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 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.
Screening Tests For Hepatitis B
Your blood may be screened for HBV for many different reasons. There are several types of test, but the three generally included are the HBsAg, the antibody to HBsAg , and the antibody to hepatitis B core antigen .
These tests allow 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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Identifying Patterns Of Risky Behavior
Screening is an opportunity to draw attention to the clients behaviors that put him or her at risk for contracting :
- Ask for the clients perception of his or her risk for having contracted : How likely do you think it is that the test will be positive?
- Listen for and identify behaviors that put the client at risk for contracting , B, and C and HIV, especially unprotected sex and sharing injection drug paraphernalia.
- Assess the clients alcohol consumption.
What Are The Different Types Of Hepatitis B
In most of the adult cases of hepatitis B , the virus is completely cleared from the body upon treatment. However, the remaining 5% can go on to develop chronic forms of the disease. It has been observed that within 6 months of the treatment, most people not only clear the virus but also become immune to the same. In general, there are 3 distinct types of hepatitis B infections seen:Healthy Chronic Carriers These people carry the virus but dont develop any symptoms. They are not infectious to others but have a higher risk of developing hepatic conditions such as cirrhosis. However, if the immune system in such individuals gets suppressed owing to an infection or treatment via immunosuppressant drugs, there are chances that they may develop hepatitis B infection. Chronic Infectious Carriers They are the contagious carriers of the disease as they have virus replicating in their systems. They show signs of hepatitis such as damaged liver that progresses into liver cirrhosis. Only 5% of the cases can show remission of the virus.Chronic Mutant The chronic mutant form is a result of a mutated strain of the virus that causes permanent alteration to the hepatitis B viruss genetic makeup. Those with it have the risk of being infectious to others and it is observed to be more resistant to treatment than other forms of hepatitis B.
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Hbsag Structure And Variants
The preS/S ORF encodes three different structurally related envelope proteins, termed the large , middle-sized and small protein, that is synthesized from alternative initiation codons. The three proteins share the same carboxy-terminus but have different amino terminal extensions. In particular, the S protein corresponding to the HBsAg consists of 226 amino acids , the M protein contains an extra N-terminal extension of 55 aa, and the L protein has a further N-terminal sequence of 108-119 aa compared with the M protein. The enhancer and basic core promoter regions of S region overlap with the X gene.
HBsAg is an envelope glycoprotein that is currently the primary element for diagnosis and target of immunoprophylaxis of HBV infection. The dominant epitopes of HBsAg, which are the targets of neutralizing B-cell responses, reside in the a determinant within the major hydrophilic region .
Several mutations in the S region have been described and those most frequently reported in the literature are listed in Table Table1.1. In most cases, they were aa substitutions due to a single mutation, but nucleotide deletions have also been reported. The majority of mutations were located in the S region, but some mutations were also identified in the pre-S1 or pre-S2 regions. Mutations in the S region have been found in various HBV genotypes, while those in pre-S1 or pre-S2 have been frequently observed in patients with HBV genotype C .
Correlation Between Hbsag Titers And Hbv Dna
The correlations between serum HBsAg titers and serum HBV DNA in each phase of CHB are shown in Figure Figure1B-F.1B-F. There was a strong correlation in the IC phase , a modest correlation in the ENH and IT phases, but a poor correlation between serum HBsAg titers and serum HBV DNA in the LR and LC phases.
The ratio of HBsAg to HBV DNA in each phase of CHB was also determined .2). The HBsAg/HBV DNA ratio was significantly higher in the LR phase compared to the IT, IC, ENH and LC phases .
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Can Hcv Cause Psychosis
At least 50% of patients infected with HCV suffer from a psychiatric illness, and the lifetime prevalences of psychotic, anxiety, affective, personality, and substance use disorders are all higher among patients with HCV,10,47 as compared to the general US population studied in the Epidemiologic Catchment Area study.
The Treatment Programs Role In The Screening Process
Medical staff members at substance abuse treatment programs might assume the primary role for screening individuals for and explaining the screening process and test results. Opioid treatment programs with medical staff members should screen for and C at intake and periodically as indicated. In programs without onsite medical staff, clients may be referred elsewhere for screening with minimal involvement of the substance abuse treatment program.
Regardless of the type of program, counselors should have a basic understanding of the importance of screening, the screening process, and the meaning of the results. Counselors can encourage clients referred for screening to follow through and complete the screening and evaluation process . Clients might feel anxious about being diagnosed with hepatitis, and they might delay or avoid getting screened.
