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
| HBsAg |
|---|
- 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.
Can I Take The Test At Home
Samples for hepatitis B testing can be collected at home. At-home hepatitis B testing requires a patient to collect a blood sample, typically from a fingerstick using a very small needle provided in the test kit. Once a blood sample is collected, it is prepared according to the instructions contained in the test kit and mailed to a laboratory for testing.
Because there are numerous types of tests for HBV, it is important to look closely at the specific components of any at-home test kit. Many at-home test kits only look for hepatitis B surface antigen .
Taking A Hepatitis B Test
Testing for hepatitis B is performed on a sample of blood. A doctor, nurse, or other health care provider can obtain a blood sample using a small needle to draw blood from a vein.
At-home hepatitis B testing requires that users carefully follow instructions provided in the test kit to collect a small sample of blood, package the sample, and mail it to a lab for testing.
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Reactivation Risk In Anti
Table 1 American Gastroenterological Association classification of reactivation risk in HBsAg/anti-HBc patients Full size table
The risk of HBV reactivation can be assessed based on positivity for HBV serum biomarkers and the type, duration, combination of agents, and dosing of immunosuppressive or chemotherapeutic agents . HBV reactivation risk can be as high as 4070% in anti-HBc-only, patients who are undergoing chemotherapy with B cell depleting antibodies like rituximab .
Noting that reactivation after immunosuppressive therapy is associated with significant morbidity and mortality, the AGA recommends antiviral prophylaxis for patients classified as at either moderate or high risk for reactivation for low-risk patients, there is no prophylaxis recommendation monitoring is per provider preference but seemingly sufficient . Entecavir and tenofovir prodrugs should be used as first-line prophylaxis or therapy due to their stronger antiviral potency and high threshold for resistance.
Finding The Cause Of A False
Since there are various reasons for false-positive results, individuals should speak with a doctor about the probable cause. Some may be due to human error, such as a technical or clerical oversight.
However, a false-positive result can also result from another condition, such as an STI or an autoimmune disorder. Autoimmune disorders that may cause false-positive results include lupus and rheumatoid arthritis.
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What Is A False Positive
A false-positive result means that a test indicated that you have a disease or condition when you actually dont.
There are two blood tests used to diagnose hepatitis C. The antibody test, also called the anti-HCV test, tests for HCV antibodies that the body has produced in response to the infection.
One drawback is that the anti-HCV test cant differentiate between an active infection versus a chronic or previously acquired infection.
A positive anti-HCV test doesnt necessarily mean that you have hepatitis C. Antibodies picked up by the test may have been triggered by an infection other than HCV, leading to a positive result.
This phenomenon is known as cross-reactivity, and it often results in a false positive. The results may be verified through a second blood test.
The hepatitis C viral load test, also called an RNA test, will show whether you have chronic hepatitis C or a false positive.
2017 report , 22 percent of 479 subjects received a false-positive anti-HCV test.
According to a 2020 report, the rate of false-positive test results among 1,814 reactive serum samples was 10 percent.
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How Is Hepatitis B Treated
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 healthcare provider about your treatment options and the risks and benefits of those currently available.
What Is Hepatitis B
Hepatitis B is a liver infection caused by the hepatitis B virus . HBV infection causes inflammation of the liver. When the liver is inflamed or damaged, its function can be affected.
- The best way to prevent HBV infection is by getting vaccinated. Safe and effective vaccines are available and covered as a preventive service by most health plans.
- For some people, HBV infection is an acute, or short-term, illness for others, it can become a long-term, chronic infection. Risk for chronic infection is related to age at infection: approximately 90% of infected infants become chronically infected, compared with 2-6% of adults.
- Chronic hepatitis B can lead to cirrhosis, liver cancer, liver failure, and premature death.
- Hepatitis B is diagnosed with a simple blood test that can detect HBV infection years before symptoms develop and the virus has caused liver damage.
- There is no cure for hepatitis B, but there are several FDA-approved medications that treat HBV infection. People with chronic hepatitis B should be monitored regularly for signs of liver disease and evaluated for possible treatment.
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Hiv And Hbv Coinfection
About 2% of people with HIV in the United States are coinfected with HBV both infections have similar routes of transmission. People with HIV are at greater risk for complications and death from HBV infection. All people with HIV are recommended to be tested for HBV, and if susceptible, are further recommended to receive the hepatitis B vaccination or, if chronically infected, evaluated for treatment to prevent liver disease and liver cancer. For more information about HIV and HBV coinfection, visit HIV.govâs pages about hepatitis B and HIV coinfection.
Is There Anything Else I Should Know
Even if you don’t have symptoms, an HBV infection can damage your liver and you can spread the infection to others. For this reason, it is important to get tested if you think you have been exposed to HBV.
Blood banks screen all donated blood for the hepatitis B virus , hepatitis B surface antigen , and hepatitis B core antibody . Donors are notified of any confirmed positive reactions. People who receive a notice regarding possible infection with hepatitis B after donating should visit their healthcare provider for further testing. The healthcare practitioner will order additional tests to make a proper diagnosis and determine if treatment is necessary.
If exposed to HBV and you haven’t been vaccinated, an infection can be avoided by getting a shot of hepatitis B immune globulin within 24 hours and typically you will also be given the first dose of the hepatitis B vaccine.
A test is available to determine the specific type of hepatitis B virus that is causing a person’s infection. This is called HBV genotyping. However, this testing is currently mainly used in research settings and not for clinical purposes.
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Hepatitis B Blood Tests
The Hepatitis B Panel of Blood Tests
Only one sample of blood is needed for a hepatitis B blood test, but the Hepatitis B Panel includes three parts. All three test results are needed to fully understand whether a person is infected or not. Below is an explanation of the 3-part Hepatitis B Panel of blood test results.
