From the Guidelines
Hepatitis B testing is crucial for individuals at risk of infection, and the standard testing panel should include hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), and hepatitis B core antibody (anti-HBc) as recommended by the Advisory Committee on Immunization Practices 1.
Importance of Testing
The testing is essential to determine the infection status, immunity, and the need for vaccination or postexposure prophylaxis.
- A positive HBsAg indicates current infection,
- positive anti-HBs suggests immunity from vaccination or resolved infection,
- and positive anti-HBc indicates previous exposure to the virus.
Testing Recommendations
According to the recommendations, postvaccination serologic testing should be performed 1–2 months after administration of the final dose of the vaccine series using a method that allows determination of a protective concentration of anti-HBs (≥10 mIU/mL) 1.
- Persons found to have anti-HBs concentrations of ≥10 mIU/mL after the primary vaccine series are considered to be immune,
- and immunocompetent persons have long-term protection and do not need further periodic testing to assess anti-HBs levels.
Special Considerations
However, immunocompromised persons might need annual testing to assess anti-HBs concentrations 1.
- Persons who do not have a protective concentration of anti-HBs after revaccination should be tested for HBsAg,
- and if the HBsAg test result is positive, the person should receive appropriate management, and any household, sexual, or needle-sharing contacts should be identified and vaccinated.
High-Risk Groups
Hepatitis B testing is particularly important for high-risk groups, including healthcare workers, hemodialysis patients, HIV-infected persons, and other immunocompromised persons, as well as sex partners of HBsAg-positive persons 1.
- These individuals should be tested to determine the need for revaccination and the type of follow-up testing,
- and to guide postexposure prophylaxis and other methods of protection against HBV infection.
From the Research
Hepatitis B Testing
- Hepatitis B testing is crucial for diagnosing and managing the infection, as chronic hepatitis B virus (HBV) infection can lead to substantial morbidity and mortality 2.
- The Centers for Disease Control and Prevention (CDC) recommends hepatitis B screening using three laboratory tests at least once during a lifetime for adults aged ≥18 years 2.
- Risk-based testing recommendations include populations such as persons incarcerated or formerly incarcerated, persons with a history of sexually transmitted infections or multiple sex partners, and persons with a history of hepatitis C virus infection 2.
Laboratory Tests for Hepatitis B
- Quantitative hepatitis B surface antigen (HBsAg) levels can assist in differentiating immune tolerance and immune clearance in hepatitis B e antigen (HBeAg)-positive patients, and predict inactive disease and spontaneous HBsAg seroclearance in HBeAg-negative patients 3.
- HBsAg level is pivotal to individualize pegylated interferon (PegIFN) treatment and decide early termination of PegIFN among non-responders 3.
- Serum HBsAg levels reflect liver HBsAg, but not cccDNA or liver HBV-DNA, suggesting that they are not solely dependent on the replicative cycle of HBV 4.
Treatment and HBsAg Levels
- Effective antiviral therapy can decrease serum HBsAg levels and liver HBV-DNA, but not cccDNA 4, 5.
- Entecavir treatment for 2 years can result in an overall decline in HBsAg levels, but the majority of patients do not show significant decline in HBsAg levels despite HBV DNA suppression 5.
- Early decline of HBsAg levels at 12/24 weeks is not associated with HBV DNA suppression or HBeAg seroconversion 5.