From the Guidelines
Hepatitis B diagnosis should involve initial screening with blood tests for hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti-HBc), followed by additional tests including hepatitis B e antigen (HBeAg) and antibody (anti-HBe), hepatitis B viral load (HBV DNA), and liver function tests if HBsAg is positive. The diagnosis of hepatitis B infection is made or excluded on the basis of various serologic and viral markers, including HBsAg, anti-HBs, HBeAg, anti-HBc-IgM/G, and HBV-DNA 1.
Key Tests for Hepatitis B Diagnosis
- HBsAg: indicates active infection
- Anti-HBc: shows exposure to the virus
- HBeAg and anti-HBe: determine infectivity
- HBV DNA: measures viral replication
- Liver function tests (ALT, AST, bilirubin, albumin): assess liver damage
- Complete blood count and prothrombin time/INR: evaluate overall health and clotting function
- Imaging studies like ultrasound, FibroScan, or FibroTest: assess liver damage and fibrosis
- Liver biopsy: determines the extent of liver damage in some cases
According to the most recent and highest quality study, the persistence of HBsAg beyond 6 months of acute hepatitis B is adequate for a diagnosis of chronic hepatitis B 1. Regular monitoring is essential for patients with chronic hepatitis B to track disease progression and treatment effectiveness. The measurement of HBV-DNA is a particularly important guiding tool for the administration and monitoring of antiviral treatment 1.
Importance of Regular Monitoring
- Track disease progression
- Monitor treatment effectiveness
- Adjust treatment plans as needed
- Prevent complications and improve patient outcomes
In real-life clinical practice, it is crucial to prioritize the side of caution when the evidence is not very strong or equivocal, and make firm decisions based on the most recent and highest quality studies, such as 1, to ensure the best possible outcomes for patients with hepatitis B infection.
From the Research
Hepatitis B Diagnosis
Hepatitis B virus (HBV) infection is a major global health problem, and timely diagnosis is crucial to diminish its burden 2. The diagnosis of HBV infection involves serological and molecular tests.
Serological Tests
Serological markers, such as hepatitis B surface antigen (HBsAg) and anti-HBs, anti-HBc IgM and IgG, and hepatitis B e antigen (HBeAg) and anti-HBe, are used to detect antigens and antibodies in the blood 2, 3. HBsAg is the hallmark of HBV infection and is the first serological marker to appear in acute hepatitis B 3.
Molecular Tests
Molecular tests, such as quantitative or qualitative PCR, are used to verify the diagnosis, quantify viral load, and identify genotypes 2, 4. These tests are essential for monitoring liver disease activity, differentiating other etiologies of hepatitis activity, and predicting the risk of hepatocellular carcinoma (HCC) development or liver-related mortality 3.
Diagnostic Approach
The diagnostic approach for HBV infection involves:
- Screening for HBsAg and anti-HBs in high-risk individuals 5
- Detecting HBV DNA in serum or tissue to diagnose occult HBV infection 3
- Monitoring serum HBV DNA levels to assess liver disease activity and predict the risk of HCC development 3
- Using new biomarkers, such as hepatitis B virus core-related antigen (HBcrAg) and HBV RNA, to reflect intrahepatic cccDNA status 4
Laboratory Tests
Various laboratory tests are available for diagnosing HBV infection, including: