Natural History Of Hbv Infection
Exposure to HBV has a variable outcome that is largely determined by the age and immune status of an infected individual. In healthy adolescents and adults, the most common population exposed to HBV in northern Europe and most of North America, exposure to HBV typically leads to acute hepatitis, followed by loss of detectable HBsAg and loss of circulating HBV DNA . Chronic infection, identified by persistence of HBsAg, may follow infections in infants, persons with immunosupression, and a small number of otherwise healthy individuals. Such chronic infection may be associated with active viral replication , or with nonreplicating infection, in which HBsAg continues to be produced but HBV DNA is undetectable in the circulation. Replicating forms of infection can convert to nonreplicating forms, either spontaneously or after treatment with either interferon or nucleotide analogs. Rarely , HBsAg will also disappear from the circulation, followed by appearance of antibody to HBsAg . This antibody is thought to be protective, and is the antibody produced with successful responses to the HBV vaccine.
What Foods Should I Avoid
Everyone should avoid eating a lot of fat, cholesterol, salt and processed sugar, even if their liver is healthy. In addition, those with HCV should limit or avoid alcohol. Drinking alcohol will speed up liver damage.
Eating properly can help decrease some of the symptoms of Hepatitis C, like feeling tired and sick. Drink lots of water for general health benefits. HCV is not a digestive disease diet will not affect the disease. Your provider may put you on a special diet if you have advanced liver disease.
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What Is The Purpose Of A Hepatitis B Test
Hepatitis B test is performed to detect, classify, and treat hepatitis B virus infection.
Hepatitis B blood tests involve the measurement of several HBV-specific antigens and antibodies. In addition, HBV blood tests also include liver enzymes and liver function tests to assess and monitor the condition of the liver and provide appropriate treatment.
The HBV specific tests include the following:
- HBsAg: HBsAg is an antigen found on the surface of hepatitis B virus. HBsAg may be detected in the blood any time after 1 week post-exposure to HB virus, but usually appears after 4 weeks.
- Anti-HBs: Anti-HBs are antibodies produced by the bodys immune system to fight HBsAg. Anti-HBs from a prior infection or vaccination provides immunity against further infection.
- Hepatitis B core antigen : HBcAg is an antigen found in the core layer which covers the hepatitis B viral DNA.
- Hepatitis B core antibody : Anti-HBc is the antibody that fights HBcAg. Anti-HBc is the first detectable antibody after HBV infection. There are two kinds of Anti-HBc:
- Immunoglobulin M hepatitis B core antibody : IgM anti-HBc indicates acute or reactivated recent infection within the previous 6 months.
- Immunoglobulin G hepatitis B core antibody : IgG anti-HBc may indicate previous or chronic infection. Once present, IgG anti-HBc persists for a lifetime.
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Understanding Your Test Results
Understanding your hepatitis B blood tests can be confusing. It is important to talk to your health care provider so you understand your test results and your hepatitis B status. Are you infected? Protected? Or at risk? The Hepatitis B Panel of blood tests includes 3 tests and all three results must be known in order to confirm your status.
Below is a chart with the most common explanation of the test results, but unusual test results can occur. Please note that this chart is not intended as medical advice, so be sure to talk to your health care provider for a full explanation and obtain a printed copy of your test results. In some cases, a person could be referred to a liver specialist for further evaluation.
More Detailed Information About Hepatitis B Blood Tests
An acute hepatitis B infection follows a relatively long incubation period from 60 to 150 days with an average of 90 days. It can take up to six months, however, for a person to get rid of the hepatitis B virus. And it can take up to six months for a hepatitis B blood test to show whether as person has recovered from an acute infection or has become chronically infected .
The following graphic from the U.S. Centers for Disease Control and Prevention represents the typical course of an acute hepatitis B infection from first exposure to recovery.
According to the CDC, a hepatitis B blood test result varies depending on whether the infection is a new acute infection or a chronic infection.
