Atypical serological profiles in hepatitis B virus infection
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REVIEW
Atypical serological profiles in hepatitis B virus infection Robério A. A. Pondé
Received: 27 September 2012 / Accepted: 12 November 2012 / Published online: 29 November 2012 # Springer-Verlag Berlin Heidelberg 2012
Abstract During hepatitis B virus (HBV) infection, at least four antigen–antibody systems are observed: HBsAg and anti-HBs; preS antigen and anti-preS antibody; HBcAg and anti-HBc; and HBeAg and anti-HBe. Through the examination of these antigen–antibody systems, hepatitis B infection is diagnosed and the course of the disorder may be observed. Although the serologic findings that allow both the diagnosis of HBV infection as well as assessing of its clinical course are already well established, the dynamics of viral proteins expression and of the antibodies production may vary during the infection natural course. This causes the HBV infection to be occasionally associated with the presence of uncommon serological profiles, which could lead to doubts in the interpretation of results or suspicion of a serological result being incorrect. This paper is dedicated to the discussion of some of these profiles and their significance.
Introduction The natural course of hepatitis B virus (HBV) infection is determined by the inter-relationship between viral replication via HBV protein production and the host’s immune R. A. A. Pondé Laboratório de Virologia Humana, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia-Goiás, Brazil R. A. A. Pondé Gerência de Hepatites Virais, SUVISA - Superintendência de Vigilância em Saúde - Secretaria Estadual de Saúde, Goiânia-Go, Brazil R. A. A. Pondé (*) Sorologia e Biologia Molecular, Central Goiana de Sorologia, Rua 7A Edifício RIOL, N° 158, 1° andar, sala 101, Setor aeroporto, Goiânia-Goiás 74075-030, Brazil e-mail: [email protected]
response, and, therefore, clinical practice diagnosis of HBV infection is established by the serological detection of HBV protein products (antigens) as well as hostproduced antibodies. During HBV infection, four structural antigen–antibody systems are observed: hepatitis B surface antigen (HBsAg) and its antibody (anti-HBs); the preS antigens associated with HBsAg particles and their antibodies; the particulate nucleocapsid antigen (HBcAg) and anti-HBc; and an antigen structurally related to HBcAg, namely, hepatitis B e antigen (HBeAg) and its antibody (anti-HBe). Through the examination of these antigen–antibody systems, hepatitis B infection is diagnosed and the course of the disorder may be observed Classically, 8–9 weeks following the infection, in the incubation period or 3–5 weeks before biochemical evidence of liver dysfunction and the appearance of clinical symptoms, it is possible to detect HBsAg in serum. HBsAg detection is used for the diagnosis of acute and chronic HBV and indicates potential infectiousness. In patients who subsequently recover from HBV infection, HBsAg usually becomes undetectable after 4–6 months [1]. If HBsAg persists for more than 6 months, spontaneous clearance
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