What Happens During A Hepatitis Panel
A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
At-home testing kits are available for hepatitis B and C. Usually the test kit will include a sharp device, to prick your finger so you can collect a drop of blood to send to a lab for testing. For more information on at-home testing for hepatitis, talk to your provider.
Antibody To Hcv Antigens
- If negative, chronic HCV infection is ruled out in immunocompetent individuals. Because the antibody to HCV antigens response in immunocompromised persons can be blunted, a qualitative test for HCV-RNA may be required to rule out occult infection in such individuals. A new HCV core antigen test, which is currently under evaluation, can also be used to confirm active infection . However, the currently available HCV core antigen test is less sensitive, detecting less than 90% to 95% of HCV-RNA-positive specimens . Therefore, the current HCV core antigen should not be used for definitive exclusion of active infection.
- If found to be anti-HCV positive, the patient has been infected with HCV. Because most HCV infections are chronic , the presence of anti-HCV is correlated with active infection however, a qualitative test for HCV-RNA is currently required to confirm active HCV infection .
What Are The Risk Factors For Getting Hepatitis B
Due to the way that hepatitis B spreads, people most at risk for getting infected include:
- Children whose mothers have been infected with hepatitis B.
- Children who have been adopted from countries with high rates of hepatitis B infection.
- People who have unprotected sex and/or have been diagnosed with a sexually transmitted infection.
- People who live with or work in an institutional setting, such as prisons or group homes.
- Healthcare providers and first responders.
- People who share needles or syringes.
- People who live in close quarters with a person with chronic hepatitis B infection.
- People who are on dialysis.
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What Laboratory Tests Are Available For Hepatitis B
Tests are available to detect the types of antigens used to identify the hepatitis B virus. The tests determine if the virus is present in the body tissue or blood. The amount of each type of antigen present indicates how advanced the disease is and how infective the individual has become.
Other tests are available to detect the bodys reaction to the viral infection or the bodys reaction to vaccination against the virus. These tests work by measuring the number of antibodies present in the blood.
Igm Class Antibody To Hav
- If the IgM class antibody to HAV is negative, HAV infection is ruled out in immunocompetent patients .
- If positive, acute HAV infection is likely. As the anti-HAV-IgM may remain detectable for up to two years after infection in a small subset of patients, the history and clinical presentation must be considered in making an accurate diagnosis .
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Diagnosis Of Hepatitis B
Jeong Eun Song, Do Young Kim
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
Contributions: Conception and design: DY Kim Administrative support: None Provision of study materials or patients: None Collection and assembly of data: None Data analysis and interpretation: None Manuscript writing: All authors Final approval of manuscript: All authors.
Correspondence to:
Abstract: Hepatitis B virus infection is a major global health problems leading to severe liver disease such as cirrhosis and hepatocellular carcinoma . HBV is a circular, partly double-stranded DNA virus with various serological markers: hepatitis B surface antigen and anti-HBs, anti-HBc IgM and IgG, and hepatitis B e antigen and anti-HBe. It is transmitted by sexual, parenteral and vertical route. One significant method to diminish the burden of this disease is timely diagnosis of acute, chronic and occult cases of HBV. First step of HBV diagnosis is achieved by using serological markers for detecting antigens and antibodies. In order to verify first step of diagnosis, to quantify viral load and to identify genotypes, quantitative or qualitative molecular tests are used. In this article, the serological and molecular tests for diagnosis of HBV infection will be reviewed.
Keywords: Hepatitis B virus serology molecular diagnosis
Submitted Aug 01, 2016. Accepted for publication Aug 28, 2016.
doi: 10.21037/atm.2016.09.11
Diagnostic Use Or Instructions
Hepatitis B status includes Hepatitis B s Ag, Hepatitis B s Ab and Hepatitis B core Ab.
Further tests will be performed as required.
- Clinicians should try to identify patients with raised LFTs due to chronic viral hepatitis,
- All HBsAg-positive pregnant women should have their HBV viral load measured,
- All HCV PCR-positive patients should be referred to a specialist, for consideration of treatment with oral direct acting antiviral therapies .
- New Zealand wide Many HBsAg-positive patients are not being properly followed up or referred, and stand the risk of developing preventable liver disease.
- HBsAg is present in almost all actively infected persons with HBV and is the first test that should be requested if HBV infection is suspected.
