Materiały źródłowe

• #1 Current Challenges and Future Perspectives of Diagnosis of Hepatitis B Virus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9914745/

  It is estimated that approximately 260 million people worldwide are infected with the hepatitis B virus (HBV), which is one of the leading causes of liver disease and liver cancer throughout the world. […] In spite of the heavy burden caused by hepatitis B virus, 90% of people are still undiagnosed. […] The majority of diagnostic laboratories still use hepatitis B surface antigen (HBsAg)-based tests. […] The aim of the elimination of HBV can only be achieved by detecting all phases of HBV infection, which can be executed by a combined approach of using new marker assays along with advanced pretesting and testing methods. […] The diagnosis and follow-up of chronic infection rely on laboratory viral biomarkers. […] There are two key categories of HBV biomarker assays: one is serology, a term encompassing the detection and quantification of viral-specific antibodies and/or antigens, and the second is nucleic acid testing (NAT) for the detection and quantification of the HBV genome and its RNA transcripts.

• #1 Hepatitis B: diagnosis and monitoring – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/hepatitis-b-diagnosis-and-monitoring

  Hepatitis B: diagnosis and monitoring […] Hepatitis B is a complex disease and diagnosis is made by assessment of biochemical, serological, virological and histological parameters. […] Hepatitis B surface antigen (HBsAg) is used to screen for the presence of infection. It is the first viral antigen to be detectable in the blood after infection — appearing during the virus’s incubation period. […] Shortly after HBsAg is detected, a second antigen (hepatitis B e antigen; HBeAg) becomes detectable. The presence of HBeAg signifies HBV replication and, along with the presence of HBV DNA (detected using polymerase chain reaction-based assays), indicates an active infection. […] Antibodies to the hepatitis B core antigen are detectable in the blood after the onset of acute hepatitis B symptoms. These antibodies (anti-HBc) persist for life and their presence indicates previous or ongoing infection.

• #1 Testing for Hepatitis B | Hepatitis B | CDC

  https://www.cdc.gov/hepatitis-b/testing/index.html

  Getting tested for hepatitis B is the only way to find out if you are infected. […] All adults and pregnant women should get tested for hepatitis B. […] People with ongoing risk need periodic testing. […] You can find out if you have hepatitis B through a blood test. […] Many people with hepatitis B do not look or feel sick, so testing is the only way to know if you are infected. […] It’s important to get tested for hepatitis B, so that if you are infected you can get medical care and avoid spreading the virus to others. […] In the case of hepatitis B, screening refers to serologic (blood) testing for people not known to be at increased risk for exposure to HBV. Testing refers to serologic (blood) testing for people with symptoms or who are identified to be at increased risk for exposure to HBV.

• #1 Core Concepts – HBV Screening, Testing, and Diagnosis – Screening and Diagnosis – Hepatitis B Online

  https://www.hepatitisb.uw.edu/go/screening-diagnosis/diagnosis-hbv/core-concept/all

  The CDC recommends universal HBV screening for all adults (18 years of age and older) using a 3-test panel, which includes: Hepatitis B surface antigen (HBsAg), Antibody to hepatitis B surface antigen (anti-HBs), Total antibody to hepatitis B core antigen (anti-HBc). […] The benefits of using a 3-test panel are that it can identify individuals with current HBV infection, those with prior HBV infection, those with immunity due to prior vaccination, and those who are susceptible to HBV and would benefit from vaccination. […] Chronic HBV is an indolent and often silent disease that over time can lead to serious health consequences, including cirrhosis, decompensated liver disease, hepatocellular carcinoma (HCC), and death. […] Universal screening for HBV has the advantage of averting substantial morbidity and mortality and it has been shown to be cost-effective.

