Clinical And Laboratory Assessments
Demographic data, medication history including antiviral agents and comorbidities such as malignancy were assessed based on electronic medical records.
Laboratory tests included assessments of serology associated with HBV infection, liver function, AFP levels, platelet counts, and antibodies against hepatitis C virus and human immunodeficiency virus. Serologic markers for HBV including HBsAg, anti-HBs, hepatitis B e antigen , and anti-HBe were assessed by chemiluminescent microparticle immunoassays . The concentration of HBsAg was determined using a previously generated Architect HBsAg calibration curve , and the samples with higher than 250 IU/ml HBsAg levels were diluted to 1:5001:1000. By June 2010, qHBsAg more than 250 were expressed as > 250 IU/ml without presenting an exact value. Thus, we divided subjects into 2 groups as those with qHBsAg> 250 IU/ml and those with qHBsAg250 IU/ml in this study.
Serum HBV DNA levels were measured with Roche COBAS TaqMan quantitative PCR assay, which has a low detection limit of 20 IU/mL. The threshold for anti-HBs positivity was an anti-HBs titer > 10 IU/mL. Blood samples were collected before 10:00 AM after the patients had completed a 12-h overnight fast. All laboratory tests were conducted using standard methods.
What Does Hepatitis B Core Igm Mean
IgM antibody to hepatitis B core antigen : Positivity indicates recent infection with hepatitis B virus . Its presence indicates acute infection. Tests.
What does it mean to be non immune to Hep B?
Answer. This means that you are susceptible hepatitis B. Often these words are used when the blood tests for hepatitis B do not show reactive, or levels of, hepatitis B surface antibody .
What does non reactive hepatitis B test results mean?
If your test results for hepatitis B came back as Non-reactive that is actually very good news. It means that you have never been exposed to the Hepatitis B virus, so you do not have the virus.
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Screening Tests For Hepatitis B
Your blood may be screened for HBV for many different reasons. The three tests generally include HBsAg, antibody to HBsAg, and antibody to hepatitis B core antigen. This allows the healthcare provider to know whether you could benefit from vaccination, or if you have active or chronic hepatitis B and need counseling, care, or treatment.
You may be routinely screened if you are pregnant, are donating blood or tissue, need immunosuppressive therapy, or have end-stage renal disease. You will also be screened if you are in groups that are at higher risk for HBV.
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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.
Youll get your test result in 2 to 5 business days with most kits. Some at-home test options are Everlywell, LetsGetChecked, myLAB Box, and iDNA.
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.
Questions For Your Doctor About Test Results
Patients may find it helpful to ask questions about their hepatitis B test results. Questions that may be helpful include:
- What was my test result?
- Do I have an acute or chronic hepatitis B infection?
- Does the test result suggest that I have immunity for hepatitis B?
- Would I benefit from hepatitis B vaccination?
- Do I need any follow-up tests based on my hepatitis B test results?
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What Is The Normal Range For Hepatitis B Surface Antibody
Hepatitis B surface antibodies are measured in blood samples in milli-International Units/milliliter mIU/mL). The ranges for hepatitis B surface antibodies are:
- Anti-HBs greater than 10-12 mIU/mL: Protected against hepatitis B virus infection, either from vaccination or successful recovery from a previous HBV infection.
- Anti-HBs less than 5 mIU/mL: Negative for HBV infection, but susceptible and hence requires vaccination.
- Anti-HBs from 5-12 mIU/mL: Inconclusive results and the test should be repeated.
However, there is no standardization of these values so it is advisable to check the manufacturers values it is the reason values are mainly reported as positive or negative.
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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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:
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Laboratory Findings And Diagnostic Tests
Serum HBsAg and anti-HBs are the most useful screening tests for chronic HBV infection or immunity to HBV. HBsAg is present in most chronically infected persons. Lack of anti-HBs in an unvaccinated HBsAg-negative person indicates susceptibility to HBV infection.3
Screening for HBsAg is recommended at the first prenatal visit for all pregnant women.3,109 Women in labor without HBsAg test information should have HBsAg serology on arrival. In addition, pretested women who have a history of certain risk factors should be retested at the time of admission to the hospital for delivery.3,110
Fabrizio Fabrizi MD, … Paul Martin MD, in, 2017
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Educating Clients About Viral Hepatitis
Clients may believe they know about viral , but their understanding of the disease may not be accurate. It is easy to confuse the three main types of viral , B, and C. Clients may have formed impressions based on limited or incorrect information. Counselors should briefly describe hepatitis A, B, and C, including their prevalence, , and relationship to drug use, as well as to other infections, such as HIV and sexually transmitted diseases. Specific strategies for speaking with clients include:
- Speak clearly and keep the message simple, focused, and brief.
- Use language, examples, and concepts that the client understands.
- Use appropriate visual aids.
- Frame numerical statements in terms that are easy to visualize. Say 5 out of 100 people rather than 5 percent of the population say more than half instead of the majority.
- Repeat the information at different times in different ways. The average client retains only approximately one-third of what he or she is told. Summarize essential points.
- Pay attention to a clients response to the information. For example, if a client stiffens his or her posture, consider saying, I notice that this topic seems to make you uncomfortable. It does for a lot of people. Please tell me what youre feeling right now. Id really like to help you with this.
- Use the opportunity to describe the potential detrimental effects of alcohol and other substance use on the liver of a person who is infected with HCV.
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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Counseling Practices That Educate Support And Motivate Clients Undergoing Screening
Clients might need help deciding whether to get screened, understanding the test results, and determining their next steps. Even when services offered through the substance abuse treatment program are limited, discussing testing with clients presents an opportunity for counselors to motivate clients for change by confronting substance use and by making choices that improve their overall health. However, this may also be true when services are offered on-site through substance abuse treatment programs. A study at one methadone clinic that offered hepatitis screening and vaccination revealed that although the majority of clients completed screening , only 54.7 percent of clients who lacked for hepatitis A received vaccinations and only 2.9 percent of clients who lacked immunity for received vaccinations .
The Consensus Panel makes the following general recommendations while recognizing that, in some programs, the counselors role may be limited:
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 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.
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.
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.
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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.
When Should You Have The Test
Anyone who has symptoms of hepatitis B may benefit from having the test. Other people who may consider undergoing the hepatitis B panel test are those with known risk factors. These people include individuals born in places with a high incidence of HBV infection and those who use needles to inject drugs.
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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 .