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Table 5 – STI Treatment Guidelines

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Interpretation of serologic test results* for hepatitis B virus infection

Table 5
Serologic marker Interpretation
HBsAg Total anti-HBc IgM anti-HBc Anti-HBs
– – – – Never infected
+† – – – Early acute infection; transient (≤18 days) after vaccination
+ + + – Acute infection
– + + – Acute resolving infection
– + – + Recovered from past infection and immune
+ + – – Chronic infection
– + – – Past infection; low-level chronic infection§; passive transfer to infant born to HBsAg-positive mother; false positive (no infection)
– – – + Immune if concentration is >10 mIU/mL after vaccination, passive transfer after HBIG administration

Source: Adapted from Schillie S, Vellozzi C, Reingold A, et al. Prevention of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep 2018;67(No. RR-1).

Abbreviations: anti-HBc = antibody to hepatitis B core antigen; anti-HBs = antibody to hepatitis B surface antigen; HBIG = hepatitis B immune globulin; HBsAg = hepatitis B surface antigen; IgM = immunoglobulin M.

* – = negative test result; + = positive test result.

† To ensure that an HBsAg-positive test result is not false positive, samples with repeatedly reactive HBsAg results should be tested with a neutralizing confirmatory test cleared by the Food and Drug Administration.

§ Persons positive for only anti-HBc are unlikely to be infectious, except under unusual circumstances involving direct percutaneous exposure to large quantities of blood (e.g., blood transfusion or organ transplantation) or mutant HBsAg-related infection.

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