• #1 Hepatitis B Foundation: Hepatitis B Blood Tests

  https://www.hepb.org/prevention-and-diagnosis/diagnosis/hbv-blood-tests/

  Only one sample of blood is needed for a hepatitis B blood test with the Hepatitis B Panel that includes three parts. All three test results are needed to fully understand a persons hepatitis B status. […] A „positive” or „reactive” HBsAg test result indicates that a person is infected with hepatitis B. This test can detect the presence of the hepatitis B virus (called the surface antigen) in the blood. If a person tests positive, then further testing is needed to determine if this is a new acute infection or a chronic hepatitis B infection. […] A „positive” or „reactive” anti-HBs (or HBsAb) test result indicates that a person is protected against the hepatitis B virus. This protection can be the result of receiving the hepatitis B vaccine or successfully recovering from a past hepatitis B infection. A positive anti-HBs (or HBsAb) test result indicates that a person is immune and protected against the hepatitis B virus and cannot be infected.

• #1 Hepatitis B Foundation: Hepatitis B Blood Tests

  https://www.hepb.org/prevention-and-diagnosis/diagnosis/hbv-blood-tests/

  A „positive” or „reactive” anti-HBc (or HBcAb) test result indicates that a person has been exposed to the hepatitis B virus at some point during their life. A positive HBcAb test alone cannot tell if a person has a past or current hepatitis B infection. The core antibody does not provide any protection against the hepatitis B virus (unlike the surface antibody described above). This test can only be fully understood by knowing the results of the first two tests (HBsAg and anti-HBs). A positive anti-HBc (or HBcAb) test result requires talking to a knowledgeable health care provider for a complete explanation of your hepatitis B status.

• #1 Core Concepts – HBV Screening, Testing, and Diagnosis – Screening and Diagnosis – Hepatitis B Online

  https://www.hepatitisb.uw.edu/go/screening-diagnosis/diagnosis-hbv/core-concept/all

  Multiple organizations in the United States have recommended performing routine screening for hepatitis B virus (HBV) infection for persons who are at increased risk of acquiring HBV, including the Centers for Disease Control and Prevention (CDC), the U.S. Preventive Services Task Force (USPSTF), the American Association for the Study of Liver Diseases (AASLD), and the American College of Physicians (ACP). […] In March 2023, the CDC issued hepatitis B screening and testing guidance that recommends universal hepatitis B virus (HBV) screening for all adults, as well as risk-based and repeat testing for selected groups, utilizing a 3-test panel, which includes hepatitis B surface antigen (HBsAg), antibody to hepatitis B surface antigen (anti-HBs), and total antibody to hepatitis B core antigen (anti-HBc).

• #1 Hepatitis B diagnostic criteria – wikidoc

  https://www.wikidoc.org/index.php/Hepatitis_B_diagnostic_criteria

  The diagnosis of hepatitis is made by biochemical assessment of liver function. A diagnosis is confirmed by demonstration in sera of specific antigens and/or antibodies. Three clinically useful antigen-antibody systems have been identified for hepatitis B, including hepatitis B surface antigen (HBsAg) and antibody to HBsAg (anti-HBs); antibody (anti-HBc IgM and anti-HBc IgG) to hepatitis B core antigen (HBcAg); and hepatitis B e antigen (HBeAg) and antibody to HBeAg (anti-HBe). […] A diagnosis is confirmed by demonstration in sera of specific antigens and/or antibodies. Three clinically useful antigen-antibody systems have been identified for hepatitis B: Hepatitis B surface antigen (HBsAg) and antibody to HBsAg (anti-HBs), Antibody (anti-HBc IgM and anti-HBc IgG) to hepatitis B core antigen (HBcAg), Hepatitis B e antigen (HBeAg) and antibody to HBeAg (anti-HBe). […] The tests, or assays, for detection of hepatitis B virus infection involve serum or blood tests that detect either viral antigens (proteins produced by the virus) or antibodies produced by the host. Interpretation of these assays is complex.

• #1 Hepatitis B: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0415/p965.html

  Although an estimated 1 million persons in the United States are chronically infected with hepatitis B virus, the prevalence of hepatitis B has declined since the implementation of a national vaccination program. […] The diagnosis of hepatitis B virus infection requires the evaluation of the patient’s blood for hepatitis B surface antigen, hepatitis B surface antibody, and hepatitis B core antibody. […] The diagnosis of HBV infection requires the evaluation of the patient’s blood for HBsAg, hepatitis B surface antibody (HBsAb), and hepatitis B core antibody (HBcAb). […] Although the presence of HBsAg indicates that the person is infectious, the presence of HBsAb indicates recovery and immunity from HBV infection or successful immunization against HBV. […] HBcAb appears at the onset of acute HBV infection, but may also indicate chronic HBV infection. […] Interpretation of HBV immunologic markers is shown in Table 4. […] HBV DNA sometimes may be the only marker present in early infections.

