Hepatitis B in
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To test whether you are a hepatitis B (HBV) carrier. The single most important test to identify whether the individual is a hepatitis B carrier is a blood test for the hepatitis B surface antigen (HBsAg).

Positive result means the individual tested is a hepatitis B carrier and has chronic hepatitis B infection.

Negative result means the individual is not a hepatitis B carrier and does not have chronic hepatitis B. Hepatitis B vaccination will prevent future infection if the individual has no evidence of immunity or current infection with hepatitis B based on HBsAb (anti-HBs) and HBcAb (anti-HBc) testing.

To test whether you are protected from HBV. The single most important test to check whether the individual is protected from hepatitis B either through prior vaccination or hepatitis B infection is a blood test for hepatitis B surface antibody (HBsAb or anti-HBs).

Positive result means that the individual is already protected from hepatitis B infection and does not require hepatitis B vaccination.

Negative result means that the individual is not protected from hepatitis B infection. If the individual is not a hepatitis B carrier based on HBsAg testing, then hepatitis B vaccination will protect the individual from being infected in the future.

The hepatitis B panel often includes a test for hepatitis B core antibody (HBcAb or anti-HBc). A positive HBcAb (also called anti-HBc) implies past or current infection with hepatitis B and does not mean the individual is protected from chronic hepatitis B.

The following tests are often ordered in hepatitis B carriers to assess 1) whether the individual may benefit from hepatitis B treatment; 2) the response of treatment; 3) whether there is evidence suggestive of cirrhosis and 3) for liver cancer screening.

Hepatitis B virus carriers who show evidence of ongoing liver damage associated with high viral activity may be suitable for treatment to reduce the risk of long-term damage that may result in cirrhosis with liver failure. The most cost-effective tests useful to assess whether treatment is indicated is ALT and HBeAg. Frequently treatment of chronic hepatitis B is only considered if ALT is greater than 1.5  times the normal value, and the liver damage is related to high hepatitis B viral activity (positive HBeAg and/or high levels of HBV DNA).

A blood test indicative of active liver damage. If ALT is normal, there is no data to support starting chronic hepatitis B treatment regardless of viral load. For individuals with mild elevation in ALT below a two-fold increase, measurements of ALT at regular 6 months interval is recommended. ALT is also elevated in other causes of liver damage not related to hepatitis B such as chronic hepatitis C infection, fatty liver, and from drugs and heavy alcohol consumption which are toxic to the liver.

A positive HBeAg, in most cases, is a good indicator of high viral load, and hence infectivity. (An exception is in individuals who have mutant strains of the hepatitis B virus and do not secrete HBeAg) Although it is not a direct measure of viral load like the more costly HBV DNA test, HBeAg is a much cheaper test and is still a widely used marker to monitor the response to treatment.

A negative HBeAg and negative HBV DNA reflects low viral activity that does not warrant anti-viral treatment.

Before starting treatment of chronic hepatitis B, two additional blood tests that are useful to monitor the response to treatment are HBV DNA and hepatitis Be antibody (anti-HBe). Favorable responses to treatment include normalization of ALT, loss of HBV DNA and HbeAg, and anti-HBe seroconversion.

This test directly measures the hepatitis B viral load often expressed as copies per milliliter of blood. A significant drop or loss of HBV DNA levels is a good measure of treatment response.

This test is useful in monitoring the response to chronic hepatitis B treatment. An anti-HBe that was negative before treatment and then turned positive during or following treatment is generally regarded as a marker for a good response. Anti-HBe seroconversion may take months or years.

A low platelet count (generally less than 150,000) and low albumin level (3.5 gm/dL or lower), with or without an elevated prothrombin time in an individual with chronic hepatitis B is compatible with the diagnosis of cirrhosis with impaired liver function.

Individuals who became infected early in childhood have a high risk of developing primary liver cancer, i.e., hepatocellular carcinoma-also called hepatoma. Liver cancer can occur in hepatitis B carriers without cirrhosis, and with normal liver function tests.

Alpha-fetoprotein level is useful in the screening and diagnosis of liver cancer because it is increased above the normal range in 60-70% of primary liver cancer. If the level is greater than 500 (normal range usually less than 10), and a mass is detected on ultrasound or CT scan, the diagnosis of liver cancer can be made without the need for a biopsy. Occasionally AFP level can be elevated in hepatitis, but the value will drop on repeat testing. A rising AFP level is almost always associated with liver cancer. Unfortunately, AFP levels are normal in 30-40% of the liver cancers, and they can only be detected by finding a mass on ultrasound or CT scan.

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- Copyright 2005 Asian Liver Center at Stanford University -