Interpretation Of Diagnostic Tests
Hepatitis B surface antigen is the first marker of HBV detectable in serum in acute infection. By the time clinical and biochemical hepatitis is present after an incubation period of up to 140 days, other serologic markers of HBV infection appearâincluding antibody to HBV core antigen . Hepatitis B core antigen, a marker of viral replication found in infected hepatocytes, does not circulate in serum. However, its corresponding antibody does. Documented HBsAg positivity in serum for 6 or more months suggests chronic HBV with a low likelihood of subsequent spontaneous resolution. Chronic HBV is diagnosed by the absence of IgM anti-HBc antibody. IgM anti-HBc antibody is a marker of acute or recent acute hepatitis B and is detectable for 6 months after infection, whereas IgG anti-HBc is lifelong. If acute HBV resolves, neutralizing antibody against HBsAg develops. If HBV infection becomes chronic, other HBV markersâincluding HBV viremia and hepatitis e antigen âshould be sought. Both of these markers imply viral replication and thus greater infectivity, although any patient who is HBsAg positive is potentially infectious.
Rima Fawaz, Maureen M. Jonas, in, 2011
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High Titers Of Hepatitis B Surface Antibodies Indicating Low Risk Of Hepatitis B Virus
Sung-Nan Pei, Ming-Chung Wang, Ming-Chung Ma, Ching-Yuan Kuo, Chien-Hung Chen, Po-Nan Wang High Titers of Hepatitis B Surface Antibodies Indicating Low Risk of Hepatitis B Virus-Related Hepatitis in Lymphoma Patients Treated with Rituximab-Based Chemotherapy. Blood 2015 126 : 3869. doi:
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Diagnosis Of Acute And Chronic Hepatitis B
HBsAg is the first serologic marker to appear and may be detected within 1 to 2 weeks after exposure. It precedes the development of symptoms by an average of 4 weeks.106 The presence of HBsAg indicates ongoing infection. Qualitative but not quantitative methods are used by most clinical laboratories because the amount of antigen does not correlate with disease activity or with the presence of an acute or chronic infection.28 Some symptomatic patients may have self-limited, acute HBV infection without detectable HBsAg. These patients, up to 9% in some studies, have other detectable markers of infection.106 HBeAg appears virtually simultaneously, peaks, and then declines in parallel with HBsAg. It usually disappears before HBsAg does. Adult patients who remain persistently positive for HBeAg for more than 10 weeks are likely to become chronically infected. HBeAg indicates a high level of viral replication and infectivity. Most patients with nondetectable HBeAg have resolving, minimal, or no active liver disease.28 Precore mutants of HBV do not express HBeAg they may be responsible for a more severe course and, in some cases, fulminant disease. Serum aminotransferase levels become elevated but are nonspecific. They begin to increase just before the development of symptoms and then peak with the development of jaundice.
Howard C. Thomas, Jennifer A. Waters, in, 1998
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Whats The Hepatitis B Titer Test Used For
A hepatitis B titer test measures antibodies in your blood to see if youre immune either due to vaccination or previous infection.
Hepatitis B is a viral infection that targets your liver. It can be transmitted by coming into contact with the bodily fluids of an infected person. A person with the virus can also infect their child during birth.
Hepatitis B can develop into a chronic infection. Chronic infection occurs when your body cant fight off the virus within six months. Chronic hepatitis B infections most commonly develop less than six years old, especially in infants.
Hepatitis B titer tests can be used to evaluate:
- whether a high-risk person is immune to hepatitis B
- whether hepatitis B immunoglobulin is needed after a needle prick
- men who have sex with men
- people born in countries with a hepatitis B prevalence greater than 2 percent
- people born in the United States not vaccinated as children and with parents born in regions with more than 8 percent hepatitis B prevalence
You may need your titer test results as proof of hepatitis B immunity in order to get into healthcare programs at many schools for example, the nursing program at Lone Star College. In the United States, employers are not allowed to withdraw a job offer if they learn you have hepatitis B.
