Hepatitis B Viral Load Quantitative

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High Hepatitis B Virus Dna Viral Load As The Most Important Risk Factor For Hbv Reactivation In Patients Positive For Hbv Surface Antigen Undergoing Autologous Hematopoietic Cell Transplantation

George K. K. Lau, Yu-hung Leung, Daniel Y. T. Fong, Wing-yan Au, Yok-lam Kwong, Albert Lie, Ji-lin Hou, Yu-mei Wen, Amin Nanj, Raymond Liang High hepatitis B virus DNA viral load as the most important risk factor for HBV reactivation in patients positive for HBV surface antigen undergoing autologous hematopoietic cell transplantation. Blood 2002 99 : 2324â2330. doi:

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Diagnosed With Chronic Hepatitis B What Does Your Hbv Dna Test Tell You

If you have been diagnosed with chronic hepatitis B, your doctor has probably run several blood tests that show if the infection is harming your liver and identify what stage of infection you are in. Doctors consider all of these results when deciding if you need treatment and how often you should be monitored.

In this blog, well examine how one of the tests the HBV DNA or viral load test can give you a snapshot into your hepatitis B infection and your health. The HBV DNA test is performed on a blood sample using a Polymerase Chain Reaction technique that rapidly generates HBV DNA fragments so they can be measured. Today, viral load is usually measured using international units per milliliter . However, in the past it was measured in copies per milliliter , and in some regions and labs, it is still used.

If you ever need to convert copies into international units, there are about 5.6 copies in one international unit, so 5,000 copies/mL equals about 893 IU/mL. Remember to keep copies of your lab information on file so you can track your status. An Excel spreadsheet works great.

The sensitivity of HBV DNA tests may vary with each lab so its a good idea to use the same lab for your test. Labs usually measure down to less than 200 IU/mL. Below the threshold, the viral load is considered undetectable something everyone with chronic hepatitis B wants to hear.

Definition Of Hbv Infection In Infants

Because the seropositivity of the HBV core antibody at age 0-24 months mainly results from passive transfer of the maternal antibody, we used seropositivity of HBsAg as the marker of infection. Infants were tested for HBsAg at 4-8 months and/or at 1-2 years of age. If an infant tested HBsAg positive, HBsAg testing was repeated 6 months later to confirm chronic infection. The institutional review board of the above-mentioned hospitals approved the protocol.

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Pretransplantation Characteristics Associated With Hbv

Pretransplantation characteristics associated with hepatitis due to HBV reactivation after HCT were an elevated serum ALT level, HBsAg positivity, detectable serum HBV DNA , and BCP . Three patients with elevated serum ALT before HCT and 10 patients with normal serum ALT before HCT had hepatitis due to HBV reactivation . Eleven patients who were positive for HBsAg before HCT had hepatitis due to HBV reactivation, where only 2 HBsAg-negative patients had hepatitis due to HBV reactivation . Nine patients with detectable serum HBV DNA and only 4 without detectable serum HBV DNA had hepatitis due to HBV reactivation . Pretransplantation serum HBV DNA levels were also significantly higher in patients with hepatitis due to HBV reactivation than in those without hepatitis due to HBV reactivation . In addition, 7 patients with BCP and 5 without BCP had hepatitis due to HBV reactivation .

Viral Load And Treatment: Unfavorable Arguments

Presently, the viral load cannot be considered as the only treatment criterion. HBV DNA persists even in persons who have serological recovery from acute HBV infection. Patients with low HBV-DNA levels, between 300 and 104 copies/mL, have, although a very low one, a risk of progression to cirrhosis and HCC. The progression in CHB infection is a multi-factorial process including interaction between host and environmental factors.

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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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Lod Of The Duplex Real

The sensitivity test, which was performed using 20 replicates of different concentrations , showed that the lowest 100% positive concentration for the duplex real-time PCR assay was 20 IU/ml . These results were further subjected to probit regression analysis. The LODs of the S region, the C region, and the duplex real-time PCR assay were 15.2 IU/ml , 16.6 IU/ml , and 11.9 IU/ml , respectively.

Table 3 Limit of detection for the S and C regions using the duplex real-time PCR assay

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Hepatitis C Viral Load / Hcv Rna Quantitative Testing

Hepatitis C

The viral load of hepatitis C refers to the amount of virus present in the bloodstream. The quantitative HCV RNA tests measure the amount of hepatitis C virus in the blood. The result will be an exact number, such as “1,215,422 IU/L.” Many people refer to the quantitative measurement as the hepatitis C “viral load.”

Viral load tests are used to confirm active hepatitis C infection and are used during treatment to help determine response. If you have lower levels of virus in your blood when you start treatment, you may have a better chance of getting rid of the virus.

Different Types Of Viral Load Testing

There are two approaches to measuring viral load: quantitative testing and qualitative testing. Quantitative testing uses different techniques to measure viral load, including polymerase chain reaction , branched-chain DNA , and transcription-mediated amplification . Both PCR and TMA measure HCV RNA levels in the blood and are accurate down to 10-15 IU/mL. The bDNA is less complex than PCR and TMI, and is limited to measurement of viral loads above 615 IU/mL.1

Quantitative testing is typically used before starting treatment to determine a baseline viral load for the purpose of evaluating treatment response. Qualitative testing is capable of detecting low levels of HCV RNA. It gives results as positive or negative and, in some cases, has a lower limit of detection below 10 IU/mL. Qualitative testing is typically used to confirm diagnosis, where a specific viral count is not needed.1

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Probbability Of Response To Treatment And Appearance Of Resistance

Treatment is indicated if there is a high risk of liver-related mortality and morbility and a high likehood of manteined viral supression after a defined course of therapy. This risk is variable during the course of HBV infection.

There are several treatment strategies for CHB: IFN and PEG-IFN, lamivudine, adefovir dipivoxil, telbivudine and entecavir. None of theses achieves complete HBV eradication and they have limited long-term efficacy. In the majority of patients, particularly those with HBeAg-negative disease, HBV is suppressed but not eradicated by treatment, and relapses occur when drug treatment is interrupted.

For HBeAg-negative patients, the sustained response is low: 15% show normalization of serum ALT and suppression of serum HBV DNA. For HBeAg-positive patients, the likelihood of response to nucleoside64/nucleotide analogs/PEG-IFN depends greatly upon degree of serum aminotransferase elevation. In general, treatment with any of these drugs does not result in higher rates of HBeAg seroconversion compared to non- treatment in those who have a serum ALT < 2 × ULN. After a year of treatment, HBeAg seroconversion occurs in < 10% of these patients treated with IFN, lamivudine or adefovir. ASSLD guidelines do not recommend treatment in normal ALT patients, because it is unlikely to achieve HbeAg seroconversion.

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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?

What A Hepatitis B Viral Load Test Can Tell You About Your Infection

The hepatitis B virus DNA quantification, also known as the viral load test, is a blood test that measures the amount of hepatitis B virus DNA in the blood of chronically infected patients. The blood is tested using a Polymerase Chain Reaction technique. By itself, the viral load shouldnt tell you all that much. The information gained from an HBV viral load test should only be considered in relation to other information like your e-antigen status, liver enzymes test results, and inflammation levels. The viral load is usually measured in international units per milliliter , but in the past, it was measured in copies per milliliter.

Viral load varies over time, depending on the phase of your hepatitis B infection. Its critical to have your viral load regularly monitored to fully understand what stage of the virus you might be experiencing. The phase you are in is determined by an array of lab results, which includes viral load.

Chronic hepatitis B infection is characterized by four phases. Not everyone will experience all four phases, and the lengths of the phases vary among people. Many people living with hepatitis B will transition between these phases.

Reactivation Phase: People who are HbeAg negative may experience reactivation. ALT loads are elevated, HBV viral loads are above 2,000 IU/mL, and liver inflammation and fibrosis levels are moderate-to-severe.

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Discusses Physiology Pathophysiology And General Clinical Aspects As They Relate To A Laboratory Test

Diagnosis of acute or chronic hepatitis B virus infection is based on the presence of HBV serologic markers such as hepatitis B surface antigen and hepatitis B core IgM antibody , or the presence of HBV DNA detected by molecular assays. Although the diagnosis of acute and chronic HBV infection is usually made by serologic methods, detection and quantification of HBV DNA in serum are useful to:

-Diagnose some cases of early acute HBV infection

-Distinguish active from inactive HBV infection

-Monitor a patient’s response to anti-HBV therapy

The presence of HBV DNA in serum is a reliable marker of active HBV replication. HBV DNA levels are detectable by 30 days following infection, generally reach a peak at the time of acute hepatitis, and gradually decrease and disappear when the infection resolves spontaneously. In cases of acute viral hepatitis with equivocal HBsAg test results, testing for HBV DNA in serum may be a useful adjunct in the diagnosis of acute HBV infection, since HBV DNA can be detected approximately 21 days before HBsAg typically appears in the serum.

Primers And Probes Selection For The Duplex Real

One thousand HBV complete sequences from Chinese patients were downloaded from the NCBI database, which include genotypes A, B, C, D, and G and were aligned by the DNAman software. Primers and probes were designed by Primer 5 to target the conserved sequences of the S and C regions of the HBV genome. Primers were selected by testing using EvaGreen, and primers with significant dimerization were removed. Probes with lower count values were chosen for further experiments . The primers and probes are listed in Table .

Table 1 The primers and probe sequences for the S and C regions

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Factors Related To Liver Carcinogenesis

Comparison of background factors was conducted for the 9 patients who developed HCC during long-term NA therapy and for the 158 patients who did not develop liver cancer during the treatment period. Among the factors that were present before NA therapy, being male and the presence of hepatic cirrhosis were significant factors for the development of HCC. However, the ALT level normalization, low HBsAg level, and HBV-DNA negativation at the last observation at the end of the long-term NA therapy were not found to be significant factors for the development of HCC .

Table 3

Characteristics of patients with HCC and without HCC after long-term NA therapy

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 didnt 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.

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Dry Blood Spots A Reliable Method For Measurement Of Hepatitis B Viral Load In Resource

• Affiliation Department of Virology, Norwegian Institute of Public Health, Oslo, Norway

• Affiliation Department of Virology, Norwegian Institute of Public Health, Oslo, Norway

• Affiliation Department of Virology, Norwegian Institute of Public Health, Oslo, Norway

• Affiliation Medical Department, St. Pauls Hospital Millennium Medical College, Addis Ababa, Ethiopia

• Affiliation Medical Department, St. Pauls Hospital Millennium Medical College, Addis Ababa, Ethiopia

• Affiliations Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia, Centre for Imported and Tropical Diseases, Oslo University Hospital, Ullevål, Oslo, Norway

• * E-mail:

  Affiliations Centre for Imported and Tropical Diseases, Oslo University Hospital, Ullevål, Oslo, Norway, Department of Microbiology, Vestre Viken HF, Bærum, Norway