Acute Hepatitis B Infection (window period) - USMLE Forums
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Old 12-12-2012
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Virus Acute Hepatitis B Infection (window period)

I have a few PM exchanges with a member here, and we were discussing some Hepatitis B serology. This was always a confusing subject for me, but I think I have finally got it down. I made this as straight forward as I could. I might have left some minor things out.

It is my hope, that others could either add other important information to this, or correct it (if its wrong).


Lets go in bullet points (in sequence of events)

Starting with ACUTE infection:

1) you get hep b (lets say blood transfusion for example)

2) about 1 month after infection, first marker to increase will be "HbsAg" (hep b surface antigen)

3) now...after this, the next thing to spike are both "HbeAg + HBV DNA"

^^^The above two, are BOTH infective! And others are at risk of being infected!!

SO THE NEXT PART IS IMPORTANT TO UNDERSTAND: As a RULE..."HBeAg + HBV DNA" always appear AFTER HbsAg rises, and they always disappear BEFORE HbsAg falls.

Look at this:

^^^Compare the orange and pink lines. HbeAg is always inside the HbsAg, so that means it appears after, and leaves before the appearnce of HbsAg!

4) Now REMEMBER: The FIRST ANTIBODY to rise = Anti-HbcAg (CORE ANTIGEN Ab) It will be IgM (because its acute infection)

5) We said this is for ACUTE hepatitis, so that is defined by less than 6 months. In the RECOVERY phase ---> "HBeAg + HBV DNA" will BOTH decrease and disappear!

6) And as we said before, HBsAg (SURFACE antigen) leaves AFTER "HbeAg + HBV DNA" fall.

7) NOW...this brings us to the WINDOW PERIOD!!

i) HBsAg leaves,
ii) about 1 month will pass (this is the window period)
iii) Now Antibodies to HbsAg begin to appear (anti HbsAg)

^^So, the time between dissapearance of HbsAg and appearance of Anti-HbsAg = window period (and usually lasts around a month)

Notice, that in this window period, there is No HbsAg (dissapeared), No "HbeAg or HBV DNA" (both gone), there is No Anti-HbsAg (Not appeared yet) (so a person will NOT be infective during the window period - because you don't have HbeAg or HBV DNA)

There is ONLY 1 thing present in the Window Period, and that is Anti-HbcAg (CORE ANTIGEN Ab). Remember, this is the IgM type, and it was the first Antibody to appear (see bullet point 4 above).

The presence of ONLY Anti-HbcAg means you HAD hep b infection, and are now recovering.

^^^REMEMBER, this is for ACUTE hepatitis! the story is a little different for Chronic hepatitis.

to show you again, the WINDOW PERIOD is between the end of the Pink curve and the beginning of the Green curve

(approx. where HbsAg falls, and Anti-HbsAg rises) u can see around this time, the only thing elevated is Anti-HbcAg, and everything else is at low levels.

And to clarify another point, the graph in the link above makes the disctinction between the 2 types of Ig's against HbsAg

There is IgM, and IgG

IgM will rise first

and later, as the line continues, it is replaced by IgG...and then IgM will fall.

Last edited by ReggieMiller; 12-12-2012 at 03:48 PM.
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Old 09-09-2013
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efficiently put
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Old 01-28-2015
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This is a nice posts.I have a learn new thinks from this site.I share it with my all friends.I impressed by the quality of good information.Best of luck,Keep up good work.

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Old 02-14-2015
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My anti-Hbs and anti-HBC, IGM is positive since October 2014

Anti-HBC, IGM gone from 3.70 to 1.9 index (where >=1.1 is positive)
Anti-HBS gone from 67 to 83 mi/Ul (where >10 is positive)

FROM October, 2014 to February, 2015

I cannot understand this scenario. Can I get help understanding this.

HBsAg is negative and Anti-HBC, TOTAL is positive.
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Old 06-01-2015
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What about the anti-HBe during the window period? Would that also not be present along with anti-HBc during window period?
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Microbiology-, Pathology-

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