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The Hbsag Test Procedure
Since a test for Hepatitis B is a blood test, a blood sample is taken by a lab technician as follows:
- An elastic band is wrapped around the upper arm
- The needle site is cleaned with alcohol
- The needle is inserted into the vein
- A tube is attached to the needle to fill it with blood
- The band is removed from the arm once enough blood is collected
- A gauze pad is applied over the needle site as the needle is removed
- A bandage is applied over the site
Study Selection And Characteristics
A total of 11,589 citations were identified, and 293 full-text articles examined which identified 40 studies meeting pre-defined criteria . Of the included studies, 33 compared RDTs and/or EIAs against an immunoassay reference standard, of which five focused on accuracy in HIV-positive individuals . Seven studies compared RDTs and/or EIAs against a NAT reference standard, of which 3 had data from HIV-positive patients . Studies were all either cross-sectional or case-control, predominantly in the laboratory setting, and performed in a broad range of populations, including healthy volunteers, blood donors, pregnant women, incarcerated adults, HIV and hepatitis patient cohorts with confirmed HBV infection. The prevalence of HBV ranged from 1.9 to 84% in populations tested. A mixture of serum, plasma and whole blood was used for RDTs, while studies of EIAs were performed on serum or plasma samples. Study characteristics are presented in Tables , and .
Three studies had data from 442 HIV-positive patients in Uganda and South Africa, with pooled sensitivity and specificity of 57.9% and 95.8% , respectively. The corresponding pooled sensitivity and specificity for the 202 HIV-negative patients across two of these studies were 83.3% and 85.7% , respectively .
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What Exactly Is Hbsag And Hbsab What Exactly Is The Difference Between Hbsag And Hbsab Are They Antibodies That Protect Against The Hbv Or Is It The Actual Virus
Ag is the antigen and Ab is the antibody.
First it is important to know the difference between and antibody and an antigen :
- Antibody = protein produced by the immune system to neutralize all molecules foreign to the body.
- Antigen = a foreign and/or toxic molecule that induces an immune response.
Now the difference in this example:
- HBsAb = Hepatitis B surface antibody that is produced because the body has been exposed to the Hepatitis B virus .
- HBsAg = Hepatitis B surface antigen, this is the part of the virus that induces an immune response.
Presence of either HBsAb and/or HBsAg mean different things:
- Presence of HBsAb = the body has been exposed to HBV. It usually appears about one month after the virus has disappeared. This means someone is no longer contagious when HBsAB is present. Also, it protects the body from getting HBV in the future.
- Presence of HBsAg = early sign of an active infection with HBV, people are contagious in this stage.
- Presence of both HBsAb and HBsAg = sometimes this occurs and means that the body is fighting off the infection, but people are still contagious.
There is also another test for HBV that tests for the presence of the Hepatitis B e-antigen . This antigen is only present during an active HBV infection. It can be used to determine how contagious someone is and to determine the effectiveness of treatment.
What Is Hepatitis B Surface Antigen In General
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Hepatitis B Surface Antigen With Reflex Confirmati
The Hepatitis B Surface Antigen with Reflex Confirmati test contains 1 test with 2 biomarkers.
Description: The hepatitis B Surface antigen test is a blood test that checks for hepatitis b antigen in your bloods serum. If hepatitis B antigen is detected, confirmation testing will be performed.
Also Known As: Hep B Test, HBsAg Test, Hepatitis B Antigen Test, HBV Test, HBV Surface Antigen Test
Collection Method: Blood Draw
Specimen Type: Serum
Test Preparation: No preparation required
IMPORTANT: NOTE THIS IS A REFLUX TEST – The price charged for this test is only for the Hepatitis B Surface Antigen. ADDITIONAL CHARGE OF $39 WILL OCCUR FOR THE REFLUX CONFIRMATION if the Hepatitis B Surface Antigen is positive.
When is a Hepatitis B Surface Antigen test ordered?
When someone develops signs and symptoms of acute hepatitis, hepatitis B tests may be conducted to see if they are caused by HBV infection.
When standard test findings such as ALT and/or AST are elevated, hepatitis B testing may be ordered as a follow-up. Acute varieties of hepatitis can sometimes be diagnosed this way since they only generate minor symptoms that are easily confused with the flu. Chronic hepatitis is more typically diagnosed when routine test results are abnormal and has no symptoms.
