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Hepatitis B virus (HBV) is a DNA virus that is endemic throughout the world. The infection is spread primarily through percutaneous contact with infected blood products (eg, blood transfusion and sharing of needles by drug addicts). The virus is also found in virtually every type of human body fluid and is known to be spread through oral and genital contact. HBV can be transmitted from mother to child during delivery through contact with blood and vaginal secretions; it is not commonly transmitted transplacentally.
After a course of acute illness, HBV persists in approximately 10% of patients. Some of these carriers are asymptomatic; others develop chronic liver disease including cirrhosis and hepatocellular carcinoma.
See HBV Infection-Diagnostic Approach and Management Algorithm and Viral Hepatitis Serologic Profile in Special Instructions.
Evaluating patients with suspected or confirmed chronic hepatitis B
Monitoring hepatitis B viral infectivity
Hepatitis B surface antigen (HBsAg) is the first serologic marker appearing in the serum 6 to 16 weeks following hepatitis B viral (HBV) infection. In acute cases, HBsAg usually disappears 1 to 2 months after the onset of symptoms. Persistence of HBsAg for more than 6 months indicates development of either chronic carrier state or chronic liver disease.
Hepatitis B surface antibody (anti-HBs) appears with the resolution of HBV infection after the disappearance of HBsAg. Anti-HBs also appears as the immune response following a course of inoculation with the hepatitis B vaccine.
Hepatitis B core antibody (anti-HBc) appears shortly after the onset of symptoms of HBV infection and may be the only serologic marker remaining years after exposure to hepatitis B.
The presence of hepatitis B envelope antigen (HBeAg) correlates with infectivity, the number of viral Dane particles, the presence of core antigen in the nucleus of the hepatocyte, and the presence of viral DNA polymerase in serum. Hepatitis B envelope antibody (anti-HBe) positivity in a carrier is often associated with chronic asymptomatic infection.
If the patient has a sudden exacerbation of disease, consider ordering hepatitis C virus antibody (anti-HCV) and hepatitis delta virus antibody (anti-HDV).
If HBsAg converts to negative and patient's condition warrants, consider testing for anti-HBs.
If HBsAg is positive, consider testing for anti-HDV.
See HBV Infection-Diagnostic Approach and Management Algorithm and Viral Hepatitis Serologic Profiles in Special Instructions.
For 24 hours before blood collection, patient should not take multivitamins or dietary supplements containing biotin (vitamin B7) that is commonly found in hair, skin, and nail supplements and multivitamins.
Positive hepatitis B surface antigen (HBsAg) test results should be reported by the attending physician to the State Department of Health, as required by law in some states.
Consider administration of hepatitis B immune globulin and hepatitis B vaccine to individuals exposed to the patient's blood or body fluids.
Performance characteristics of these assays have not been established in patients under the age of 2 or in populations of immunocompromised or immunosuppressed patients. These assays are not licensed by the FDA for testing cord blood samples or screening donors of blood, plasma, human cell, or tissue products.
Performance characteristics have not been established for the following specimen characteristics:
-Grossly icteric (total bilirubin level of >20 mg/dL)
-Grossly lipemic (triolein level of >3,000 mg/dL)
-Grossly hemolyzed (hemoglobin level of >61 mg/dL)
-Containing particulate matter
HEPATITIS B SURFACE ANTIGEN
HEPATITIS Be ANTIGEN
HEPATITIS Be ANTIBODY
Interpretation depends on clinical setting. See Viral Hepatitis Serologic Profiles in Special Instructions.
1. Bonino F, Piratvisuth T, Brunetto MR, et al: Diagnostic markers of chronic hepatitis B infection and disease. Antiviral Therapy 2010;15(3):35-44
2. Servoss JC, Friedman LS: Serologic and molecular diagnosis of hepatitis B virus. Clin Liver Dis 2004;8:267-281
3. Badur S, Akgun A: Diagnosis of hepatitis B infections and monitoring of treatment. J Clin Virol 2001;21:229-237