NOTE :

We are currently translating the 2009-2010 "Medical Management of HIV Infection" into a web-ready format. We will post each chapter as it is completed. To make any comments or suggestions click here

  HOME
Previous         54         Next
dkfhkd

Discussion Thread

infection, injection drug use, MSM, persons with clotting disorders, persons with chronic liver disease, and travelers to HAV-endemic areas (MMWR 1996;45[RR- 15]:1). Some authorities believe that all HIV-infected persons who are susceptible should be vaccinated. The prevalence of anti-HAV lgG is 40- 70% in adults in the US and most European countries (Clin Infect Dis 1997;25:726; MMWR 1999;48:[RR-12]:1). To diagnose acute hepatitis the preferred test is anti-HAV IgM. The anti-HAV IgG becomes positive at 8 to 16 weeks. 

HBV TESTS:

  • HBsAg: Indicates acute or chronic HBV infection
  • Anti-HBs (HBsAb): Indicates immunity to HBV due to prior infection or immunization.
  • Anti-HBc (HBcAb): Usually indicates immunity to HBV due to infection, not immunization. False positives can occur in nonimmune individuals. Can also be positive in patients with chronic HBV infection.
  • HBeAg: Indicates infection with high rate of infectivity and of viral replication.
  • Anti-HBe (HBeAb): May be present with chronic infection or immunity. Main use is chronic infection in whom HBV DNA indicates low viral titer and low degree of infectivity.
  • HBV DNA: Marker of viral replication.
  • Anti-HBc lgM: Indicates recent infection (within 6 months).

TABLE 2-18:

Interpretation of tests
Test Results          
HBsAg ----- ----- ----- + + -----
Anti-HBc ----- ----- + + + +
Anti-HBc lgM       + -----  
Anti-HBsAg -* +** + ----- ----- -----
Interpretation Susceptible Immune
due to
vaccination		 Immune
due to
infection		 Acute
HBV		 Chronic
HBV		 See***
Vaccinate Yes No No No No See***

*Some patients with prior immunization will have negative serology due to waning humoral
immunity but appear protected by CMI (Ann Intern Med 2005; 142:333)

**Titer ≥ 10 IU/ml: Post vaccination testing, if done, should be at 1-2 months after last dose.

***Possibilites: 1) May be recovering from acute HBV,2) Distant immunity 3) False positive anti-HBc (non-immune) 4) chronic HBV with undetectable HBsAg (check HBV DNA). Recommend clinical judgement regarding vaccination.
2007 © John G. Bartlett, M.D. All rights reserved.54

Chapter 2: Laboratory Tests

Page 54 of 58 (0 Posts)

Add Thread | View All Threads

 

ImagesThreadsNamePostsDate

No Threads...