How To Detect Hepatitis B

Chronic Hepatitis B Symptoms

Most patients with chronic hepatitis B are asymptomatic unless their disease progresses. Others might have nonspecific symptoms, such as fatigue.

Some patients experience worsening of the infection and develop signs and symptoms similar to acute hepatitis.

If patients with chronic hepatitis B progress to cirrhosis they will develop signs and symptoms of liver failure, including:

• Peripheral edema
• Hepatocellular carcinoma

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.

When Is It Ordered

Hepatitis B tests may be ordered when someone has signs and symptoms associated with acute hepatitis to determine if they are due to infection with HBV. Some of these include:

Hepatitis B tests may be done as follow up when routine tests results such as ALT and/or AST are elevated. Sometimes acute forms of hepatitis may be detected this way since they may cause only mild symptoms that can be confused with the flu. Chronic hepatitis more often has no symptoms and is more commonly detected when routine test results are abnormal.

A test for hepatitis B surface antigen may be used for screening when someone falls into one of the high-risk categories for chronic hepatitis B. Joint guidelines from the Centers for Disease Control and Prevention and American College of Physicians were published in December 2017 and recommend the following groups be tested for HBsAg:

When hepatitis B tests are used to monitor people with chronic hepatitis B infections, they may be performed on a regular basis. Hepatitis B surface antigen and hepatitis B e antigen , often along with HBV DNA, are usually measured about every 6 months to a year since, in some people, HBeAg will go away on their own. In those who are being treated for chronic HBV, HBeAg and HBV DNA tests can be used to determine whether the treatment is successful.

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Search Strategy And Identification Of Studies

We conducted a systematic review and meta-analysis on the diagnostic accuracy of HBsAg tests. The review was registered in PROSPERO and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses check list. We utilised standardised methods for systematic reviews on diagnostics, including an a priori protocol .

Literature search strategies were developed by a medical librarian with expertise in systematic review searching, using a search algorithm consisting of terms for: hepatitis B, diagnostic tests, and diagnostic accuracy. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Science Citation Index Expanded, SCOPUS, Literatura Latino-Americana e do Caribe em Ciências da Saúde , WHO Global Index Medicus, WHOs International Clinical Trials Registry and the Web of Science. We also contacted researchers, experts and authors of major trials, with no relevant manuscripts in preparation identified. Additional pertinent citations were identified through bibliographies of retrieved studies.

Abstracts were screened by reviewers AA and HK according to standard inclusion and exclusion criteria. All studies identified for full manuscript review were assessed independently by two reviewers against inclusion criteria. Papers were accepted or rejected, with reasons for exclusion specified. Discrepancies were resolved by discussion between review authors and, when required, a third independent reviewer .

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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How Do I Get Tested For Hepatitis B/hbv

There are three blood tests for Hepatitis B. One tests for the virus itself, and two test for your bodys reaction to the virus. Sometimes your healthcare provider will do all three tests because each can supply different information.

• If you are positive for the antigen test it means that you are currently infected with the virus and can pass it to other. If you clear an HBV infection and do not remain chronically infected, you will usually test negative again within 4 months after your symptoms resolve.
• If you are positive on the anti-HBs test, which looks for your bodys reaction to a surface protein of the virus, it means that you are immune to Hepatitis B. This could either be because you were previously exposed to the virus or because you were vaccinated. You can not pass the virus to others.
• If you are positive on the anti-HBc test, which looks for your bodys reaction to a core protein of the virus, it usually means that you are chronically infected with HBV, and can pass the disease to others. However, if you are also positive on the anti-HBs test, then a positive anti-HBc test is probably because of a previous infection.

Other tests may be ordered if your healthcare provider thinks you are chronically infected with HBV. These tests are done to monitor the progress of the disease and its treatmentnot to detect whether or not you are infected.

What If I Have Symptoms Of Viral Hepatitis

If you have symptoms or signs of viral hepatitis, your health care provider can perform a blood test to check for the presence of an antibody. If you have hepatitis B or C, more blood samples may be necessary later — even if the symptoms have vanished — to check for complications and determine if you have progressed from acute to chronic disease. Most people have vague or no symptoms at all hence, viral hepatitis is often referred to as a silent disease.

Your healthcare provider may also require a liverbiopsy, or tissue sample, in order to determine the extent of the damage. A biopsy is commonly performed by inserting a needle into the liver and drawing out a fragment of tissue, which is then sent to a lab to be analyzed.

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

Acute HBV infection generally presents after an incubation period of six weeks to several months with an onset of nonspecific symptoms that may include fever, malaise, anorexia and nausea, followed by the onset of jaundice, dark urine and pale stools. Approximately 25% to 40% of infected adults will be symptomatic, and most will demonstrate elevations in ALT however, infants, toddlers and immunosuppressed individuals may not manifest signs or symptoms of infection. The management of acute infections is largely supportive unless fulminant hepatitis develops, in which case the patient should be referred to a liver specialist. Because the clinical features of acute hepatitis are very similar for HAV, HBV and HCV, testing for all three agents should be performed when working up an acute case. While the sexual transmission of HCV is rare, varying between zero to six cases per 1000 person-years , HAV that is typically spread by the fecal-oral route poses a clear risk to sexual partners. Figure Figure11 and Table Table22 outline the appropriate serological tests to investigate acute hepatitis.

