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.
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.
Is It Possible To Prevent Hepatitis
Hepatitis prevention is very much a possibility with the right strategies. A vaccine is available for hepatitis A. Healthcare providers recommend this vaccine for all people who are at high risk of exposure to the virus. Children- one year and above, should take this vaccine. Prevention of hepatitis A is possible with good hygiene and sanitation. Washing hands especially after using the toilet and before consumption of food can help with cutting hepatitis A transmission. Hepatitis B vaccine has become the norm in developed nations and most new-borns are given these shots. The hepatitis B shots are recommended for children and adolescents as well as adults in high-risk groups. Hepatitis C vaccine is not developed yet, and efforts are in the process to have a vaccine for this infection. Prevention of hepatitis C is possible by avoiding contact or exposure to blood and bodily fluids. Further, avoiding the sharing of needles or other instruments to inject drugs can cut the rate of transmission of this disease.
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Specific Hcv Rna Assays And Range Of Detectable Virus
HCV RNA tests use target amplification techniques. Several assays exist for HCV RNA testing. Methods include polymerase chain reaction , transcription mediated amplification , and branched chain DNA tests. Results are expressed as international units/mL . The different methods and different commercial assays each have a lower limit of quantification and lower limit of detection , therefore a patient’s results could be reported differently depending on the assay used. HCV RNA tests must have an LLOQ of 25 IU/mL or lower when used to assess treatment response with DAAs.
LLOQ = the lowest HCV RNA level that is within the linear and analytically acceptable range of the assay.
LLOD = the lowest level of HCV RNA that is detected 95% of the time.
Diagnosing Hepatitis A B & C
At NYU Langone, hepatologists, or liver specialists, and infectious disease specialists use blood tests to diagnose hepatitis A, B, and C. These viral infections cause inflammation of the liver.
If the results of a blood test confirm a diagnosis of viral hepatitis, your doctor may recommend imaging tests or a liver biopsy to determine the extent of liver disease.
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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:
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All Adults Pregnant Women And People With Risk Factors Should Get Tested For Hepatitis C
Most people who get infected with hepatitis C virus develop a chronic, or lifelong, infection. Left untreated, chronic hepatitis C can cause serious health problems, including liver damage, cirrhosis, liver cancer, and even death. People can live without symptoms or feeling sick, so testing is the only way to know if you have hepatitis C. Getting tested is important to find out if you are infected so you can get lifesaving treatment that can cure hepatitis C.
Acute Vs Chronic Infection
Doctors distinguish between chronic and acute infection with hepatitis viruses. Acute infection is a short-term condition, lasting under six months. Chronic infection is a long-term condition, lasting more than six months.
Hepatitis B infection can be either acute or chronic. Most people who get acute hepatitis B dont end up progressing to chronic hepatitis B. By contrast, acute hepatitis C tends to develop into chronic hepatitis C. Approximately 7585 percent of adults newly infected with hepatitis C develop a chronic infection, according to the CDC . Others clear the infection.
When you get acute hepatitis C you may or may not have symptoms. Most cases of acute hepatitis C are asymptomatic, meaning people dont notice the symptoms. Symptoms are only noticeable in 15 percent of cases of acute hepatitis C.
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Hcv Core Antigen Testing
The hepatitis C core antigen is a viral protein. Since the core antigen is part of hepatitis C virus, it can usually be found in the bloodstream two weeks after infection.
Since HCV core antigen testing is simpler and less expensive than viral-load testing, some experts suggest using it in resource-limited settings. Core antigen testing can be usedoften with HCV antibody testingto detect acute HCV or to confirm chronic HCV infection. HCV core antigen testing can also be used to measure treatment outcome. Although it does not detect low levels of HCV , usually the hepatitis C viral load is much higher in people who relapse after HCV treatment.
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Time For Processing Hcv Ab Test Results
The turnaround time for 3rd-generation EIAs is at least 1 day. Many labs do not perform the tests on site and must send specimens to another lab for processing, which may further increase the turnaround time.
A point-of-care test is also available. The OraQuick® HCV Rapid Antibody Test is an FDA-approved test that can be performed with a fingerstick . It is also a CLIA-waived test and therefore can be used in clinic offices and outreach facilities. Results are reported as reactive or nonreactive within 20 minutes. Just as for the standard HCV Ab test done in the lab, a positive OraQuick® test must be confirmed by an HCV RNA test. The sensitivity and specificity of the test is similar to that of the laboratory-based assays.
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What Are The Risk Factors For Hepatitis B And C
Hepatitis B: Although most commonly acquired early in life, adults can also contract it. Hepatitis B is largely transmitted through bodily fluids. It can be passed at birth from a hepatitis B-infected mother or through exposure in early childhood to body fluids, blood or contaminated medical instruments. Hepatitis B can also be transmitted through intranasal and injection drug use as well as infected tools used during tattooing and body piercing.
Hepatitis C: The key risk factors are also intranasal and injection drug use, tattoos and body piercings, high-risk sexual contact, blood transfusions before 1992 and organ transplantation.
Another key risk factor for hepatitis C is being born from 1945 to 1965, during the baby-boom years. Eighty percent of all people who currently have hepatitis C in the United States were born in that timeframe.
Although the reasons that baby boomers are more likely to have hepatitis C than others arent entirely understood, its believed that most were infected in the 1970s and 1980s, when rates of hepatitis C were at their peak.
The Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force recommend that all U.S. adults born from 1945 to 1965 undergo a one-time screening test for hepatitis C. Connecticut is one of several states that has written this recommendation into law. In Connecticut ,the law requires that primary care clinicians screen all adults born within those years.
Taking A Hepatitis C Test
Hepatitis C testing is conducted on a sample of blood. Blood samples can be collected by a doctor, nurse, technician, or other health care provider from an adult patients vein using a small needle or a skin prick on a childs heel.
For an at-home hepatitis C test, patients collect a blood sample according to the manufacturers directions. Instructions provided in the test kit detail the steps to obtain a small sample of blood and mail it for testing.
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Dried Blood Spot /microsample Specimen Collection
DBS collection and testing was found to provide sensitive and specific detection of HCV antibody by third-generation EIA testing of eluates , while the sensitivity of HCV core antigen detection was reduced compared to standard LBT using plasma or serum however, specificity was high . HCV RNA quantification from DBS was reported to be lower than LBT viral load tests in chronic HCV patients , but quantification values were more accurate with an increase in the number of DBS punched spots used . However, a study by Wlassow et al. , in which the Xpert HCV Viral Load assay was used to detect and quantify HCV RNA in DBS whole blood, showed excellent correlation of quantification with serum-based Xpert HCV Viral Load testing and two commercial real-time PCR viral load assays . DBS collection provides options within LMIC or remote areas for confirmatory testing or monitoring of HCV viral load levels, as patients are typically lost to post-screening follow-up requiring a visit to a healthcare facility .
The major limitation with the use of DBS or other absorptive blood collection formats is the lower sensitivity of detection often observed when compared to standard LBT testing of fresh plasma or serum collected by venous puncture . Another important limitation is the need for a central or reference laboratory for DBS processing . Results may not be obtained within the same day and this can delay linkage to care and treatment of patients .
Hepatitis C Serologic Testing
All sera were tested for antibodies for hepatitis C using the VITROS Anti-HCV Reagent Pack on the VITROS 3600 Immunodiagnostic System . Specimens with a signal-to-cutoff ratio of less than 1.0 were considered positive and underwent further testing for the quantitation of HCV RNA with Cobas/Ampliprep . Testing of all blood specimens was completed within 48 hours after the end of the festival.
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Is Hepatitis Testing Recommended For People With Hiv
Yes. Everyone living with HIV should be tested for HBV and HCV when they are first diagnosed with HIV and begin treatment. People living with HIV who have ongoing risk factors for getting hepatitis B or hepatitis C should be tested annually.
In addition, new HCV screening recommendations from the Centers for Disease Control and Prevention call for:
- One-time screening for all adults 18 years and older
- Screening of all pregnant women during every pregnancy
- Testing for all persons with risk factors, with testing continued periodic testing those with ongoing risk.
Will I Need Any Other Tests Along With The Hepatitis Panel
Apart from the tests for hepatitis viruses, your doctor may want to know the impact of disease or medical conditions on your liver. Your healthcare provider may recommend liver enzyme tests such as alkaline phosphatase aminotransferase , and aspartate alanine aminotransferase . Further, you may also be asked to undergo a test for prothrombin time and bilirubin to ascertain the extent of liver damage.
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The Schiff Center For Liver Diseases
The Schiff Center for Liver Diseases, located at the Miller School of Medicine at the University of Miami in Florida, is an internationally recognized center for the care of patients with liver disease. The Hepatology Diagnostic Laboratory is a reference laboratory that is directed and supervised by the Schiff Center for Liver Diseases and provides clinical and research assays.
Serological And Molecular Markers Of Hbv And Hcv Infections
Table 1. Detectable serological and molecular markers of HBV and HCV infection.
HCV is initially diagnosed through serology by the use of an enzyme immunoassay which typically detects anti-HCV in serum or plasma . Primary serological results are normally confirmed by an orthogonal immunoassay approach, an immunoassay signal to cutoff ratio or by use of molecular tools such as nucleic acid amplification tests using polymerase chain reaction to detect the HCV RNA . As a positive antibody test alone cannot differentiate acute from chronic HCV infection , laboratory diagnosis of acute HCV infection is aided by observed seroconversion, or a positive test for viral detection in a seropositive case not previously reported, consistent with epidemiological risk and exposure history.
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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.
Home Screening Tests For Hepatitis C
At-home screening tests provide privacy if you prefer not to go to a doctor or clinic for testing. These tests typically look for antibodies to hepatitis C, but they may not always test for active viral infection. Make sure you know what type of test youll be taking before you buy.
Many at-home tests have close to or the same reliability as blood tests received by a medical professional.
If youve recently been exposed to hepatitis C, wait several weeks before testing at home.
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Persons At Risk For Hcv Infection
IDU is the most common means of HCV transmission in the United States. Invasive medical procedures pose risks for HCV infection when standard infection-control practices are not followed . Health carerelated hepatitis C outbreaks also stem from drug diversion . Although HCV infection is primarily associated with IDU, high-risk behaviors , primarily among persons with HIV, are also important risk factors for transmission . Other possible exposures include sharing personal items contaminated with blood , unregulated tattooing, needlestick injuries among health care personnel, and birth to a mother with hepatitis C. Receipt of donated blood, blood products, and organs was once a common means of transmission but is now rare in the United States .
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Positive Hcv Antibody And Negative Hcv Rna
Individuals with a positive HCV antibody test and a negative HCV RNA should be informed they do not have evidence of current hepatitis C infection. It should be explained to the patient that most likely they were infected at some time with HCV, but cleared the infection on their own and they do not have current infection. They do not need further follow-up HCV testing, unless they had recent exposure to HCV. A single negative HCV RNA value does not prove that a patient is not infected, given the potential fluctuations of the viral level early in HCV infection a follow-up HCV RNA level would be indicated depending on the clinical case. Patients should be reevaluated if they have exposure to HCV in the future. In addition, they should receive counseling that prior infection does not make them immune to reinfection with HCV.
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Diagnosis Of Acute And Chronic Hepatitis B
HBsAg is the first serologic marker to appear and may be detected within 1 to 2 weeks after exposure. It precedes the development of symptoms by an average of 4 weeks.106 The presence of HBsAg indicates ongoing infection. Qualitative but not quantitative methods are used by most clinical laboratories because the amount of antigen does not correlate with disease activity or with the presence of an acute or chronic infection.28 Some symptomatic patients may have self-limited, acute HBV infection without detectable HBsAg. These patients, up to 9% in some studies, have other detectable markers of infection.106 HBeAg appears virtually simultaneously, peaks, and then declines in parallel with HBsAg. It usually disappears before HBsAg does. Adult patients who remain persistently positive for HBeAg for more than 10 weeks are likely to become chronically infected. HBeAg indicates a high level of viral replication and infectivity. Most patients with nondetectable HBeAg have resolving, minimal, or no active liver disease.28 Precore mutants of HBV do not express HBeAg they may be responsible for a more severe course and, in some cases, fulminant disease. Serum aminotransferase levels become elevated but are nonspecific. They begin to increase just before the development of symptoms and then peak with the development of jaundice.
Howard C. Thomas, Jennifer A. Waters, in, 1998
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