A 42-year-old man presents to his GP complaining of persistent lethargy. Routine bloods show abnormal liver function tests so a hepatitis screen is sent. The results are shown below:
Anti-HAV IgG negative
HBsAg negative
Anti-HBsAb positive
Anti-HBcAg negative
Anti-HCV positive
What do these results most likely demonstrate?
A. Hepatitis B infection
B. Hepatitis C infection
C. Previous vaccination to hepatitis B and C
D. Hepatitis C infection with previous hepatitis B vaccination
E. Hepatitis B and C infection
Answer:
D. Hepatitis C infection with previous hepatitis B vaccination
Discussion: Given the deranged liver function tests these results most likely indicate previous hepatitis B vaccination with active hepatitis C infection. However, around 15% of patients exposed to the hepatitis C virus clear the infection. It would therefore be necessary to perform a HCV PCR to see if the virus is still present. There is currently no vaccination for hepatitis C.
Interpreting hepatitis B serology:
surface antigen (HBsAg) is the first marker to appear and causes the production of anti-HBs
HBsAg normally implies acute disease (present for 1-6 months)
if HBsAg is present for > 6 months then this implies chronic disease (i.e. Infective)
Anti-HBsAb implies immunity (either exposure or immunisation). It is negative in chronic disease Anti-HBc implies previous (or current) infection. IgM anti-HBcAg appears during acute or recent hepatitis B infection and is present for about 6 months
HbeAg results from breakdown of core antigen from infected liver cells as is therefore a marker of infectivity
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