBc negative
  
• Immune due to vaccination:
  HBsAg negative
  Anti-HBc negative
  anti-HBs positive > 10 milli-unit/mL
  
• Immune from natural infection:
  HBsAg negative
  Anti-HBc positive
  anti-HBs positive
  
• Acute infection:
  HBsAg positive
  Anti-HBc positive
  anti-HBs negative
  IgM anti-HBc positive
  
• Chronic infection:
  HBsAg positive
  Anti-HBc positive
  anti-HBs negative
  IgM anti-HBc negative
  
• Four possible interpretations:
  1. Recovering from acute HBV infection.
  2. Distantly immune anti-HBs level too low to detect.
  3. Susceptible with false positive anti-HBc.
  4. Chronic infection with HBsAg levels too low to detect.
     HBsAg negative
     Anti-HBc positive
     anti-HBs negative

REFERRAL

• For confirmation of diagnosis and initiation of treatment.