• #1 HBV Triple Screen Panel With Reflexes | Test Summary | Quest Diagnostics HBV Screen Panel With Reflexes HBV Screen Panel With Reflexes

  https://testdirectory.questdiagnostics.com/test/test-guides/TS_HBVScreen/hbv-triple-screen-panel-with-reflexes

  HBV Triple Screen Panel with Reflexes (test code 39170) includes a qualitative test for HBsAg, a quantitative test for HBsAb, and a qualitative test for HBcAb. […] Interpretations of the results from the HBV Triple Screen Panel with Reflexes are summarized in Table 2. Briefly, positive results for HBsAg and HBcAb likely indicate HBV infection; for these patients, the presence of HBcAb IgM indicates an acute infection, and its absence suggests a chronic infection. […] Negative results for all 3 markers (HBsAg, HBsAb, and HBcAb) most likely indicate susceptibility to infection. […] In some situations, HBcAb may be the only detectable marker of HBV infection. […] HBsAg contained in the HBV vaccine can cause transient positive HBsAg results.

• #1 The laboratory diagnosis of hepatitis B virus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2095015/

  Chronic HBV infection is defined by the continued presence of HBsAg in the blood for longer than six months. […] Test selection should be based on the person’s risk factors, vaccination history and findings from previous tests. […] If negative, chronic HBV infection is typically ruled out. […] If positive, the patient is considered HBV-infected. Chronic infection is diagnosed when the HBsAg remains detectable for greater than six months. […] If negative, past infection with HBV is typically ruled out. […] If positive, the patient has been infected with HBV. […] If negative, the patient has no apparent immunity to HBV. […] If positive, the patient is considered immune to HBV. […] Once an individual has been diagnosed with chronic HBV infection, follow-up testing must be performed for alanine aminotransferase (ALT), a marker of liver cell inflammation.

• #1 Current Challenges and Future Perspectives of Diagnosis of Hepatitis B Virus

  https://www.mdpi.com/2075-4418/13/3/368

  HBV can be diagnosed by various HBV markers such as hepatitis B surface antigens (HBsAgs), hepatitis B surface antibodies (anti-HBs), hepatitis B e-antigen (HBeAgs), hepatitis B e-antibodies (anti-HBes), and hepatitis core antigens (anti-HBcs). […] The elimination of hepatitis refers to the reduction of 90% incidence and 65% of deaths from the 2015 baseline. […] Screening and diagnosis should be made available to the people unacquainted with their status of HBV infection or who have not so far entered into care and treatment. […] The presence of anti HBc with absence of HBs Ag and presence of anti HBs is also seen in recovered patients, however, HBV DNA is negative in such patients. […] A resolved HBV infection is defined as a positive HBc antibody without detectable serum HBV DNA or negative HBsAg.

• #1 Testing for Hepatitis B | Hepatitis B | CDC

  https://www.cdc.gov/hepatitis-b/testing/index.html

  Are immune to hepatitis B because you’ve been vaccinated. […] Were infected in the past, have resolved infection, and should be counseled. […] If you are diagnosed with hepatitis B and have received an ultrasound, your doctor will talk to you about whether the infection has damaged your liver. […] After getting your results, your doctor will decide on the best treatment option for you. […] It is important to continue to talk to your doctor about how to stay healthy and prevent spreading the disease.

• #1 Hepatitis B serology

  https://www.racgp.org.au/afp/2012/april/hepatitis-b-serology

  The diagnostic panel for HBV does not itself differentiate between acute and chronic HBV infection this requires further clinical and laboratory information, including anti-HBc IgM. […] If the pattern of HBV serology indicates active infection (HBsAg positive, anti-HBc positive, anti-HBs negative), a number of steps are required, including: conveying the test result and discussing what this means and what happens next with the patient, notification by the pathology laboratory (and by the treating doctor in many jurisdictions) to the relevant state or territory health department, testing of household and sexual contacts (and vaccination if they are susceptible often funded). […] All patients with CHB require regular monitoring at least annually for disease activity, complications and the need for treatment. It is now known that there is no such thing as a healthy carrier all patients with CHB require active management to detect progressive liver disease and allow intervention to prevent complications including cirrhosis and liver cancer.

