DGRC
AddressSinamangal-9, Kathmandu, Nepal
Call us01-4116637, 9808250408

Hepatitis B

Hepatitis B virus (HBV) tests may be used for a variety of reasons. Some of the tests detect antibodies produced in response to HBV infection; some detect antigens produced by the virus, and others detect viral DNA.

The main uses for HBV tests include:

  • To determine whether acute signs and symptoms are due to HBV infection; two tests, hepatitis B surface Ag and hepatitis B core antibody IgM, may be performed as part of an acute viral hepatitis panel along with tests for hepatitis A (HAV) and hepatitis C (HCV) to determine which virus may be causing the infection.

  • To diagnose chronic HBV hepatitis.

  • To monitor chronic hepatitis B infection and its treatment.

  • To detect previous exposure to hepatitis B, in a person who is immune compromised (when the virus can become reactivated).

Some of the secondary reasons to perform testing include: to screen for hepatitis B infection in at-risk populations or in blood donors, to determine if someone is a carrier, to detect previous infection (with subsequent immunity), and to determine if immunity has developed due to vaccination.

Generally, one set of tests is used as an initial panel of tests to detect HBV infection or to determine the cause of acutesymptoms while another set of tests may be used after a diagnosis is made to monitor possible progression of the disease, to detect chronic infection, and/or to determine carrier status.

The following table summarizes the set of tests typically used for initial testing:

Test

 

Description

 

Use and Comments

 

Hepatitis B surface antigen (HBsAG)

Detects protein that is present on the surface of the virus

To screen for, detect, and help diagnose acute and chronic HBV infections; earliest routine indicator of acute hepatitis B and frequently identifies infected people before symptoms appear; undetectable in the blood during the recovery period; it is the primary way of identifying those with chronic infections, including "HBV carrier" state.

Hepatitis B

surface

antibody (anti-

HBs)

Detects antibody produced in response to HBV surface antigen

Used to detect previous exposure to HBV; it can also develop from successful vaccination so it is used to determine the need for vaccination (if anti-HBs is absent) or to determine if a person has recovered from an infection and is immune (cannot get the infection again).

Total anti-

hepatitis B

core (anti-

HBc, IgM

and IgG)

Detects both IgM and IgG antibodies to hepatitis B core antigen

Can be used to help detect acute and chronic HBV infections; the IgM antibody is the first antibody produced after infection with HBV; IgG antibody is produced in response to the core antigen later in the course of the infection and usually persists for life.

The following table summarizes tests that may be used as follow-up after initial tests detect an HBV infection:

Test

 

Description

 

Use and Comments

 

Anti-hepatitis

B core (anti-HBc), IgM

Detects only the IgM antibody to the hepatitis B core antigen

Used to detect acute infections; sometimes present in chronic infections as well

Hepatitis

Be-antigen (HBeAG)

Detects protein produced and released into the blood

Often used as a marker of ability to spread the virus to other people (infectivity); it may also be used to monitor the effectiveness of treatment. However, there are some types (strains) of HBV that do not make e-antigen; these are especially common in the Middle East and Asia. In areas where these strains of HBV are common, testing for HBeAg is not very useful to determine whether the virus can be spread to others.

Anti-hepatitis B e antibody (Anti-HBe)

Detects antibody produced by the body in response to the hepatitis B "e" antigen

Used to monitor acute infections in those who have recovered from acute hepatitis B infection; anti-HBe will be present along with anti-HBc and anti-HBs.

Hepatitis B viral DNA

Detects hepatitis B viral genetic material in the blood

A positive test indicates that the virus is multiplying in a person's body and that person is highly contagious. The test is often used to monitor the effectiveness of antiviral therapy in people with chronic HBV infections.

Hepatitis B virus resistance mutations

Detects mutations in the particular virus causing a person's infection that allows the virus to be resistant to treatments (reverse transcriptase inhibitors)

Helps to select appropriate treatment, especially in people who have been treated previously or in those who are not responding to treatment

While the tests described above are specific for HBV, other liver tests such as ASTALT, and gamma-glutamyl transferase (GGT) may be used to monitor the progress of the disease. In some cases, a liver biopsy may be performed to evaluate how much damage has occurred to the liver.

What does the test result mean?

The tests for hepatitis B may be ordered individually but are often ordered in some combination, depending on the reason for testing. Results of the tests are typically evaluated together. Sometimes the meaning of one result depends on the result of another test. However, not all tests are performed for all people.

