Hepatitis B In Blood Test

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.

*Note: There are some types of HBV that do not make e-antigen. In areas where these strains of HBV are common , testing for HBeAg is not very useful. In these cases, a negative HbeAg result does not necessarily mean 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 and HBs antigen and antibody and HBV DNA:

How Is Hepatitis B Spread

You can become infected with hepatitis B through exposure to blood, semen and other bodily fluids of an infected person. You can get the infection by:

• Having unprotected sex.
• Sharing or using dirty needles for drug use, tattoos or piercing.
• Sharing everyday items that may contain body fluids, including razors, toothbrushes, jewelry for piercings and nail clippers.
• Being treated medically by someone who does not use sterile instruments.
• Being bitten by someone with the infection.
• Being born to a pregnant woman with the infection.

Hepatitis B is not spread by:

• Kissing on the cheek or lips.
• Coughing or sneezing.
• Hugging, shaking hands or holding hands.
• Eating food that someone with the infection has prepared.
• Breastfeeding.

What Are The Types Of Hepatitis B

There are two types of hepatitis B infection: acute and chronic.

Acute

An acute infection happens at the beginning, when you first get infected with hepatitis B. Many people are able to clear it from their bodies and recover. In fact, this is true of about 4 in 5 adults who are infected.

Chronic

If you are not able to clear the infection within six months or longer, you have chronic hepatitis B. It is chronic hepatitis B that leads to inflammation and the serious, and possibly fatal, illnesses of cirrhosis of the liver and liver cancer. Treatment can slow disease progress, reduce the chance of liver cancer and increase your chances of surviving.

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Who Are Hepatitis B Carriers

Hepatitis B carriers are people who have the hepatitis B virus in their blood, even though they dont feel sick. Between 6% and 10% of those people whove been infected with the virus will become carriers and can infect others without knowing it. There are over 250 million people in the world who are carriers of HBV, with about 10% to 15% of the total located in India. Children are at the highest risk of becoming carriers. About 9 in 10 babies infected at birth become HBV carriers, and about half of children who are infected between birth and age 5 carry the virus. A blood test can tell you if you are a hepatitis B carrier.

Can Hepatitis B Be Prevented

The hepatitis B vaccine is one of the best ways to control the disease. It is safe, effective and widely available. More than one billion doses of the vaccine have been administered globally since 1982. The World Health Organization says the vaccine is 98-100% effective in guarding against the virus. Newborns should be vaccinated.

The disease has also been more widely prevented thanks to:

• Widespread global adoption of safe blood-handling practices. WHO says 97% of the blood donated around the world is now screened for HBV and other diseases.
• Safer blood injection practices, using clean needles.
• Safe-sex practices.

You can help prevent hepatitis B infections by:

• Practicing safe sex .
• Never sharing personal care items like toothbrushes or razors.
• Getting tattoos or piercings only at shops that employ safe hygiene practices.
• Not sharing needles to use drugs.
• Asking your healthcare provider for blood tests to determine if you have HBV or if you are immune.

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What Do Hepatitis B Test Results Mean

Hepatitis B test results help determine if HBV infection is negative or positive, and if positive, whether the infection is acute or chronic, or if recovery is complete. A combination of results are considered to identify and classify HBV infection status.

The following are some interpretations of hepatitis B test results:

Table: Hepatitis B test results and interpretations

Recommended Tests To Investigate Chronic Hbv Infection And The Interpretation Of Results

Chronic HBV infection is defined by the continued presence of HBsAg in the blood for longer than six months. Figure Figure11 and Table Table22 outline the tests used to diagnose most cases of chronic HBV. Test selection should be based on the person’s risk factors, vaccination history and findings from previous tests .

Diagnostic tests for acute or chronic hepatitis B virus infection . ALT Alanine aminotransferase Anti-HAV-IgM Immunoglobulin M class antibody to HAV Anti-HCV Antibody to HCV antigens HBsAg Hepatitis B surface antigen

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Are There Blood Tests For Hepatitis B

Yes. Many chronically infected persons show no outward signs of hepatitis B infection. Therefore, screening for hepatitis B is important and necessary. Ask your doctor for the following blood tests:

HEPATITIS B SURFACE ANTIGEN : Tells if you have chronic hepatitis B. Only the HBsAg blood test can tell if you have chronic hepatitis B.

HEPATITIS B SURFACE ANTIBODY : Tells if you are protected against hepatitis B.

What Blood Tests Are Important To Diagnose And Evaluate My Hepatitis B Infection

In order to understand your hepatitis B status, it is important that your doctor order the hepatitis B blood panel. This panel includes 3 basic biomarkers, but only one sample of blood is needed. Make sure you request a written copy of your blood test results so that you fully understand what tests were ordered and the actual results of each. Also, be sure to have your doctor clearly explain the results to you so that you fully understand your situation.

It is important to wait 6-8 weeks after a possible exposure before getting tested. If done before this time , the blood tests can have a false negative result. The window period is the time between exposure and the appearance of these markers in blood. The 3-part blood test includes the following:

1) Hepatitis B surface Antigen – This directly tests for the presence of the hepatitis B virus. It should be negative if there is NO virus present. 2) Hepatitis B surface Antibody – This tests for the production of protective antibodies against the hepatitis B virus. This blood test should be positive if the protective antibodies are produced in response to vaccination or recovery from a natural infection. 3) Hepatitis B core Antibody – This antibody does not provide any protection. A positive result may indicate that a person has been exposed to the hepatitis B virus. This test must be interpreted in relation to the above 2 test results.

