Everything About Hepatitis B and HBV Testing

The hepatitis B virus (HBV) is a contagious infection that affects the liver. “Hepatitis” means inflammation of the liver, and is a condition that can stem from a variety of sources. Check our article on Hepatitis B prevention from items like shopping carts. It is most often caused by viruses, especially hepatitis A, hepatitis B, and hepatitis C. The liver is a vital organ and its key roles include filtering the body’s blood, fighting infections and processing nutrients. When the liver is infected, inflamed or damaged, it can severely affect these important functions.

Hepatitis B is typically spread when HBV-infected bodily fluids, such as semen, blood, and/or menstrual or vaginal fluids enter the body of an individual without the infection. HBV can also be transmitted from shared drug equipment, improperly sterilized tattooing equipment, or from an infected mother to her baby at birth. Donated whole blood products (clotting factor concentrates) were not screened for HBV before 1987, so if an individual received a donation of whole blood products before 1987, they could have been infected.

While hepatitis B can be found in the saliva of those with the virus, this is believed to not be a route the virus takes for spread— so kissing and sharing food or drinks are considered safe.

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Hepatitis B Phases

There are two phases of hepatitis B— Acute and chronic. Acute hepatitis B occurs within the first six months of infection. Because symptoms do not always present themselves (approximately 70 percent of cases are symptomless), especially in young children, few people realize they have the disease. Adults who do exhibit signs and symptoms, often do so within the first three months post-exposure.

Acute hepatitis B can display the following symptoms: Flu-like symptoms including fever, fatigue, nausea, loss of appetite, and vomiting, as well as joint pain, jaundice, stomach/abdominal pain, dark urine and/or gray-colored stool.

After the initial six months of a hepatitis infection, it becomes chronic hepatitis B. According to the CDC, approximately 15-25 percent of people with chronic hepatitis B develop serious liver problems. Chronic hepatitis B can take up to 30 years to develop and display symptoms, but when it does they are typically serious. Chronic hepatitis B can result in liver damage, liver cancer, cirrhosis and even liver failure.

Getting tested for hepatitis B six weeks after unprotected sex is recommended. Hepatitis B can occasionally be detected as early as three weeks after exposure, but for more accurate results we recommend getting tested after six weeks.

While there is no cure for hepatitis B, more than 90 percent of healthy adults who contract the virus will recover naturally from it within the first year. Treatment for hepatitis B includes: adequate rest, nutrition and fluid intake as well as close monitoring of the liver’s health and the individual’s overall health. Some cases may be more severe and might require hospitalization.

Hepatitis B is preventable by a vaccine. The hepatitis B immunization must be given prior to exposure to the virus. The best way to prevent contracting hepatitis B is to get vaccinated. For adults, the hepatitis B vaccine is given as a series of three shots over six-month period. The entire series is critical for long-term protection.

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Hepatitis B and Pregnancy

A baby can contract hepatitis B during childbirth if the mother carries the virus. Infected newborns can develop liver disease from hepatitis B, which is sometimes fatal. Doctors will vaccinate newborns born to hepatitis B-positive mothers with antibodies to protect them from infection. Hepatitis B is not spread through breastfeeding.

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The testing methods for hepatitis B include:

Core Antibody Immunoassay (IgM) Blood Test

• Hepatitis B core-specific IgM class antibodies have been detected in most acute infections and is a reliable marker for acute disease.
• This is a blood test; IgM antibodies are found mainly in the blood and lymph fluid; they are the first antibody to be made by the body to fight a new infection. Hepatitis B core-specific IgM class antibody has been detected in most acute infections and is a reliable marker for acute disease.
• In some cases, hepatitis B core IgM antibodies may be the only specific marker for the diagnosis of acute infection with hepatitis B virus.
• False-positives may be detected shortly after immunization to influenza and with patients with hypergammaglobulinemia, positive rheumatoid factor, and connective tissue disorders.

Immunochemiluminometric Assay (ICMA) Surface Antigen Test

• Blood test
• Used to test blood donors (HBsAg positive individuals are rejected).
• Hepatitis B surface antigen is the earliest indicator of the presence of acute infection. Also indicative of chronic infection.
• Test is useful in the differential diagnosis of hepatitis.
• Patients who are negative for HBsAg may still have acute type B viral hepatitis. There is sometimes a “core window” stage when HBsAg has become negative and the patient has not yet developed the antibody (anti-HBs). On such occasions, both tests for anti-HBc are usually positive and anti-HBc, IgM is the only specific marker for the diagnosis of acute infection with hepatitis B. In cases with strong clinical suspicion of viral hepatitis, serologic testing should not be limited to detecting HBsAg, but should include a battery of tests to evaluate different stages of acute and convalescent hepatitis.

DNA Polymerase Chain Reaction (PCR)

• Blood test
• Chronic carriers will persist in producing detectable HBV. Patients with chronic liver disease of unknown origin most commonly have HBV that is detected by viral DNA testing.
• Quantitative measurement of HBV viral DNA may be used to monitor progression of disease.
  

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Key Takeaways:

• The hepatitis B virus (HBV) is a contagious infection that affects the liver.
• The liver is a vital organ and its key roles include filtering the body’s blood, fighting infections and processing nutrients. When the liver is infected, inflamed or damaged, it can severely affect these important functions.
• Hepatitis B is typically spread when HBV-infected bodily fluids, such as semen, blood, and/or menstrual or vaginal fluids enter the body of an individual without the infection.
• HBV can also be transmitted from shared drug equipment, improperly sterilized tattooing equipment, or from an infected mother to her baby at birth.
• Approximately 70 percent of hepatitis B cases are symptomless.
• The best initial test is for HBV is the IgM antibody for acute infection, and IgG antibody for chronic HBV.
• Acute hepatitis B can display the following symptoms: fever, fatigue, nausea, loss of appetite, and vomiting, as well as joint pain, jaundice, stomach/abdominal pain, dark urine and/or gray-colored stool.
• Chronic hepatitis B can take up to 30 years to develop and display symptoms, but when it does they are typically serious. Chronic hepatitis B can result in liver damage, liver cancer, cirrhosis and even liver failure.
• There are two phases of hepatitis B, acute and chronic. Acute hepatitis B occurs within the first six months of infection.
• A baby can contract hepatitis B during childbirth if the mother carries the virus. A quarter of these cases result in liver failure or liver cancer later in adulthood.
• While there is no cure for hepatitis B, more than 90 percent of healthy adults who contract the virus will recover naturally from it within the first year.
• The best way to prevent contracting hepatitis B is to get vaccinated.
• Get tested for hepatitis B.

Read Section 8 on Hepatitis C and HCV Testing.