• #1 Current Challenges and Future Perspectives of Diagnosis of Hepatitis B Virus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9914745/

  Serology tests that identify or measure HB surface antigen (HBsAg) serum levels, HB surface antibodies (anti-HBs), and HB core antibodies (anti-HBcs) are used to detect patients who have been exposed to HBV, whereas NAT tests provide information on the level of virus replication, the manifestation of particular variants, and occurrence of virus reservoirs. […] HBV can be diagnosed by various HBV markers such as hepatitis B surface antigens (HBsAgs), hepatitis B surface antibodies (anti-HBs), hepatitis B e-antigen (HBeAgs), hepatitis B e-antibodies (anti-HBes), and hepatitis core antigens (anti-HBcs). […] HBsAg is the key marker of chronic HBV infection when persistence is more than 6 months, whereas the absence of HBsAg in serum indicates recovery from acute HBV infection. […] The levels of HBsAg in the body fluid are important to reveal the infection stage because it reflects the transcriptional activity of cccDNA, which is higher in HBeAg-positive infection than in HBeAg-negative patients.

• #1 The laboratory diagnosis of hepatitis B virus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2095015/

  Sustained and intermittent elevations in ALT beyond the upper limit of normal are indicative of hepatic inflammation and correlate with an increased risk of progressive liver disease. […] The presence of HBV-DNA in serum or plasma denotes active HBV infection and, depending on the viral load, correlates with the infectivity of the patient. […] Testing for appropriate biochemical and virological markers at defined intervals can be used to follow the progression or resolution of chronic HBV infection. […] The presence of HBeAg is correlated with high levels of viral replication as measured by HBV-DNA and a higher risk of cirrhosis and hepatocellular carcinoma. […] Antiviral therapy has been used only to a limited extent for the treatment of chronic HBV infection; the outcomes of such treatment have not been consistently measured. […] The most important risk factor for hepatocellular carcinoma is prolonged chronic HBV infection for decades, particularly in patients with active disease based on elevated ALT levels.

• #1 A critical review of diagnostic and prognostic markers of chronic hepatitis B infection

  https://www.degruyter.com/document/doi/10.1515/mr-2024-0022/html?lang=en

  The degree of HBV replication is reflected in the predictive value of the hepatitis B e antigen (HBeAg) status which is a protein associated with the active replication of the hepatitis B virus. Its presence indicates high levels of viral replication and increased infectivity. The detection of HBeAg is typically associated with a high viral load and a higher risk of transmission. A decreased risk of liver disease development is linked to seroconversion to anti-HBe and seroclearance of HBeAg. […] One important diagnostic indicator for hepatitis B infection is HBsAg. Its presence confirms the diagnosis of persistent infection and points to ongoing viral replication. When diagnosing CHB infection, HBsAg is a useful diagnostic tool. It is advised for CHB patient diagnosis and follow-up. […] Assessing the level of viral replication in the blood requires quantifying the HBV DNA. A greater risk of progression of disease and transmission is linked to higher viral loads. As diagnostic indicators for chronic HBV infection, HBV DNA levels have significant clinical ramifications.

• #1 Hepatitis B Foundation: Understanding Your Hepatitis B Test Results

  https://www.hepb.org/prevention-and-diagnosis/diagnosis/understanding-your-test-results/

  Acutely infected persons who spontaneously recover from an infection will generally test negative for HBsAg and negative for HBV DNA about 15 weeks after the appearance of symptoms. […] Anti-HBs or HBsAb (hepatitis B surface antibody) becomes detectable on a blood test after the disappearance of HBsAg in persons who are able to get rid of the virus (recover from an acute infection). The presence of anti-HBs following a new acute infection generally indicates recovery and a person is then protected (or immune) from re-infection with hepatitis B. […] HBeAg (hepatitis B e-antigen) is generally detectable in patients with a new acute infection but can also be present in a chronic infection. The presence of HBeAg is associated with higher HBV DNA levels, thus, increased infectiousness. […] IgM anti-HBc a positive blood test result indicates a person has a new acute hepatitis B infection. IgM anti-HBc is generally detectable at the time symptoms appear and declines to sub-detectable levels within 6 – 9 months. […] IgG anti-HBc this blood test remains positive indefinitely as a marker of past HBV infection.

