About the Test

Purpose of the test

Hepatitis B is a viral infection that causes inflammation of the liver. Test results can identify present hepatitis B infection, past exposure to HBV, or immunity to the virus.

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HBV is spread through contact with body fluids. Most frequently, it is spread from blood-to-blood contact, but it may be transmitted through other body fluids. Common forms of exposure to HBV vary based on geographical area but often occur during childbirth and infancy, when sharing needles for intravenous drug use, or during unprotected sex.

A hepatitis B infection can be acute or chronic. Acute hepatitis B is a short-lived infection. You can usually recover completely from acute hepatitis B without treatment within a few weeks to six months.

Around 5 to 10% of patients with acute hepatitis B progress to having chronic hepatitis B, a long-term infection lasting six months or longer. If you have chronic hepatitis B, you are at an increased risk of developing complications, including severe damage to the liver, liver failure, and liver cancer.

A doctor may order hepatitis B testing for several purposes:

• Screening for HBV: Screening tests attempt to find a disease before a person develops symptoms. Many people with hepatitis B have no symptoms, so screening for this disease enables early detection so you can receive treatment and avoid unknowingly spreading the virus to others. Hepatitis B screening may be recommended if you are at an increased risk of contracting this infection.
• Diagnosing and evaluating HBV infection: Hepatitis B testing can identify whether you have a current hepatitis B infection, if it is acute or chronic, and whether you can spread the virus to others.
• Assessing past HBV infection and future immunity: Tests for hepatitis B can show whether you are immune either due to HBV vaccination or having recovered from a past infection. Hepatitis B testing may also be used to assess whether vaccination successfully generated immunity and to identify who is at an increased risk of HBV reactivation.
• Monitoring HBV infections: Testing may be used after a person is diagnosed with hepatitis B to monitor the disease, detect complications, and assess response to treatment.

What does the test measure?

Hepatitis B testing looks for antigens, antibodies, or the genetic material of HBV. Antigens of HBV are substances from the virus that cause your body to produce an immune response. Antibodies are substances made by the immune system in response to HBV.

Initial tests for hepatitis B measure antibodies and antigens related to HBV including:

• Hepatitis B surface antigen (HBsAg): These are proteins present on the surface of HBV. The proteins can be detected in high levels during both an acute or chronic hepatitis B infection. This test may be used to screen for, detect, and help diagnose acute and chronic HBV infections.
• Hepatitis B surface antibody (anti-HBs): In response to HBsAg, the body naturally produces surface antibodies within a few weeks or months. Detecting anti-HBs suggests that you have recovered from hepatitis B and are now immune to the disease. These antibodies are also detected in those who have previous exposure to HBV, including through vaccination.
• Total hepatitis B core antibody (anti-HBc): Hepatitis B core antibodies appear as you develop symptoms of hepatitis, and they remain detectable for life. The results of this test are interpreted alongside other tests to assess recovery from a previous HBV infection and to differentiate between acute and chronic infections. This test detects two types of anti-HBc antibodies, called IgM and IgG anti-HBc antibodies.
• IgM Hepatitis B core antibody (IgM anti-HBc): This test detects only IgM anti-HBc antibodies. IgM Hepatitis B core antibody is detected only in acute hepatitis B infections within six months of infection.

If you are diagnosed with hepatitis B based on these initial tests, additional testing may be used to monitor the disease, guide treatment, and determine if you can spread hepatitis B to others. These additional tests may include:

• Hepatitis B e antigen (HBeAg): This is a protein from HBV found in some patients who are positive for HBsAg. Measuring this antigen can help doctors understand infectivity, your ability to spread HBV to others.
• Hepatitis B e antibody (anti-HBe): This is produced in response to HBeAg. The disappearance of HBeAg and detection of anti-HBe in the blood, called seroconversion, suggests improvement of the condition and predicts long-term clearance of the virus. Chronic liver disease is more common in those with HBeAg and is less common with anti-HBe, so this test may monitor acute HBV infections.
• Hepatitis B viral DNA: A hepatitis B viral DNA test detects the virus&#;s genetic material and determines the viral load in the blood. A positive test indicates that the virus is multiplying in a person&#;s body, making that person contagious. The test is often used to monitor the effectiveness of antiviral therapy in people with chronic HBV infections.

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:

• Are pregnant
• 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
• Didn&#;t 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.

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Testing is common in those that show symptoms that could be caused by hepatitis B. Symptoms of hepatitis B include:

• Dark urine
• Fatigue
• Fever
• Gray- or clay-colored stools
• 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.

Understanding Your Test Results

Understanding your hepatitis B blood tests can be confusing. It is important to talk to your health care provider so you understand your test results and your hepatitis B status. Are you infected? Protected? Or at risk? The Hepatitis B Panel of blood tests includes 3 tests and all three results must be known in order to confirm your status.

Below is a chart with the most common explanation of the test results, but unusual test results can occur. Please note that this chart is not intended as medical advice, so be sure to talk to your health care provider for a full explanation and obtain a printed copy of your test results. In some cases, a person could be referred to a liver specialist for further evaluation.

More Detailed Information About Hepatitis B Blood Tests

An acute hepatitis B infection follows a relatively long incubation period - from 60 to 150 days with an average of 90 days. It can take up to six months, however, for a person to get rid of the hepatitis B virus. And it can take up to six months for a hepatitis B blood test to show whether as person has recovered from an acute infection or has become chronically infected .

The following graphic from the U.S. Centers for Disease Control and Prevention (CDC) represents the typical course of an acute hepatitis B infection from first exposure to recovery.

Source: Centers for Disease Control and Prevention Video

According to the CDC, a hepatitis B blood test result (or serologic marker) varies depending on whether the infection is a new acute infection or a chronic infection.

• HBsAg (hepatitis B surface antigen) is the first serologic marker to appear in a new acute infection, which can be detected as early as 1 week and as late as 9 weeks, with an average of one month after exposure to the hepatitis B virus (HBV). 

- HBsAg is detectable for a variable amount of time, along with the HBV DNA, though about 50% of persons will test HBsAg and HBV DNA negative 7 weeks after symptoms.

- All persons who spontaneously recover from an infection will test negative for HBsAg and negative for HBV DNA about 15 weeks after the appearance of symptoms.

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• Anti-HBs or HBsAb (hepatitis B surface antibody) &#; this becomes detectable on a blood test after the disappearance of HBsAg in persons who are able to get rid of the virus and avoid a chronic infection. The presence of anti-HBs following a new acute infection generally indicates recovery and a person is then protected (or &#;immune&#;) from re-infection with hepatitis B.
• Anti-HBc or HBcAb (hepatitis B core antibody) &#; this blood test remains positive indefinitely as a marker of past HBV infection.
• HBeAg (hepatitis B e-antigen) is generally detectable in patients with a new acute infection; the presence of HBeAg is associated with higher HBV DNA levels, thus, increased infectiousness.
• IgM anti-HBc &#; a positive blood test result indicates a person has a new acute hepatitis B infection.IgM anti-HBc is generally detectable at the time symptoms appear and declines to sub-detectable levels within 6 - 9 months. Note: An acute exacerbation (or liver flare) in a chronic HBV infection can also result in a positive anti-HBc IgM test result. So follow-up testing after 6 months is required.
• IgG anti-HBc &#; this blood test remains positive indefinitely as a marker of past HBV infection.