Select the patient's three-marker Hepatitis B serology result. The interpretation, clinical context, and next steps update automatically. Aligned with ASHM B Positive: Hepatitis B Guide for Primary Care (4th edition).
⚠ Use clinical judgement. Lab assays vary — pattern interpretation can be confounded by recent vaccination, window periods, or false positives. Repeat indeterminate panels. Anti-HBs <10 mIU/mL is considered non-immune. Australia: 24.5% of people living with chronic HBV are currently engaged in care (target 50%) — if you find a positive result, engaging the patient in monitoring matters.
Select results
HBsAgHepatitis B surface antigen
anti-HBcTotal core antibody
anti-HBsSurface antibody
All eight standard patterns — reference table
HBsAg
anti-HBc
anti-HBs
Interpretation
−
−
−
Susceptible (no immunity, no infection). Vaccinate.
−
−
+
Vaccinated (immunity from vaccine).
−
+
+
Past resolved infection (natural immunity).
−
+
−
Isolated anti-HBc — repeat & investigate.
+
+
−
Active infection (acute vs chronic — check anti-HBc IgM).
+
+
+
Unusual — recheck; sometimes seen during seroconversion.
+
−
−
Very early acute (window) or false positive — repeat.
+
−
+
Very unusual — repeat & consult.
Phase classifier — chronic HBV
When chronic infection is confirmed (HBsAg + for > 6 months), the phase guides monitoring and treatment. Enter the four phase markers below for the classification, the monitor-vs-treat decision, and referral guidance.
HBeAge-antigen
HBV DNAviral load (IU/mL)
ALTvs upper limit normal
FibrosisFibroScan / APRI / FIB-4
Full phase reference table
Phase
HBeAg
HBV DNA
ALT
Action
HBeAg-positive infection (immune tolerant)
+
Very high (typically >10⁷)
Normal
Monitor 6-monthly. No treatment.
HBeAg-positive hepatitis (immune clearance)
+
Elevated
Elevated
Treat — refer to s100 prescriber or specialist.
HBeAg-negative infection (inactive carrier)
− / anti-HBe +
Low (<2,000 IU/mL)
Normal
Monitor 6-monthly. Confirm stable phase over time.
HBeAg-negative hepatitis (reactivation)
−
Elevated (>2,000 IU/mL)
Elevated
Treat — refer to s100 prescriber or specialist.
Occult HBV (HBsAg-negative phase)
−
Detectable (low)
Normal
Monitor; risk of reactivation if immunosuppressed.
All people with chronic HBV need 6-monthly monitoring (ALT, HBV DNA, ± AFP/USS if HCC surveillance indicated). HCC surveillance criteria: Asian-born males >40, Asian-born females >50, Aboriginal & Torres Strait Islander people >50, African-born >20, family history of HCC, or cirrhosis at any age.
Who to test in primary care
People born in countries with HBV prevalence ≥2% (most of Asia, Africa, Pacific Islands, parts of Eastern Europe / South America)
Aboriginal and Torres Strait Islander people
Household and sexual contacts of people with HBV
People who inject drugs (current or past)
Men who have sex with men
People living with HIV or HCV
People with elevated ALT of unknown cause
Pregnant women (universal antenatal screening)
Before chemotherapy, immunosuppression (especially anti-CD20 / rituximab), biologics, or transplant
Anyone requesting testing
Order the three-marker panel together: HBsAg + anti-HBc + anti-HBs. This single combined test gives you the full picture in one go.
Treating chronic HBV — s100 pathway
Antiviral treatment of CHB (tenofovir disoproxil, tenofovir alafenamide, entecavir) is funded through Section 100 (s100). Only accredited s100 prescribers can initiate. Pathway options for primary care:
Refer to a community s100-accredited GP, hepatologist, or infectious diseases physician
Refer to a tertiary liver clinic (mandatory if cirrhosis is present)
Maintenance prescribing of an established regimen does NOT require s100 accreditation in most jurisdictions — verify locally
Clinical support — phone-a-friend
Australian Centre for Disease Control HepLink Free, gov-funded line for clinical and patient support across all hepatitis. Mon–Fri 9am–5pm. 1800 437 222 (1800 HEP ABC)
HepBhelp Online portal for Australian GPs needing further investigation/management advice on chronic HBV. hepbhelp.org.au
B Positive Guide (4th ed) ASHM's flagship primary-care reference for chronic hepatitis B — free online. hepatitisb.org.au