Who Is More Likely To Get Hepatitis C

People more likely to get hepatitis C are those who

• have injected drugs
• have been on kidney dialysis
• have been in contact with blood or infected needles at work
• have had tattoos or body piercings
• have worked or lived in a prison
• were born to a mother with hepatitis C
• are infected with HIV
• have had more than one sex partner in the last 6 months or have a history of sexually transmitted disease
• are men who have or had sex with men

In the United States, injecting drugs is the most common way that people get hepatitis C.13

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When To Get Tested

For screening: at least once when you are age 18 years or older when you are pregnant when you have risk factors for HCV infection, regardless of age

For diagnosis: when you may have been exposed to the hepatitis C virus, such as through injection drug use, or when you have signs and symptoms associated with liver disease

For monitoring: before, during, and after hepatitis C treatment

Which Serological Assay To Use

A systematic review compared the diagnostic performance of commercially available serological assays for the detection of HBsAg, when compared to a laboratory-based immunoassay reference standard . The review identified 30 studies from 23 countries with varying prevalence of hepatitis B and evaluated 33 different RDTs. There were five studies of eight different EIAs against an immunoassay reference standard . A mixture of serum, plasma, capillary and venous whole blood specimens were used for RDTs, but only serum or plasma was used for EIAs. Seven studies assessed performance using capillary or venous whole blood . Sample size varied from 25 to 3928, and populations studied included healthy volunteers and blood donors, at-risk populations, pregnant women, incarcerated adults, and patients with confirmed hepatitis B.

RDTs. In 30 studies of 33 different RDTs, the pooled clinical sensitivity of RDTs against different EIA reference standards was 90.0% and pooled specificity was 99.5% .

Summary test accuracy of RDTs and EIAs for HBsAg .

Brands: there was significant variation in performance between RDT brands and within the same brand of RDT, with sensitivity ranging from 50% to 100% and specificity from 69% to 100%.

Specimen type: results for capillary whole blood specimens were comparable to serum but less heterogeneous.

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Enzyme Immunoassays For Detection Of Hepatitis C Antibody

The HCV Ab test is used for initial screening for hepatitis C. The test is performed by enzyme immunoassays , which detect the presence of hepatitis C antibodies in serum. The result of the test is reported as positive or negative. Third-generation EIAs have a sensitivity/specificity of approximately 99%. However, the presence of HCV Ab does not indicate whether the infection is acute, chronic, or resolved. A positive antibody test result should be followed up with an HCV RNA test to confirm that viremia is present.

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:

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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 .
• Youve 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 its working.

What Do The Results Mean

A hepatitis B blood panel consists of three tests that can be done with just one blood sample:

• Hepatitis B surface antigen . A positive test indicates that youre infected with hepatitis B and that you can spread it to other people. Further tests are needed to see if you have an acute or chronic infection.
• Hepatitis B core antibody . A positive result can indicate a past or current hepatitis B infection, but doesnt mean youre immune. A positive result needs to be interpreted by a doctor by examining the results of the other two tests.
• Hepatitis B surface antibody . A positive test indicates that youre protected from hepatitis B either through previous infection or vaccination .

The combination of these tests can indicate your hepatitis B status and whether you need to be vaccinated. Your test will give a negative or positive result for each category depending on whether your results are above or below the cutoff value.

Most peoples test results fall into the following categories. But its possible to have a result that doesnt fall into one of these groups. If youre reading your results yourself, be careful not to confuse HBsAb with HBcAb.

is associated with hepatitis B immunity after vaccination. But research has found that anti-HBs decline over time.

A found that more than 95 percent of people had anti-HBs levels greater than 10IU/L two years after vaccination. But this rate decreased to 70 percent after eight years.

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Management Of Pregnant Hbv Carriers

Pregnant HBV carrier mothers present a unique opportunity to prevent transmission of HBV to their neonates. All infants born to HBsAg-positive mothers should receive hepatitis B immune globulin and a full course of HBV vaccination . Vaccine failure in the neonate is rare but does occur , and may be accounted for by transplacental transmission before birth. Follow-up testing of the neonate should be performed to confirm vaccination effectiveness. Testing should be performed for HBsAg to detect vaccine failures, anti-HBs to confirm a successful vaccine response and anti-HBc-Total to determine if the anti-HBs response was due to vaccination or resolution of natural infection. While testing for these markers is recommended one to two months after completion of the vaccine series, testing at approximately 18 months would ensure that the anti-HBc-Total test does not represent maternal antibody. This may be important because vaccination failures have occasionally been associated with HBV vaccine escape mutants that may only demonstrate a positive anti-HBc-Total as the sole marker of infection. These mutations occur in the open reading frame of the HBsAg, may not be recognized by antibodies induced by current HBV vaccine, and may not be detected by currently available HBsAg enzyme immunoassays . Clearly, surveillance systems need to be in place to ensure that HBV vaccines remain effective and vaccine escape mutants do not replace current HBV strains.

Hepatitis B Surface Antigen Test

A hepatitis B surface antigen test shows if you have an active infection. A positive result means you have hepatitis B and can transmit the virus to others. A negative result means you dont currently have hepatitis B.

This test doesnt distinguish between chronic and acute infection. This test is used together with other hepatitis B tests to determine the state of a hepatitis B infection.

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