From the Guidelines
The recommended approach to investigate for Hepatitis B involves a thorough history-taking, physical examination, and laboratory tests, including HBsAg, HBeAg, anti-HBe, HBV DNA quantification, liver function tests, and screening for other viral coinfections, as outlined in the 2016 guidelines 1. The initial evaluation of patients with suspected Hepatitis B should include a comprehensive assessment of risk factors, such as alcohol consumption, family history of HBV infection and liver cancer, and coinfection with other viruses like HCV and HDV.
- Laboratory tests should include:
- HBsAg, HBeAg, and anti-HBe to assess HBV replication
- HBV DNA quantification to determine viral load
- Liver function tests, such as ALT, AST, bilirubin, albumin, and prothrombin time, to evaluate liver damage
- Complete blood count and abdominal ultrasound to assess for complications like cirrhosis or hepatocellular carcinoma
- For patients with chronic HBV (HBsAg positive for >6 months), regular monitoring every 3-6 months is recommended, with periodic assessment of viral load and liver function, as suggested by the 2012 guidelines 1 and supported by the 2016 guidelines 1.
- The 2007 review on molecular testing in the diagnosis and management of chronic Hepatitis B highlights the importance of HBV DNA quantification and genotyping in disease management 1.
- Additionally, testing for IgG anti-HAV is necessary in CHB patients younger than 50 years, as recommended by the 2012 guidelines 1 and the 2012 guidelines 1, to determine the need for hepatitis A vaccination.
- It is essential to note that the approach to investigating Hepatitis B should prioritize the most recent and highest-quality evidence, which in this case is the 2016 guidelines 1, to ensure optimal patient outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Investigation Approach for Hepatitis B
To investigate for Hepatitis B (HB), the following steps can be taken:
- Initial evaluation: Assess disease activity and stage through medical history, physical examination, serological, biochemical, and virological tests, as well as imaging studies to establish a baseline for future monitoring 2
- Serological tests: Use 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 to detect antigens and antibodies 3
- Molecular tests: Use quantitative or qualitative molecular tests to verify diagnosis, quantify viral load, and identify genotypes 3
- Monitoring: Determine disease progression, development of complications, and reassess the need for treatment, with monitoring frequency based on disease activity and stage 2
Diagnostic Tests
The following diagnostic tests can be used to investigate for HB:
- Serological tests:
- HBsAg
- Anti-HBs
- Anti-HBc IgM and IgG
- HBeAg and anti-HBe
- Molecular tests:
- Quantitative PCR to quantify viral load
- Genotyping to identify HBV genotypes
- Imaging studies:
- Ultrasonography to establish a baseline for future monitoring and to screen for hepatocellular carcinoma (HCC) 2
- Liver biopsy: May be used to provide useful information on prognosis, need for surveillance for HCC, and whether to recommend therapy, although not generally needed 2
Biomarkers and Future Perspectives
New biomarkers such as hepatitis B virus core-related antigen (HBcrAg) and HBV RNA have emerged, which may reflect intrahepatic cccDNA status and be useful for diagnosis and treatment response monitoring 4 Anti-HBc IgG levels may be a predictor of HBsAg seroclearance in chronic hepatitis B patients with nucleos(t)ide analogue-induced HBeAg seroclearance 5 Anti-HBs responses may be involved in functional cure of HBeAg+ chronic hepatitis B patients infected with HBV genotype A 6