- HBV surface antibody is a test that should really only be ordered for adults in occupational health settings, preferably within a few months of the final dose of vaccine: those who develop a clear response will be protected for life.
- HBV e antigen predicts high titres of virus, but its absence does not exclude high viral loads, especially in adults who were infected in childhood.
- HBV DNA measurement is an essential part of assessment and management
Note: Waikato DHB Laboratory screen with HBsAg, anti-HBs and anti-HBc to reduce the need for repeat testing. HBc IgM may help in selected cases for Public Health to determine if the infection is acute.
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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.
When Should I Get This Test
Using hepatitis B tests to screen for HBV is recommended for certain groups at an increased risk of infection. You may benefit from hepatitis B screening if you:
- Were born in parts of the world where the disease is more common, including Africa, Asia, Eastern Europe, South America, and parts of the Middle East
- Didnât receive a hepatitis B vaccine
- Are HIV-positive
- Use injectable drugs
- Are at risk of HBV infection due to sexual exposure
A doctor may order hepatitis testing based on your symptoms, medical and family history, and a physical exam. If you develop symptoms without recent exposure to HBV, doctors may recommend an acute viral hepatitis panel that looks for hepatitis A, B, and C in one sample of blood.
Hepatitis tests may also be performed as follow-up tests when other tests of liver health are abnormal.
Testing is common in those that show symptoms that could be caused by hepatitis B. Symptoms of hepatitis B include:
- Loss of appetite, nausea, or vomiting
- Pain in the joints or abdomen
- Yellowish skin and eyes
Using hepatitis B testing to assess immunity to HBV may take place before or after vaccination. Pre-vaccination testing is not always needed but may be performed if there is a chance that you have previously been infected with HBV or have already been vaccinated. Post-vaccination testing is used in certain groups of people at an especially elevated risk for HBV infection, including infants born to mothers with a hepatitis B infection.
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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.
Molecular Methods For Hbv Infection
HBV DNA is a direct measurement of the viral load, which reveals the replication activity of the virus. It is detectable at the early stage of infection and increases up to peak level approximately 3 months after the exposure to HBV and then gradually diminishes in chronic infection or disappears at the recovery from HBV infection.
As the prevalence of serologically negative HBV infection has increased, HBV-DNA detection has obtained more awareness in clinical medicine . The detection of HBV DNA is a reliable marker of replication activity, and higher titers of HBV DNA are related to the more rapid disease progression and higher incidence of HCC . Furthermore, HBV DNA testing is useful in routine clinical setting to determine patients who need antiviral therapy and monitor them for suitable treatment .
There are two principles of techniques to identify and quantify HBV DNA: signal amplification such as hybrid capture and branched DNA technology target amplification such as polymerase chain reaction . Real-time PCR can detect wide dynamic range of viral load . For this reason, it has come to be the standard method to detect and quantify HBV DNA in clinical setting. Furthermore, it can be fully automated and does not generate carry-over contamination . Table 1 displays the comparison of assays for quantitative measurement of HBV DNA.
Table 1
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How Can I Get A Hepatitis B Test
Hepatitis B testing is typically prescribed by a doctor and performed in a hospital, lab, or another medical setting. Taking a hepatitis B test requires a blood sample, which can be collected by a health care professional.
For laboratory-based testing, blood is drawn from your vein. After blood is collected, the sample is sent to a laboratory for analysis.
The test can also be ordered online and is available through our shop page.
Transmission Of Hepatitis B
The hepatitis B virus is transmitted through blood and sexual fluids. This can most commonly occur in the following ways:
Direct contact with infected blood
From an infected pregnant person to their newborn during pregnancy and childbirth
Needles and other medical/dental equipments or procedures that are contaminated or not sterile
Unprotected sex
Use of illegal or street drugs
Body piercing, tattooing, acupuncture and even nail salons are other potential routes of infection unless sterile needles and equipment are used. In addition, sharing sharp instruments such as razors, toothbrushes, nail clippers, earrings and body jewelry can be a source of infection.
Hepatitis B is NOT transmitted casually. It cannot be spread through toilet seats, doorknobs, sneezing, coughing, hugging or eating meals with someone who is infected with hepatitis B.
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How Is Hepatitis B Diagnosed
Hepatitis B is diagnosed via blood tests. Blood tests can help your clinician determine whether you have hepatitis B and if its acute or chronic.