Cases And Clusters Of Potential Public Health Importance
Jurisdictions should review and analyze hepatitis B data regularly to identify cases and clusters of hepatitis B that merit further investigation. When resources are limited, these should be prioritized for investigation based on the degree of public health importance. The following are examples of high priority cases and clusters:
- People of childbearing age who are or have the potential to become pregnant, indicating the potential for perinatal transmission
- Children 24 months of age to detect perinatal transmission
- People in age and demographic groups for whom infection may be acute due to recent transmission, including those
- 70 years of age
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How To Get Tested
Hepatitis B testing is typically prescribed by a doctor and performed in a hospital, lab, or other medical setting. Taking a hepatitis B test requires a blood sample, which can be collected by a health care professional.
For laboratory-based testing, blood is drawn from a patientâs vein. After blood is collected, the sample is sent to a laboratory for analysis.
Notes From The Field: False
Weekly / March 16, 2018 / 67 311â312
Please note: An erratum has been published for this report. To view the erratum, please .
Blake Hendrickson, MPH1 Saleem Kamili, PhD2 Tim Timmons3 Peter C. Iwen, PhD4 Caitlin Pedati, MD1 Thomas Safranek, MD1
In March 2017, the Nebraska Department of Health and Human Services was contacted by a hemodialysis clinic regarding a patient who had tested negative for hepatitis B virus surface antigen after vaccination in 2010 and who later tested positive for HBsAg. A public health investigation subsequently determined that the false-negative results were caused by a surface antigen mutation. Notably, several commercial HBsAg testing kits cannot detect this mutant virus, making it a challenging pathogen for public health surveillance and intervention efforts .
Specific precautions for HBV-positive patients in a dialysis center include receiving dialysis in a separate room and being assigned separate staff members and equipment . These control measures were not implemented during 20102016 because the index patient had not had a positive HBsAg test result. After the positive HBsAg results were reported, an epidemiologic investigation was initiated by NDHHS and the Lincoln-Lancaster County Health Department to determine the cause of the false-negative test results and to identify any HBV transmission.
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Should I Get The Hbv Vaccine
The Centers for Disease Control and Prevention recommends that adults in high-risk groups get vaccinated. Some of these groups include people:
- In close contact with someone who has hepatitis B
- Who undergo dialysis
- With chronic liver or kidney disease
- With HIV or who seek treatment for other sexually transmitted diseases or drug treatment
- Who travel to countries where hepatitis B is common
- Who are healthcare workers with potential exposure to HBV
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.
Case Reporting And National Notification
Cases of acute, chronic, and perinatal hepatitis B, and hepatitis B during pregnancy should be reported to HDs as specified by state, territorial, or local regulations. Acute, chronic, and perinatal hepatitis B are nationally notifiable conditions . Hepatitis B cases are identified using an event code corresponding to the hepatitis B condition . Data are sent weekly or more frequently, depending on the infrastructure of the jurisdiction sending the data. Cases might be re-classified or removed as needed after the initial transmission to CDC, as long as the changes occur before surveillance data are finalized each year.
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How Many People Have Hepatitis B
In the United States, an estimated 862,000 people were chronically infected with HBV in 2016. New cases of HBV infection in the United States had been decreasing until 2012. Since that time, reported cases of acute hepatitis B have been fluctuating around 3,000 cases per year. In 2019, 3,192 cases of acute hepatitis B were reported however, because of low case detection and reporting, the Centers for Disease Control and Prevention estimates that there were 20,700 acute hepatitis B infections. New HBV infections are likely linked to the ongoing opioid crisis in the United States.
Globally, HBV is the most common blood-borne infection with an estimated 296 million people infected according to the World Health Organization .
What Does The Test Measure
Hepatitis B testing looks for antigens, antibodies, or the genetic material of the hepatitis B virus. HBV antigens are substances from the virus that cause a patientâs body to produce an immune response. Antibodies are substances made by the immune system in response to the hepatitis B virus.
Initial tests for hepatitis B measure antibodies and antigens related to HBV including:
If a patient is diagnosed with hepatitis B based on these initial tests, additional hepatitis B testing may be used to monitor the disease, guide treatment, and determine if a person can spread hepatitis B to others. These additional tests may include:
- Hepatitis B e antigen : Hepatitis B e antigen is a protein from the hepatitis B virus found in some patients who are positive for hepatitis B surface antigen. Measuring this antigen can help doctors understand infectivity, which describes a personâs ability to spread HBV to others.
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Understanding Changes In Biomarkers During Disease Progression
Understanding the changes in HBV biomarkers over the course of a persons infection and recovery is key to interpreting the test results. Figure 3-1 and Figure 3-2 depict the typical biomarker changes over the course of hepatitis B disease.
Figure 3-1. Typical serologic course of acute hepatitis B to recovery
Figure 3-2. Typical serologic course of the progression to chronic hepatitis B
Acute, resolved, and chronic hepatitis BApproximately 90% of people > 5 years of age with acute hepatitis B will spontaneously clear their infection . People with resolved hepatitis B will remain positive for total anti-HBc and develop anti-HBs that protect against future HBV infection . Chronic hepatitis B is defined as an HBV infection lasting > 6 months. During the typical course of chronic infection, the total anti-HBc and HBsAg markers will always be present, whereas anti-HBc IgM will disappear . Hepatitis B envelope antigen and hepatitis B envelope antibody are variably present. HBV DNA levels vary during the course of chronic infection. Any detectable HBV DNA level is considered positive for surveillance purposes.
Among people with previously inactive hepatitis B , laboratory evidence of reactivation includes meeting any one of the following criteria:
- HBV DNA is now detectable or
- HBsAg test conversion occurs .