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.
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.
Diagnosis
Your health care provider will examine you and look for signs of liver damage, such as yellowing skin or belly pain. Tests that can help diagnose hepatitis B or its complications are:
- Blood tests. Blood tests can detect signs of the hepatitis B virus in your body and tell your provider whether it's acute or chronic. A simple blood test can also determine if you're immune to the condition.
- Liver ultrasound. A special ultrasound called transient elastography can show the amount of liver damage.
- Liver biopsy. Your provider might remove a small sample of your liver for testing to check for liver damage. This is called a liver biopsy. During this test, your provider inserts a thin needle through your skin and into your liver and removes a tissue sample for laboratory analysis.
Screening healthy people for hepatitis B
Health care providers sometimes test certain healthy people for hepatitis B infection because the virus can damage the liver before causing signs and symptoms. Talk to your provider about screening for hepatitis B infection if you:
- Are pregnant
- Live with someone who has hepatitis B
- Have had many sexual partners
- Have had sex with someone who has hepatitis B
- Are a man who has sex with men
- Have a history of a sexually transmitted illness
- Have HIV or hepatitis C
- Have a liver enzyme test with unexplained abnormal results
- Receive kidney dialysis
- Take medications that suppress the immune system, such as those used to prevent rejection after an organ transplant
- Use illegal injected drugs
- Are in prison
- Were born in a country where hepatitis B is common, including Asia, the Pacific Islands, Africa and Eastern Europe
- Have parents or adopted children from places where hepatitis B is common, including Asia, the Pacific Islands, Africa and Eastern Europe
Treatment
Treatment to prevent hepatitis B infection after exposure
If you know you've been exposed to the hepatitis B virus, call your health care provider immediately. It is important to know whether you have been vaccinated for hepatitis B. Your health care provider will want to know when you were exposed and what kind of exposure you had.
An injection of immunoglobulin (an antibody) given within 24 hours of exposure to the virus may help protect you from getting sick with hepatitis B. Because this treatment only provides short-term protection, you also should get the hepatitis B vaccine at the same time if you never received it.
Treatment for acute hepatitis B infection
If your provider determines your hepatitis B infection is acute &#; meaning it is short lived and will go away on its own &#; you may not need treatment. Instead, your provider might recommend rest, proper nutrition, plenty of fluids and close monitoring while your body fights the infection. In severe cases, antiviral drugs or a hospital stay is needed to prevent complications.
Treatment for chronic hepatitis B infection
Most people diagnosed with chronic hepatitis B infection need treatment for the rest of their lives. The decision to start treatment depends on many factors, including: if the virus is causing inflammation or scarring of the liver, also called cirrhosis; if you have other infections, such as hepatitis C or HIV; or if your immune system is suppressed by medicine or illness. Treatment helps reduce the risk of liver disease and prevents you from passing the infection to others.
Treatment for chronic hepatitis B may include:
- Antiviral medications. Several antiviral medicines &#; including entecavir (Baraclude), tenofovir (Viread), lamivudine (Epivir), adefovir (Hepsera) and telbivudine &#; can help fight the virus and slow its ability to damage your liver. These drugs are taken by mouth. Your provider may recommend combining two of these medications or taking one of these medications with interferon to improve treatment response.
- Interferon injections. Interferon alfa-2b (Intron A) is a man-made version of a substance produced by the body to fight infection. It's used mainly for young people with hepatitis B who wish to avoid long-term treatment or women who might want to get pregnant within a few years, after completing a finite course of therapy. Women should use contraception during interferon treatment. Interferon should not be used during pregnancy. Side effects may include nausea, vomiting, difficulty breathing and depression.
- Liver transplant. If your liver has been severely damaged, a liver transplant may be an option. During a liver transplant, the surgeon removes your damaged liver and replaces it with a healthy liver. Most transplanted livers come from deceased donors, though a small number come from living donors who donate a portion of their livers.
Other drugs to treat hepatitis B are being developed.
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Lifestyle and home remedies
If you've been infected with hepatitis B, take steps to protect others from the virus.
- Make sex safer. If you're sexually active, tell your partner you have HBV and talk about the risk of transmitting it to him or her. Use a new latex condom every time you have sex, but remember that condoms reduce but don't eliminate the risk.
- Tell your sexual partner to get tested. Anyone with whom you've had sex needs to be tested for the virus. Your partners also need to know their HBV status so that they don't infect others. If positive, they should be evaluated for possible treatment.
- Don't share personal care items. If you use IV drugs, never share needles and syringes. And don't share razor blades or toothbrushes, which may carry traces of infected blood.
Coping and support
If you've been diagnosed with hepatitis B infection, the following suggestions might help you cope:
- Learn about hepatitis B. The Centers for Disease Control and Prevention is a good place to start.
- Stay connected to friends and family. You can't spread hepatitis B through casual contact, so don't cut yourself off from people who can offer support.
- Take care of yourself. Eat a healthy diet full of fruits and vegetables, exercise regularly, and get enough sleep.
- Take care of your liver. Don't drink alcohol or take prescription or over-the-counter drugs without consulting your health care provider. Get tested for hepatitis A and C. Get vaccinated for hepatitis A if you haven't been exposed.
Preparing for your appointment
You're likely to start by seeing your family health care provider. However, in some cases, you may be referred immediately to a specialist. Doctors who specialize in treating hepatitis B include:
- Doctors who treat digestive diseases (gastroenterologists)
- Doctors who treat liver diseases (hepatologists)
- Doctors who treat infectious diseases
What you can do
Here's some information to help you get ready for your appointment.
- Be aware of pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.
- Write down your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including major stresses or recent life changes.
- Make a list of all medications, vitamins and supplements you take.
- Consider taking a family member or friend along. Someone who accompanies you may help you remember the information you receive.
- Write down questions to ask your provider.
For hepatitis B infection, some basic questions to ask include:
- What is likely causing my symptoms or condition?
- Other than the most likely cause, what are other possible causes for my symptoms or condition?
- What tests do I need?
- Is my condition likely temporary or chronic?
- Has hepatitis B damaged my liver or caused other complications, such as kidney problems?
- What is the best course of action?
- What are the alternatives to the primary approach you're suggesting?
- I have other health conditions. How can I best manage them together?
- Are there restrictions that I need to follow?
- Should I see a specialist?
- Should my family be tested for hepatitis B?
- How can I prevent people around me from hepatitis B?
- Is there a generic alternative to the medicine you're prescribing?
- Are there brochures or other printed material I can have? What websites do you recommend?
What to expect from your doctor
Your health care provider is likely to ask you a number of questions, including:
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- When did your symptoms begin?
- Have you ever developed jaundice symptoms, including yellowing of the eyes or clay-colored stool?
- Were you previously vaccinated for hepatitis B?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- Have you ever had a blood transfusion?
- Do you inject drugs?
- Have you had unprotected sex?
- How many sexual partners have you had?
- Have you been diagnosed with hepatitis?