How Do I Get Tested For Hep C
Finding out whether you have hep C starts with getting tested for HCV. This involves a blood test called an HCV antibody test.
You can ask to be tested at your primary care doctors office or a public health clinic, or you can test yourself using a home testing kit.
To find a clinic with HCV testing near you, visit the CDCs GetTested website and enter your zip code. This tool will help you find testing or free testing in nearby locations.
At-home test kits usually cost $50 to $100 for one test, which comes with all the materials and instructions you need. Youll collect a small amount of blood and send it off to a lab for testing.
Test results may seem intimidating, especially if they can be a little more complicated than just positive or negative. With HCV testing, the antibody test determines whether you have ever contracted HCV.
Breaking down test results:
- A non-reactive HCV antibody test result means you do not currently have HCV.
- A reactive HCV antibody test result means you currently have HCV or had it at some point, and the antibodies are in your blood.
So, if you dont have any HCV antibodies, you are negative for HCV.
If you do have HCV antibodies, that means youve either had it before or currently have it. If youve had it once, youll always have antibodies for it, whether your treatment has cleared it or not.
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Question 7 What Proportion Of Hcv Antibody
Among specimens with reactive HCV antibody results, approximately 52% have detectable HCV RNA at a level of > 15 IU/mL on reflex testing. However, the frequency varies markedly based on the strength of the signal of the antibody test, or signal-to-cutoff ratio. Specimens with an S/C ratio of at least 1.0 are considered reactive for HCV antibody7 and thus undergo reflex testing for HCV RNA. Analysis of approximately 200,000 specimens submitted to Quest Diagnostics for HCV antibody testing with reflex to HCV RNA testing demonstrate that the frequency of positive reflex results increases with increasing S/C ratio:
Kinetics And Risk Of De Novo Hepatitis B Infection In Hbsagnegative Patients Undergoing Cytotoxic Chemotherapy
- CheeKin HuiCorrespondenceAddress requests for reprints to: CheeKin Hui, MD, University of Hong Kong, Queen Mary Hospital, Department of Medicine, 102 Pokfulam Road, Hong Kong SAR, China. fax: 2281 84030.Centre For The Study of Liver Diseases, The University of Hong Kong, Hong Kong SAR, ChinaResearch Centre For Infection and Immunity, The University of Hong Kong, Hong Kong SAR, China
- HaiYing ZhangAffiliationsCentre For The Study of Liver Diseases, The University of Hong Kong, Hong Kong SAR, ChinaResearch Centre For Infection and Immunity, The University of Hong Kong, Hong Kong SAR, China
- YuiHung YuengAffiliationsCentre For The Study of Liver Diseases, The University of Hong Kong, Hong Kong SAR, ChinaResearch Centre For Infection and Immunity, The University of Hong Kong, Hong Kong SAR, China
- John M. LukAffiliationsCentre For The Study of Liver Diseases, The University of Hong Kong, Hong Kong SAR, ChinaDepartment of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
- George K.K. LauAffiliationsCentre For The Study of Liver Diseases, The University of Hong Kong, Hong Kong SAR, ChinaResearch Centre For Infection and Immunity, The University of Hong Kong, Hong Kong SAR, China
Background & Aims:Methods:Results:
Abbreviations used in this paper:
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Discussing Screening Results With Clients
The medical personnel who ordered or arranged the screening test, not counselors, usually explain the results. Hepatitis screening should be part of the intake physical examination in an opioid treatment program, and medical personnel may report the results. However, the client may want to discuss the results with the counselor or ask the counselor questions.
Anxiety might interfere with some clients ability to comprehend or retain information, which might need to be repeated.
Suggestions for conversations with clients when the test results are negative include the following:
- Explain results clearly and simply: So the HCV screening result was negative? This means that, as of 6 months ago, you did not have .
- Emphasize that a negative result to an HCV test does not indicate to and that the client should take precautions to avoid . If a relapse to drug use occurs, advise clients to avoid sharing any drug paraphernalia or equipment. Specify that this includes cookers, cotton, water, needles, syringes, pipes, and straws.
