From the Guidelines
Diagnosing hepatitis B involves a combination of blood tests that detect viral markers and assess liver function, with the initial screening test being the hepatitis B surface antigen (HBsAg), which indicates active infection when positive, as recommended by the most recent guidelines 1. The diagnosis of hepatitis B is crucial for preventing serious complications like cirrhosis and liver cancer. The following steps are involved in diagnosing hepatitis B:
- Initial screening test: HBsAg, which indicates active infection when positive
- Additional tests:
- Hepatitis B surface antibody (anti-HBs), which shows immunity from vaccination or past infection
- Hepatitis B core antibody (anti-HBc), which indicates previous or ongoing infection
- Hepatitis B e antigen (HBeAg) and antibody (anti-HBe), which help determine infectivity and disease activity
- Liver function tests:
- ALT, AST, bilirubin, and albumin to assess liver damage
- Viral load testing: HBV DNA to monitor disease progression and treatment response in chronic hepatitis B
- Liver imaging: ultrasound, CT, or MRI may be recommended in some cases
- Liver biopsy: may be performed to determine the extent of liver damage It is essential to note that early diagnosis is crucial, and the most recent guidelines should be followed for accurate diagnosis and management of hepatitis B 1.
From the Research
Diagnosis of Hepatitis B
To diagnose Hepatitis B, several methods can be employed, including:
- Qualitative hepatitis B surface antigen (HBsAg) testing, which has been used to diagnose patients infected with chronic hepatitis B (CHB) 2
- Quantitative HBsAg titers, which can be used to predict treatment outcome when measured at baseline or early into treatment 2
- Serum HBV DNA levels, which have been shown to be important in the natural history of CHB infection, with higher levels being significantly associated with the development of cirrhosis and hepatocellular carcinoma 2
- Hepatitis B e antigen (HBeAg) quantification, which can be used to assess the outcome of HBV infection and predict the efficacy of antiviral therapy 3
- Detection of the serological markers HBsAg and hepatitis B core IgM antibody (anti-HBcIgM) in the diagnosis of acute hepatitis B virus infection after recent exposure 4
Diagnostic Tools
Various diagnostic tools are available, including:
- Elecsys and Architect assays for HBsAg and HBeAg quantification, which have been shown to be highly correlated and can be used to monitor HBsAg and HBeAg levels in patients with chronic hepatitis B 3
- Enzyme immunoassay for quantification of HBeAg and HBsAg 5
- Quantitative immunohistochemical (IHC) staining for HBsAg 5
Predicting Treatment Outcome
Several factors can be used to predict treatment outcome, including: