Understanding the Hepatitis B Test

Why Conduct the Test?

Hepatitis B is a viral disease that can lead to liver inflammation. Testing helps in identifying whether an individual has an active infection, has previously been exposed to HBV, or has developed immunity against the virus.

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HBV spreads through contact with infected bodily fluids, predominantly via blood but can also occur through other body fluids. Common transmission routes depend on geographical factors, typically occurring at childbirth, during needle sharing in intravenous drug use, or through unprotected sexual activity.

There are two types of hepatitis B infections: acute and chronic. Acute hepatitis B is a temporary infection, usually resolving completely within weeks to six months and often doesn’t require treatment.

However, 5-10% of individuals with acute hepatitis B can transition into chronic hepatitis B, lasting six months or longer, increasing risks for severe liver complications, including failure and cancer.

A healthcare professional might recommend hepatitis B testing for various reasons:

• Screening for HBV: Screening identifies the disease even before symptoms appear, which is crucial since many with hepatitis B remain asymptomatic. This proactive approach enables early treatment and prevents virus transmission.
• Diagnosis and Evaluation: Testing clarifies if there’s a current hepatitis B infection, determines its status (acute or chronic), and assesses contagion risk.
• Assessing Past Infection and Immunity: Hepatitis B tests can confirm immunity status from vaccination or previous infections, and evaluate vaccination effectiveness.
• Monitoring Active HBV: Continuous testing after diagnosed hepatitis B helps track disease progression, complication development, and treatment effectiveness.

What Does the Test Evaluate?

The hepatitis B examination identifies antigens, antibodies, or the genetic material of HBV. These components provoke an immune response, with specific antigens prompting antibody production.

Initial screenings typically evaluate antibodies and antigens related to HBV, including:

• Hepatitis B Surface Antigen (HBsAg): Proteins from the virus present during acute or chronic infections, useful for screening and diagnosing hepatitis B.
• Hepatitis B Surface Antibody (anti-HBs): Developed in response to HBsAg, indicating recovery and immunity after exposure or vaccination.
• Total Hepatitis B Core Antibody (anti-HBc): Appears with hepatitis symptoms and remains detectable for life, helping differentiate between infection types.
• IgM Hepatitis B Core Antibody (IgM anti-HBc): Specifically indicates acute infections within six months post-exposure.

Following an initial positive hepatitis B diagnosis, additional testing may guide treatment and assess infectious potential:

• Hepatitis B E Antigen (HBeAg): Found in some HBsAg-positive individuals, aiding in understanding viral infectivity.
• Hepatitis B E Antibody (anti-HBe): Indicates improvement and possible long-term virus clearance upon detection with HBeAg disappearance.
• Hepatitis B Viral DNA: Identifies the virus's genetic material, assesses viral load, and is frequently used to evaluate antiviral therapy efficacy in chronic cases.

When Should You Get Tested?

Testing for hepatitis B is especially recommended for individuals at elevated risk, including:

• Pregnant women
• Individuals born in regions with high HBV prevalence (e.g., parts of Africa, Asia, Eastern Europe, South America, and the Middle East)
• Those who haven’t received hepatitis B vaccination
• People who are HIV-positive
• Injectable drug users
• People with potential sexual exposure risks

A healthcare provider may recommend testing based on your symptoms, medical history, family history, and a physical examination. If symptoms arise without recent exposure, an acute viral hepatitis panel may be ordered to test for Hepatitis A, B, and C.

Testing may also serve as a follow-up for abnormal liver health assessments.

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Individuals exhibiting hepatitis B symptoms may undergo testing. Common symptoms include:

• Dark urine
• Extreme fatigue
• Fever
• Pale or clay-colored stools
• Loss of appetite, nausea, or vomiting
• Joint or abdominal pain
• Yellowing of the skin and eyes

Assessing hepatitis B immunity can happen before or after vaccination. Although pre-vaccination testing isn't mandatory, it may be useful for those suspecting prior HBV exposure or vaccination. Post-vaccination testing is pertinent in high-risk groups, such as infants born to infected mothers.

Interpreting Your Test Results

Comprehending hepatitis B test outcomes can be challenging. It's crucial to consult with your healthcare provider to clarify your results and hepatitis B status. Are you infected? Immune? Or at risk? The Hepatitis B Panel consists of three tests, and understanding all results is essential for accurate status confirmation.

The chart below illustrates common interpretations of test results; however, atypical results may occur. This chart does not substitute professional medical advice. Always consult your healthcare provider for comprehensive explanations and obtain a printout of your results. In certain situations, referrals to specialists may be necessary.

Detailed Insights on Hepatitis B Blood Tests

An acute hepatitis B infection usually follows a relatively extended incubation, lasting 60 to 150 days, averaging 90 days. It may take up to six months to clear the hepatitis B virus and for blood tests to indicate whether recovery has occurred.

The initial symptoms of an acute hepatitis B infection commonly lead to follow-up testing to ascertain the recovery status or chronic infection development after up to six months.

The graphic from the U.S. Centers for Disease Control and Prevention (CDC) illustrates the typical progression of an acute hepatitis B infection from initial exposure to recovery.

Source: Centers for Disease Control and Prevention Video

According to the CDC, the results of hepatitis B blood tests (serologic markers) vary based on whether the infection is acute or chronic.

• HBsAg (hepatitis B surface antigen) is the earliest serologic marker in a new acute infection, detectable 1 to 9 weeks post-exposure, with an average detection time of one month.

- HBsAg results can fluctuate, yet around 50% of individuals test negative for both HBsAg and HBV DNA seven weeks after symptom onset.

- All individuals who spontaneously recover will test negative for both HBsAg and HBV DNA, typically 15 weeks after symptom emergence.

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• Anti-HBs or HBsAb (hepatitis B surface antibody) is detectable on blood tests once HBsAg disappears in those clearing the virus, indicating recovery and immunity from future infections.
• Anti-HBc or HBcAb (hepatitis B core antibody) signifies past HBV infection and remains positive indefinitely.
• HBeAg (hepatitis B e-antigen) usually appears in acute infections, correlating with higher HBV DNA levels and increased infectiousness.
• IgM anti-HBc indicates a recent acute hepatitis B infection and is typically present during symptom onset, declining over six to nine months. Note that a chronic HBV infection can also result in a positive IgM anti-HBc test, necessitating follow-up testing after six months.
• IgG anti-HBc remains positive indefinitely, serving as a marker for past HBV infection.