- Emphasize the importance of getting HAV and HBV vaccinations. Provide information about the availability of low- or no-cost vaccinations.
Clients whose screening test results are positive for will need additional tests and examinationsusually with doctors who specialize in diseases of the liver to get accurate diagnoses and to determine their health status and the extent of liver damage. These tests are described in .
About The Hepatitis B Virus
The hepatitis B virus is a small DNA virus that belongs to the Hepadnaviridae family. Related viruses in this family are also found in woodchucks, ground squirrels, tree squirrels, Peking ducks, and herons.
Structure of the Hepatitis B Virus The hepatitis B virus contains an outer envelope and an inner core.
- The outer envelope of the virus is composed of a surface protein called the hepatitis B surface antigen or HBsAg. The HBsAg can be detected by a simple blood test and a positive test result indicates a person is infected with the hepatitis B virus.
- The inner core of the virus is a protein shell referred to as the hepatitis B core antigen or HBcAg, which contains the hepatitis B virus DNA and enzymes used in viral replication.
Life Cycle of the Hepatitis B Virus
The hepatitis B virus has a complex life cycle. The virus enters the host liver cell and is transported into the nucleus of the liver cell. Once inside the nucleus, the viral DNA is transformed into a covalently closed circular DNA , which serves as a template for viral replication . New HBV virus is packaged and leaves the liver cell, with the stable viral cccDNA remaining in the nucleus where it can integrate into the DNA of the host liver cell, as well as continue to create new hepatitis B virus. Although the life cycle is not completely understood, parts of this replicative process are error prone, which accounts for different genotypes or genetic codes of the hepatitis B virus.
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Is Hepatitis B Core Antibody Contagious
If this test is positive or reactive, then your immune system has successfully developed a protective antibody against the hepatitis B virus. This will provide long-term protection against future hepatitis B infection. Someone who is HBsAb+ is not infected and cannot pass the virus to others.
What is antibody to hepatitis B core antigen?
Antibody to hepatitis B core antigen is one of the most classical serological markers in HBV infection. Unlike antibody to HBsAg, it is not a protective marker that appears by itself and cannot be used to differentiate acute infections from chronic ones.
What is the difference between hep B core antibody and surface antibody?
The basic blood test for hepatitis B consists of three screening tests: a hepatitis B surface antigen test, which determines whether a person currently has the infection a hepatitis B core antibody test, which determines whether a person has ever been infected and a hepatitis B surface antibody test, which determines
How Much Does A Hepatitis B Titer Test Cost
The cost of a hepatitis B test varies based on where you get the test. Prices range from roughly $24 to $110.
Your insurance may cover some or all of the cost. Under the Affordable Care Act, all new health plans must cover preventative services including hepatitis B vaccination and testing without a deductible or copay.
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Interpreting Hepatitis B Laboratory Results
Many jurisdictions have regulations requiring laboratories to report all positive HBsAg, HBV DNA, and anti-HBc IgM laboratory results to the HD while a subset might also routinely receive positive total anti-HBc and anti-HBs results.
Additionally, some HDs might receive negative hepatitis B laboratory results, which are useful for determining false-positive results and monitoring patients through their infection and recovery. Table 3-1 shows how to interpret the combinations of laboratory results frequently available in hepatitis B test panels, following the biomarker changes over the course of disease as shown in Figure 3-1.
Table 3-1. Interpretation of hepatitis B laboratory results
- Concurrent ALT and total bilirubin result
- Other hepatitis serological results
- Negative HBsAg and/or negative/undetectable HBV DNA results
Total anti-HBc is detectable, on average, approximately 5 weeks post-HBV exposure, remains detectable indefinitely following exposure, and indicates past or current infection. In the presence of total anti-HBc, a positive HBsAg, HBeAg, or anti-HBc IgM result is a more reliable indication of recent or current infection. Jurisdictions that receive total anti-HBc laboratory results can use these results to clarify a persons HBV infection status.