From the Guidelines
The initial step in a hepatitis workup should include a thorough history-taking and physical examination, with emphasis on risk factors such as coinfection, alcohol consumption, and the family history of HBV infection and liver cancer. This initial evaluation is crucial in determining the specific type of hepatitis and guiding further diagnostic tests and treatment decisions. According to the guidelines outlined in 1, the initial evaluation of patients with chronic hepatitis B should include laboratory tests to assess liver disease, such as complete blood count, AST/ALT, alkaline phosphatase, gamma-glutamyl transpeptidase, bilirubin, albumin, creatinine, and prothrombin time.
Some key points to consider in the initial hepatitis workup include:
- Obtaining a comprehensive medical history, including risk factors for hepatitis infection, such as travel history, sexual practices, and injection drug use 1
- Performing a physical examination to look for signs of liver disease, such as jaundice, hepatomegaly, and ascites 1
- Ordering laboratory tests, including liver function tests and serologic tests for hepatitis A, B, and C, to determine the specific type of hepatitis and assess the extent of liver damage 1
- Considering tests for coinfection with other viruses, such as HCV and HIV, in patients at risk 1
It is also important to note that the initial workup should be tailored to the individual patient's risk factors and clinical presentation. For example, patients younger than 50 years with chronic hepatitis B should undergo testing for IgG anti-HAV, and those with a negative immune status for hepatitis A should receive vaccination 1. By following a comprehensive and individualized approach to the initial hepatitis workup, healthcare providers can ensure prompt and effective diagnosis and treatment of hepatitis, ultimately improving patient outcomes and reducing the risk of complications.
From the Research
Initial Steps in Hepatitis Workup
The initial step in a hepatitis workup involves determining specific viral markers to accurately diagnose viral hepatitis.
- For HBV infection, these markers include HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBc, IgM anti-HBc, and HBV DNA 2.
- For HCV infection, anti-HCV and HCV RNA are found in the sera of patients 2.
Importance of Viral Markers
- Mutations in HBV genes, particularly the precore mutation, can lead to a decrease or complete inhibition of HBeAg production, resulting in HBeAg-negative HBV infection 2.
- Surface gene mutations can lead to false diagnoses or delays in diagnosis, especially in important groups of patients 2.
- HCV genotyping is essential, as different viral genotypes respond differently to therapy, and therapeutic protocols vary 2.
Screening Strategies
- Guideline-based screening strategies, including HBsAg, anti-HCV, and alanine aminotransferase (ALT) tests, can help identify previously undiagnosed hepatitis B and C infections in the primary care setting 3.
- The presence of guideline-defined risk scenarios or elevated ALT levels can identify a significant proportion of previously undiagnosed patients 3.
Correlation with Liver Inflammation
- HBsAg titre, HBsAg/HBV DNA ratio, and ALT levels can be used as indices to judge the degree of liver inflammation in HBeAg-positive chronic hepatitis B patients 4.
- Higher sensitivity and specificity are attained when HBsAg and ALT are used in series or parallel 4.
HBV RNA Levels
- Serum HBV RNA levels are positively correlated with HBV DNA, HBsAg, ALT, and AST levels, and can be used as a virological indicator for antiviral therapy in HBsAg and HBsAb copositive hepatitis B patients 5.
- HBV RNA levels are also correlated with intrahepatic covalently closed circular DNA (cccDNA) levels, although the correlation is less strong than that with serum HBV DNA at baseline and HBsAg at 96 weeks after treatment 6.