Which serology pattern indicates a chronic active state of hepatitis B?

• A. +HbsAG
• B. -HbsAG +HbcAB
• C. +HbsAB
• D. +HbsAG +HbcAB

Answer: (D)

Understanding hepatitis B serology involves two key markers: HBsAg and anti-HBc. HBsAg being present means an active infection, which can be either acute or chronic. Anti-HBc shows that the person has been exposed to the virus; the presence of this antibody (especially IgG) with ongoing HBsAg suggests the infection has persisted over time. In chronic active hepatitis B, the surface antigen remains positive and the core antibody is also present, reflecting ongoing viral activity and immune response. If anti-HBs were present, that would indicate immunity or recovery, not active chronic infection. If only HBsAg is positive, chronicity isn’t confirmed, and if only anti-HBc is present, it could reflect past exposure or a window period. Therefore, the pattern of both HBsAg positive and anti-HBc positive best indicates a chronic active HBV state.