The table below summarizes possible interpretations of some common patterns of results.

Initial Tests

 

    Follow-up Tests

 

       
Hep B

 

surface antigen (HBsAg)

Hep B

 

surface antibody (Anti-HBs)

Hep B

 

core antibody Total (Anti-HBc IgG+IgM)

Hep core antibody (Anti-HBc IgM)

 

Hep B e

 

antigen (HBeAg)*

Hep B e

 

antibody (Anti-HBe)

HBV DNA

 

Possible Interpretation / Stage of Infection

 

Negative

 

Negative

 

Negative

 

Not performed

 

Not performed

 

Not performed

 

Not performed

 

No active or prior infection; not immune — may be good candidate for vaccine; possibly in the incubation stage

Negative

 

Positive

 

Negative

 

Not performed

 

Not performed

 

Not performed

 

Not performed

 

Immunity due to vaccination

 

Negative

 

Positive

 

Positive

 

Not performed

 

Not performed

 

Not performed

 

Not performed

 

Infection resolved (recovery), virus cleared; immunity due to natural infection. However, if immunosuppressed, virus can reactivate.

Positive

 

Negative

 

Positive or Negative

 

Positive or Negative

 

Positive

 

Negative

 

Detected or none detected

 

Acute infection, usually with symptoms; contagious; could also be flare of chronic infection

Negative

 

Negative

 

Positive

 

Positive

 

Negative*

 

Positive

 

None detected

 

Acute infection is resolving (convalescent)

Positive

 

Negative

 

Positive

 

Negative

 

Positive

 

Negative

 

Detected

 

Usually indicates an active chronic infection (liver damage likely)

Positive

 

Negative

 

Positive

 

Negative

 

Negative*

 

Positive

 

None detected or detected at very low level

 

Chronic infection but low risk of liver damage — carrier state

*Note: There are some types (strains) of HBV that do not make e-antigen. In areas where these strains of HBV are common (in the Middle East and Asia), testing for HBeAg is not very useful. In these cases, a negative HbeAg result does not necessarily mean that the antigen is not present or that the person is not infectious; it may be that the person is infected with a strain that does not make the e-antigen.

Monitoring treatment of chronic infection

 If the results from initial and follow-up testing indicate that a person has chronic hepatitis B, then the individual may be treated with medication and the effectiveness of that treatment may be monitored using the tests for HBe antigen and antibody and HBV DNA:

  • If HBeAg becomes negative and anti-HBe becomes positive during treatment, this usually indicates that it is effective and that treatment can be discontinued after an additional 6-12 months.

  • HBV DNA measures the amount of virus present in the blood. A high result usually means that the virus is actively replicating and that treatment is not effective. A low result or one that is reported as below a lower limit (none detected) means the virus is not present or is present in such low numbers that it cannot be detected. This usually indicates that the therapy is effective.

HBV vaccine

The Centers for Disease Control and Prevention (CDC) recommends that adults in high risk groups get vaccinated. Some of these groups include those in close contact with someone who has hepatitis B, dialysis patients, people with chronic liver or kidney disease, people with HIV or who seek treatment for other sexually transmitted diseases or drug treatment, and those who travel to countries where hepatitis B is common. Unless there is something in your medical history to the contrary, it is prudent to get the series of vaccinations. Babies, children and adolescents are routinely given the series of shots; if you have already been vaccinated, you probably are protected for many years, perhaps for life, and will not usually need to get the vaccine again.

 

Hepatitis B treatment

There is no specific treatment for acute hepatitis B infections. Symptoms are usually treated with supportive care. This usually involves making sure that you are getting plenty of rest and enough fluids and nutrition by eating and drinking small amounts several times a day.

Chronic forms of hepatitis B may be treated with antiviral medications such as interferon, entecavir, tenofovir, lamivudine, and adefovir. However, some antiviral drugs can have serious side effects and not all people need to be treated. Often, people with chronic hepatitis will be closely monitored to see if they develop cirrhosis or liver cancer. It is important to talk to your health care provider about your treatment options and the risks and benefits of those currently available.

Image placeholder

George Washington

Lorem ipsum dolor sit amet, consectetur adipisicing elit. Ducimus itaque, autem necessitatibus voluptate quod mollitia delectus aut, sunt placeat nam vero culpa sapiente consectetur similique, inventore eos fugit cupiditate numquam!

Leave a comment