In some cases, your clinician might also suggest a liver ultrasound. An ultrasound can show whether your liver is damaged and to what extent.
The hepatitis B vaccine is the most effective way to prevent infection. You might have to have two or three shots depending on the type of vaccine you receive.
The now recommends the hepatitis B vaccine for:
- all infants within 24 hours of birth
- children and adolescents who werent vaccinated at birth
- unvaccinated adults under the age of 59
- unvaccinated adults ages 60 and older who are at risk of hepatitis B
You can also reduce your risk of exposure to hepatitis B by:
- using condoms and other barrier methods during sexual activity
- avoiding exposure to other peoples blood
- avoiding sharing razors, needles, and toothbrushes with others
If youre concerned about hepatitis B exposure, consider speaking with a healthcare professional about getting the vaccine.
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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Hepatitis B Lab Tests
If you have chronic hepatitis B, your health care provider will usually order additional tests to determine whether the infection is active, such as:
- HBeAg and anti-HBe: HBeAg is the hepatitis B envelope antigen, and anti-HBe are the antibodies produced against this antigen. If HBeAg is detectable in a blood sample, this means that the virus is still active in the liver . If HBeAg is negative and anti-HBe is positive, this generally means that the virus is inactive. However, this is not always the case. Some people with chronic hepatitisespecially those who have been infected with HBV for many yearsmay have what is known as a precore or core variant mutated form of HBV. This can cause HBeAg to be negative and anti-HBe to be positive, even though the virus is still active in the liver.
- Liver function tests: One of the most important liver enzymes to look for is alanine aminotransferase , sometimes called SGPT on lab reports. An elevated ALT level indicates that the liver is not functioning properly and that there is a risk of permanent liver damage. During acute hepatitis B infection, ALT levels can be temporarily elevated, but this rarely leads to long-term liver problems. In chronic hepatitis B, ALT levels can be either periodically or consistently increased, indicating a higher risk of long-term liver damage.
Tips for Understanding Lab Tests
Before discussing specific lab tests, here are some important tips:
Last Reviewed: March 4, 2019
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Data Collection And Cleaning
Data was collected into a Redcap database. All variables were inspected for outliers, inconsistencies, missing data and distribution. Continuous variables were summarized while categorical variables were tabulated to identify inconsistencies and outliers. Visual inspection using scatter plots and histogram was also used to identify outliers and distribution of the data. No inconsistencies or outliers were identified in the data.
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Can I Take The Test At Home
Samples for hepatitis B testing can be collected at home. At-home hepatitis B testing requires you to collect a blood sample, typically from a fingerstick using a very small needle provided in the test kit. Once a blood sample is collected, it is prepared according to the instructions contained in the test kit and mailed to a laboratory for testing.
Because there are numerous types of tests for HBV, it is important to look closely at the specific components of any at-home test kit. Many at-home test kits only look for HBsAg.
You can order a test through our shop page quickly and easily with local lab testing and results in one to three business days.
How You Can Get Hepatitis B
You can get hepatitis B from:
- injecting drugs using shared needles
- being injured by a used needle
- having a tattoo or piercing with unsterilised equipment
- having a blood transfusion in a country that does not check blood for hepatitis B. Blood transfusions in the UK are checked for hepatitis B.
If youre pregnant and have hepatitis B, you can also pass it onto your baby during pregnancy or birth.
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Ethical approval for the study was obtained from Institutional Research and Ethical Committee of Moi University/Moi Teaching and Referral Hospital. The ethical committee waived the need for written consent since this analysis was done retrospectively. All the clinical data has been de-identified as per the ethical board requirement.
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The hepatitis B virus is spread through contact with infected blood or bodily fluids, usually passing into a host via damaged skin or mucous membranes, such as the eyes or genitalia.
The hepatitis B virus is spread through contact with infected blood or bodily fluids. The virus usually passes into a host via damaged skin or mucous membranes, such as the eyes or genitalia. HBV is viable for at least 7 days outside a host therefore, the virus can be spread for days in areas visited by an infected individual. HBV can incubate for 40 to 90 days before signs and symptoms are detected.1 With a lack of early and specific symptomology, many cases of HBV infection go undetected until severe liver damage has occurred.2 Because of these factors, vaccination for HBV is critical for almost everyone, especially anyone working or living in a high-risk environment such as a health care setting, or among household contacts or sexual partners who are infected with HBV.1,3
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