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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.

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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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.

Will I Need Any Other Tests Along With The Hepatitis Panel

Apart from the tests for hepatitis viruses, your doctor may want to know the impact of disease or medical conditions on your liver. Your healthcare provider may recommend liver enzyme tests such as alkaline phosphatase aminotransferase , and aspartate alanine aminotransferase . Further, you may also be asked to undergo a test for prothrombin time and bilirubin to ascertain the extent of liver damage.

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What Is Hepatitis B Surface Antibody

When you are exposed to HBV, your body mounts an immune defense to specifically target and neutralize the invader. Unlike innate immunity which mounts a generalized defense against all invaders, this type of immunity is disease-specific.

This immune response occurs whether you are exposed to HBV through blood or sexual contact, or if you are vaccinated with the hepatitis B vaccine.

The virus has proteins on its surface, called antigens, that serve as unique identification tags. When HBV enters the body, the immune system “encodes” antibodies specific to these antigens so that it can recognize and attack the virus should it appear again.

There are two types of antibodies produced in response to the virus:

• Immunoglobulin M is the antibody that mounts the initial attack but eventually fades away.
• Immunoglobulin G is the antibody that provides long-lasting immune protection against HBV. The immunity can last for many years, but it gradually wanes over time.

Why It Is Done

You may need testing if:

• You have symptoms of hepatitis.
• You may have been exposed to the hepatitis B virus. You are more likely to have been exposed to the virus if you inject drugs, have many sex partners, or are likely to be exposed to body fluids .
• You’ve had other tests that show you have liver problems.
• You are pregnant.
• You or your doctor wants to know if you are protected from getting the disease.

The tests also are done to help your doctor decide about your treatment and see how well it’s working.

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Preparation Prior To Transport

Label the specimen container with the patients full name, date of collection and one other unique identifier such as the patients date of birth or Health Card Number. Failure to provide this information may result in rejection or testing delay.

Centrifuge if using SST. Place specimen in biohazard bag and seal. Specimens should be stored at 2-8°C following collection.

Specimens more than the following number of days post collection will not be tested:

• > 6 days for Hepatitis B surface antigen
• > 7 days for Hepatitis B e Antigen and Hepatitis B e Antibody
• > 10 days for Hepatitis B core Antigen and Hepatitis B surface Antibody

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.

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Chronic Hbv Carriers At Greatest Risk Of Hepatic Sequelae

Sustained elevations in ALT, although an imperfect marker for hepatic damage, can help identify chronic HBV carriers at greatest risk of sequelae and those most likely to benefit from current treatments . Chronically infected patients with sustained ALT elevations greater than the upper limit of normal may be candidates for treatment and should undergo additional prognostic hepatitis marker testing as outlined below. Chronic carriers whose ALT is within the normal range should be tested for this marker periodically because ALT levels can fluctuate with this illness. Determination of ALT levels and HBV serological and nucleic acid markers, although valuable in following infection, is not adequate to assess the severity of infection and the resulting liver damage. Before appropriate treatment can be initiated, consultation with a specialist and assessment of the disease through histological examination of a liver biopsy is strongly recommended.

What Are My Next Steps Once I Get My Results

It can be difficult to understand what the results of your test mean. A healthcare provider can help you interpret your results and decide whether you need to take further action:

• If your results suggest that youre already immune to hepatitis B and arent contagious, you likely wont need to do anything.
• If your results suggest that youre not immune, a doctor may recommend vaccination, especially if youre somebody whos at a high risk of infection.

You may also need additional testing if more information is needed to interpret your results.

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When Should I Get Hepatitis B Testing

Using hepatitis B tests to screen for HBV is recommended for certain groups that are at an increased risk of infection. Groups that may benefit from hepatitis B screening include:

• Pregnant people
• People born in parts of the world where hepatitis B is more common, including Africa, Asia, Eastern Europe, South America, and parts of the Middle East
• People who didnât receive a hepatitis B vaccine
• HIV-positive people

• Pain in the joints or abdomen
• Loss of appetite, nausea, or vomiting
• Yellowish skin and eyes

Using hepatitis B testing to assess immunity to HBV may be used before or after vaccination. Pre-vaccination testing is not always needed but may be performed if there is a chance that a patient has previously been infected with HBV or has already been vaccinated. Post-vaccination testing is used in certain groups of people who are at an especially elevated risk for HBV infection, including infants born to mothers with a hepatitis B infection.

Detection Of Antiviral Resistance

Lamivudine monotherapy has been reported to be associated with the rapid emergence of antiviral resistance in 15% to 60% of treated individuals . Resistant HBV genomes have mutations in codon 552 within the YMDD motif of the reverse transcriptase/polymerase where a valine or isoleucine replaces the methionine. Resistance is typically clinically manifested by significant elevations in ALT after an initial decline in response to treatment. Prolonged treatment after development of the YMDD mutant is controversial, although improvement in liver pathology with decreased fibrosis may occur with continuation of treatment. Concerns about disease flares after stopping lamivudine have been raised . The development of genotypic resistance can be documented by molecular sequencing or by the INNO-LiPA HBV DR assay , which involves hybridization of amplified HBV-DNA fragments onto specific nucleotide probes that have been immobilized on nitrocellulose strips .

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