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MARKER HBsAg (envelope protein of virion)also known as hepatitis B 's' or surface antigen ACUTE INFECTION Present during acute infection. CHRONIC INFECTION GENERAL NOTES Always present in chronic Indicates person is potentially infectious. infection. Useful for diagnosis of HBV infection. Can be detected for several weeks before symptoms of acute infection. Used in vaccines to elicit a protective antibody response. Anti-HBs (antibody to HBsAg) also known as HBsAb or 'surface antibody' HBcAg (nucleocaspid of virion) also known as hepatitis B 'c' or core antigen Anti-HBc (antibody to core antigen) Appearance 1-4 months after start of symptoms indicates recovery and subsequent immunity to hepatitis B virus infection.In people who are recovering from acute hepatitis B virus infection, surface antibody usually appears after surface antigen has disappeared. Can neutralise hepatitis B virus. Protects against reinfection. Marker of immunity against hepatitis B virus (is used to assess response to vaccination). Not detectable in serum so is detected indirectly via presence of core antibody. Usually anti-HBc IgM indicates recent infection.Appears soon after surface antigen and may be only marker of infection in 'window period' after surface antigen disappears and before Two classes: anti-HBc IgM, and anti-HBc surface antibody appears. IgG also known as HBcAb or 'core antibody' HBeAg (water-soluble form of core Detectable in early phase of hepatitis B virus infection, shortly protein - secreted by cells infected with after surface antigen appears. At this early stage it indicates an hepatitis B virus)also known as hepatitis active acute infection, at its most infectious period. B 'e' antigen Anti-HBe (antibody to HBeAg) Indicates infection is likely to resolve spontaneously. also known as HBeAb or 'e antibody Never detectable in chronic infection. Anti-HBc IgG is always present in chronic infection. Anti-HBc IgM is not present. Anti-HBc indicates past or present infection i.e. the person has been in contact with the virus. Anti-HBc testing identifies all previously infected people but does not differentiate between carriers and non-carriers. Positivity in chronic infection Treatment for e antigen positivity aims to convert to e antigen is always associated with negativity. high levels of virus. In chronic infection its presence usually (but not always) indicates that the level of virus is likely to be low. Transition from e antigen to e antibody positivity usually indicates that virus production has decreased significantly. But e antibody may be associated with low or high viral DNA levels (usually low). e antibody positivity with high viral DNA levels is likely to require treatment.