[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Liver and gallbladder](https://durgical.com/en/general-pathology/areas/liver/) › Hepatitis B and D

# Hepatitis B and D

- Topic

Hepatitis B hides in liver cell nuclei; the immune attack on infected cells, not the virus itself, damages the liver.

Updated Nov 12, 2026

## Key points

- HBsAg: infection present (acute or chronic); anti-HBs: immunity (recovery or vaccine).
- IgM anti-HBc: recent infection, and the only marker in the window period between HBsAg loss and anti-HBs appearance.
- HBeAg and HBV DNA: active replication and high infectivity; anti-HBe: lower replication.
- Chronic infection: HBsAg for more than six months.
- HBV raises HCC risk even without cirrhosis, through DNA integration and the HBx protein.
- Coinfection (HBV and HDV together) usually clears; superinfection of an HBV carrier often becomes chronic and severe.

On this page

- The basics Key points
- What it is
- Structure
- Step by step
- Reading hepatitis B serology
- Markers
- Memory aid
- Elsewhere in DurgiPedia

- Clinical Clinical notes

- Study Test yourself

- Connections Connections

## What it is

Hepatitis B virus is a DNA virus that keeps a stable copy of its genome (cccDNA) in the hepatocyte nucleus and can integrate into host DNA. The virus is not directly cytopathic: liver damage comes from cytotoxic T cells killing infected hepatocytes. Age at infection decides the outcome: most infections at birth become chronic, most adult infections resolve. The serologic markers trace each phase and are a must-know table. Hepatitis D needs HBV and makes its course worse.

## Structure

- Ground-glass hepatocytes: finely granular pale pink cytoplasm full of HBsAg in the endoplasmic reticulum (chronic infection).
- Sanded nuclei from abundant core antigen, seen in some chronic infections.
- Otherwise the pattern of acute or chronic hepatitis: lobular inflammation, acidophil bodies, interface hepatitis.

## Step by step

- The virus enters hepatocytes through the bile acid transporter NTCP.
- Its genome becomes cccDNA in the nucleus, a long-lived template for viral RNA.
- Viral proteins are made; excess HBsAg circulates as non-infectious particles.
- Cytotoxic T cells recognize viral peptides and kill infected hepatocytes: hepatitis.
- A strong response clears the virus; a weak or tolerant one (as in newborns) lets it persist.
- Years of inflammation, regeneration and DNA integration lead to cirrhosis and hepatocellular carcinoma.

## Reading hepatitis B serology

| Pattern | HBsAg | Anti-HBs | Anti-HBc | HBeAg |
| --- | --- | --- | --- | --- |
| Acute infection | Positive | Negative | IgM positive | Usually positive |
| Window period | Negative | Negative | IgM positive | Negative |
| Recovered, immune | Negative | Positive | IgG positive | Negative |
| Vaccinated | Negative | Positive | Negative | Negative |
| Chronic, replicative | Positive (over six months) | Negative | IgG positive | Positive (or HBeAg-negative with high DNA in precore mutants) |
| Chronic, low replication | Positive | Negative | IgG positive | Negative, anti-HBe positive |

## Markers

- HBsAg immunostain
- HBcAg immunostain
- Orcein or Victoria blue (HBsAg)

## Clinical notes

- Extrahepatic immune-complex disease: polyarteritis nodosa, membranous glomerulonephritis.
- Spread: blood, sex, mother to child at birth; vaccination at birth prevents most perinatal infection.

## Memory aid

S for Surface (sick now), anti-S for Safe, core IgM for 'Currently' infected, e for 'easily spread'.

## Test yourself

Think of the answer, then tap the question to see it.

## Which marker is the only positive one in the window period of hepatitis B?

IgM anti-HBc (antibody to the core antigen).

## How do you tell vaccination from past infection on serology?

Both have anti-HBs, but only past infection has anti-HBc; vaccine contains only surface antigen.

## What causes liver cell damage in hepatitis B?

The host's cytotoxic T cells attacking infected hepatocytes; the virus itself is not directly cytopathic.

## Why is HDV superinfection worse than coinfection?

In a chronic HBV carrier HBsAg is always present, so HDV replicates freely and the infection tends to become chronic and severe.

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## Elsewhere in DurgiPedia

- [Type III hypersensitivity (immune complexes)](https://durgical.com/en/immunology/type-iii-hypersensitivity/)

## Connections

## Related 4

- [Hepatitis viruses A to E: the comparison table](https://durgical.com/en/general-pathology/hepatitis-viruses-a-to-e-the-comparison-table/)
- [Viral hepatitis on biopsy: acute and chronic](https://durgical.com/en/general-pathology/viral-hepatitis-on-biopsy-acute-and-chronic/)
- [Hepatocellular carcinoma](https://durgical.com/en/general-pathology/hepatocellular-carcinoma/)
- [Oncogenic viruses and H. pylori: the table to know](https://durgical.com/en/general-pathology/oncogenic-viruses-and-h-pylori-the-table-to-know/)

## Related conditions 6

- [Viral hepatitis](https://durgical.com/en/conditions/viral-hepatitis/)
- [Hepatocellular carcinoma](https://durgical.com/en/conditions/hepatocellular-carcinoma/)
- [Polyarteritis nodosa](https://durgical.com/en/conditions/polyarteritis-nodosa/)
- [Membranous nephropathy](https://durgical.com/en/conditions/membranous-nephropathy/)
- [Cirrhosis](https://durgical.com/en/conditions/cirrhosis/)
- [Acute liver failure](https://durgical.com/en/conditions/acute-liver-failure/)

## Microorganisms 2

- [Hepatitis B virus](https://durgical.com/en/microbiology/hepatitis-b-virus/)
- [Hepatitis D virus](https://durgical.com/en/microbiology/hepatitis-d-virus/)

[← All of general pathology](https://durgical.com/en/general-pathology/)

Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Hepatitis B: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000279.htm) (MedlinePlus, US National Library of Medicine, 2026); [Hepatitis D (Delta agent): MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000216.htm) (MedlinePlus, US National Library of Medicine, 2026); [Hepatitis B](https://www.who.int/news-room/fact-sheets/detail/hepatitis-b) (World Health Organization, 2026).

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Representative model, for educational purposes only.

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