When someone falls into one of the high risk categories for chronic hepatitis B, a test for hepatitis B surface antigen may be utilized for screening.
What does a Hepatitis B Surface Antigen blood test check for?
Hepatitis B Surface Antigen With Reflex To Confirmation
CPT Code: 87340
Includes: Positive samples will be confirmed based on the manufacturer’s FDA approved recommendations at an additional charge : 87341).
Clinical Significance: Surface antigen usually appears in the serum after an incubation period of 1 to 6 months following exposure to Hepatitis B virus and peaks shortly after onset of symptoms. It typically disappears within 1 to 3 months. Persistence of Hepatitis B surface antigen for greater than 6 months is a prognostic indicator of chronic Hepatitis B infection.
Alternative Name: Australian Antigen,HBsAg,Auszyme
Supply: T01 – Red/Gray SST 8.5mL
Preferred Specimen: Serum
Transport Container: Serum Separator Tube
Transport Temperature: Room Temperature
Specimen Stability: Room Temperature: 7 days
Rejection Criteria: Gross Hemolysis, Gross Lipemia
For additional supply or collection device information, please contact DLO’s Customer Service at 891-2917, option 2.
The CPT codes provided are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the Payor being billed.
Immunohistochemical Stains For Viral Antigens In Chronic Hepatitis B
Immunohistochemical stains for HBcAg and HBsAg are a useful diagnostic adjunct in biopsies of patients with chronic HBV infection. In addition to confirming HBV as the cause of liver disease in any given case, positive staining for HBcAg is also indicative of active viral replication. Such staining is usually confined to hepatocyte nuclei however, in cases with abundant HBcAg production, the cytoplasm may be stained as well . Extensive positivity for HBcAg may be seen in perinatally infected patients who have developed tolerance to the virus, as well as in immunosuppressed patients . Immunostaining for HBsAg is cytoplasmic but may also be membranous the latter is seen in cases of active viral replication in parallel with HBcAg positivity.18
Monica A. Konerman, Anna S. Lok, in, 2018
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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What Is Hepatitis B
Hepatitis B is a serious liver infection caused by the hepatitis B virus . For some people, hepatitis B infection becomes chronic, meaning it lasts more than six months. Having chronic hepatitis B increases your risk of developing liver failure, liver cancer or cirrhosisa condition that causes permanent scarring of the liver.
Most people infected with hepatitis B as adults recover fully, even if their signs and symptoms are severe. Infants and children are more likely to develop a chronic hepatitis B infection.
Question 5 How Can Quantitative Hbsag Levels Help Distinguish The Different Phases Of Hbv Infection
Quantitative HBsAg results, along with selected immunologic and virologic characteristics, may help differentiate infection phases and inform prognosis and therapeutic decision-making. For example, the HBeAg-negative inactive carrier state may be identified by low HBV DNA and low HBsAg in patients with certain genotypes.2 Low serum HBsAg levels measured 1 year after documented HBeAg seroconversion may predict subsequent HBsAg loss in HBV genotype B or C infection.5 It has been documented that a drop in HBsAg levels in patients who are on NA treatment can predict subsequent HBsAg loss. The observed decrease in HBsAg concentration may help predict HBsAg loss and support the decision to discontinue peg-IFN and/or NA therapy.
Peg-interferon and/or NA treatment may lead to reductions in HBsAg. In general, sustained responders display greater and/or more rapid HBsAg decline than non-responders.1-2,4-6 The quantitative HBsAg level that best predicts sustained virologic response has yet to be well established. However, some experts consider 2 or more measurements of HBsAg below the assayÃ¢s lower limit of detection obtained Ã¢Â¥6 months apart to be a potentially useful endpoint for antiviral therapy.9-11
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Understanding Of Lab Tests Results
Please visit the page about Hepatitis B Testing on the site associated with The American Association for Clinical Chemistry for better understanding of tests. There you will find the most detailed and full information regarding lab tests. In “common questions” tab you will find answers on the most common questions.
In addition, you can use a special form to ask the question. It is useful, if there is no answer on your question on the web site. A laboratory scientist will answer your question. It is a part of voluntary service provided by the American Society for Clinical Laboratory Science.
Negative But Other Hepatitis Tests Are Positive
Your HBsAb test may be negative even when other hepatitis B tests are positive, showing active or chronic infection. Further testing is necessary, especially for the hepatitis B surface antigen , which shows that the virus itself is circulating in your bloodstream and that you have an active or chronic infection.
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