Evaluating patients with suspected or confirmed chronic hepatitis B

Monitoring hepatitis B viral infectivity

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, 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"

in Special Instructions and "Viral Hepatitis Serologic Profile" in Special

Instructions.

HEPATITIS B SURFACE ANTIGEN

Negative

HBeAg

Negative

HEPATITIS Be ANTIBODY (ANTI-HBe)
Negative

Interpretation depends on clinical setting. See "Viral Hepatitis Serologic Profiles" in Special Instructions.

Hepatitis B surface antigen (HBsAg) is the first serologic marker

appearing in the serum 6 to 16 weeks following HBV infection.

(HBV). 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 core 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"

in Special Instructions and "Viral Hepatitis Serologic Profile" in Special

Instructions.

Positive 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 (HBIG) and

hepatitis B vaccine to individuals exposed to the patient's blood

and/or body fluids

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 >500 mg/dL)

-  Containing particulate matter

-  Cadaveric specimens

1.   Mahoney FJ:  Update on diagnosis, management, and prevention

      of hepatitis B virus infection. Clin Microbiol Rev 1999;12:351-366

2.   Gane E:  Chronic hepatitis B virus infection in south Auckland.  

      N Z Med J 1998;111:120-123

3.   Gitlin N:  Hepatitis B:  diagnosis , prevention, and treatment. Clin

      Chem 1997;43:1500-1506