Testing for hepatitis B virus (HBV) infection is indicated for those with signs and symptoms of acute or chronic hepatitis. Asymptomatic persons should also be tested if they are at high risk for infection or are at risk for severe adverse outcomes from undiagnosed infection.
Hepatitis B surface antigen (HBsAg) is the serologic hallmark of hepatitis B virus (HBV) infection. Hepatitis B core antigen (HBcAg) is an intracellular antigen that is expressed in infected hepatocytes. It is not detectable in serum. Anti-HBc can be detected throughout the course of HBV infection. Hepatitis B e antigen (HBeAg) is a secretory protein that is processed from the precore protein. It is generally considered to be a marker of HBV replication and infectivity.
The diagnosis of acute hepatitis B is based upon the detection of HBsAg and IgM anti-HBc. Previous HBV infection is characterized by the presence of anti-HBs and IgG anti-HBc. Immunity to HBV infection after vaccination is indicated by the presence of anti-HBs only.
The diagnosis of chronic HBV infection is based upon the persistence of HBsAg for more than six months. Additional tests for HBV replication – HBeAg and serum HBV DNA – should be performed to determine if the patient should be considered for antiviral therapy.
Occult HBV infection is defined as the presence of detectable HBV DNA by PCR in patients who are negative for HBsAg. Such patients have been further subclassified as having “seropositive” or “seronegative” HBV depending upon whether they are positive or negative for other HBV markers, most commonly anti-HBc. Most of these patients have very low or undetectable serum HBV DNA levels accounting for the failure.
The evaluation of patients with chronic hepatitis C virus (HCV) infection involves assessing the extent of liver disease, assessing other viral and host factors that inform optimal antiviral selection, and identifying comorbidities associated with HCV infection (including extrahepatic manifestations of HCV infection as well as human immunodeficiency virus [HIV] and hepatitis B virus [HBV] infection).
Patient with HCV should be counselled against alcohol use, obesity and marijuana use. They are also advised to avoid certain medications, twice yearly ultrasound for hepatocellular carcinoma and gastroscopy for oesophageal varices. The goal of antiviral therapy is to eradicate HCV RNA, which is associated with decreases in all-cause mortality, liver-related death, need for liver transplantation, hepatocellular carcinoma rates, and liver-related complications. Where direct-acting antivirals are available, highly effective, interferon-free (and in many cases, ribavirin-free) regimens are appropriate options for the majority of HCV infected individuals.
Consultation with a Hepatologist
Liver Fibrosis Scan