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INTERPRETING HEPATITIS B SEROLOGY

KY Loh, MMed(FamMed UKM), 
ST Kew, FRCP(Lond),
Dr Loh Keng Yin is from the Department of Family Medicine, while Dato’ Prof Kew Siang Tong is from the Department of Internal Medicine, International Medical University, Seremban, Malaysia

Address for correspondence: Dr Loh Keng Yin, Senior Lecturer, International Medical University, Jalan Rasah, 70300 Seremban, Malaysia. Tel: 06-7677798, Fax: 06-7677709, Email: kengyin_loh@imu.edu.my

Loh KY, Kew ST. Interpreting hepatitis B serology. Malaysian Family Physician. 2007;2(1):31-32

Hepatitis B screening is one of the most common tests performed in the primary care setting. With the availability of these tests in many private medical laboratories, patients can get them done easily. Very often, they will bring the test results to consult their family doctors for advice. The following are five clinical case scenarios which may be encountered by the primary care doctor. What is your plan of management for these cases?

Case 1
Ms. AM is a healthy health care worker from a community health clinic. She comes with the following results of hepatitis B screening.
HBs Antigen NEGATIVE
Anti-HBs Antibody NEGATIVE

What is your advice to her?

Case 2
Mr. BA underwent pre-employment health assessment. He shows you the following results:
HBs Antigen NEGATIVE
Anti-HBs Antibody POSITIVE. Titre: 5 mIU/mL
Anti-HBc Antibody NEGATIVE

What is your advice to him?

Case 3
Mr. KC shows you the following results. He has past history of intravenous drugs use. Currently he is asymptomatic.
HBs Antigen NEGATIVE
HBe Antigen NEGATIVE
Anti-HBs Antibody POSITIVE. Titre: 50 mIU/mL
Anti-HBc Antibody POSITIVE

What is your management plan?

Case 4
Mr. LD was admitted to hospital 8 months ago for acute jaundice. He was diagnosed with hepatitis B infection and subsequently discharged from hospital without any complications. Today he comes to the clinic with these blood tests done three days ago.
HBs Antigen POSITIVE
HBe Antigen POSITIVE
Anti-HBs Antibody NEGATIVE
Anti-HBe Antibody NEGATIVE

What is your conclusion and what is the management plan for him?

Case 5
Madam YK was diagnosed with chronic hepatitis B two years ago. The records from the hospital follow up last year showed the following result:
HBs Antigen POSITIVE
HBe Antigen POSITIVE
Anti-HBs Antibody NEGATIVE
Anti-HBe Antibody NEGATIVE

Today Madam YK shows you her latest blood test which was done one week ago:

HBs Antigen POSITIVE
HBe Antigen NEGATIVE
Anti HBs Antibody NEGATIVE
Anti HBe Antibody POSITIVE

Liver enzyme:
ALT  40 IU/L   (Normal: < 45 IU/L)
AST  45 IU/L   (Normal:< 45 IU/L)

What is your conclusion?

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