• #1 Hepatitis B virus: Screening and diagnosis in adults – UpToDate

  https://www.uptodate.com/contents/hepatitis-b-virus-screening-and-diagnosis-in-adults

  Hepatitis B virus: Screening and diagnosis in adults […] The identification of hepatitis B virus (HBV) infection was revolutionized by the discovery of Australia antigen, now called hepatitis B surface antigen (HBsAg). During the ensuing two decades, serologic assays were established for HBsAg and other HBV antigens and antibodies. Advances in molecular biology techniques led to the development of hybridization and polymerase chain reaction (PCR) assays for direct determination of hepatitis B virus DNA (HBV DNA). The diagnosis of HBV infection can also be made by the detection of HBsAg or hepatitis B core antigen (HBcAg) in liver tissues by immunohistochemical staining and of HBV DNA by Southern hybridization, in-situ hybridization, or PCR. […] Screening persons for HBV is supported by the American Association for the Study of Liver Diseases, the American College of Physicians, the United States Centers for Disease Control and Prevention, the World Health Organization, and the United States Preventative Task Force.

• #1 Hepatitis B Virus (HBV) DNA Detection and Quantification by Real-Time PCR, Serum – Mayo Clinic Laboratories | Microbiology and Infectious Disease Catalog

  https://microbiology.testcatalog.org/show/HBVQN

  -Diagnose some cases of early acute HBV infection (before the appearance of HBsAg) […] -Distinguish active from inactive HBV infection […] -Monitor a patient’s response to anti-HBV therapy […] The presence of HBV DNA in serum is a reliable marker of active HBV replication. […] In cases of acute viral hepatitis with equivocal HBsAg test results, testing for HBV DNA in serum may be a useful adjunct in the diagnosis of acute HBV infection, since HBV DNA can be detected approximately 21 days before HBsAg typically appears in the serum. […] HBV DNA levels in serum are useful in determining the status of chronic HBV infection, by differentiating between active and inactive disease states. […] Monitoring HBV DNA levels over time is important for assessing disease progression or monitoring a patient’s response to anti-HBV therapy.

• #1 Hepatitis B Virus (HBV) DNA Detection and Quantification by Real-Time PCR, Serum – Mayo Clinic Laboratories | Microbiology and Infectious Disease Catalog

  https://microbiology.testcatalog.org/show/HBVQN

  The therapeutic goal of anti-HBV therapy in patients who are HBeAg-positive is to achieve long-term suppression of viral replication with undetectable HBV DNA, HBe seroconversion and loss of HBeAg. […] The emergence of drug-resistant HBV strains in response to treatment with nucleoside/nucleotide analogs (eg, lamivudine, adefovir, entecavir, tenofovir), is characterized by either the reappearance of HBV DNA in serum (after it had become undetectable) or an increase in HBV DNA levels (following an initial decline). […] The following algorithms are available: […] -Hepatitis B: Testing Algorithm for Screening, Diagnosis, and Management […] -HBV Infection-Monitoring Before and After Liver Transplantation […] An „Undetected” result indicates that hepatitis B virus (HBV) DNA was not detected in the serum specimen.

• #1 Hepatitis B Workup: Approach Considerations, Diagnostic Tests, Radiologic Studies

  https://emedicine.medscape.com/article/177632-workup

  Please note that the guidelines for the current diagnostic workup and management of hepatitis B virus (HBV) infection continue to evolve. Clinicians are advised to refer frequently to the most recent recommendations of the American Association for the Study of Liver Diseases (AASLD). […] Laboratory evaluation of hepatitis B disease generally consists of liver enzyme tests, including levels of alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gamma-glutamyl transpeptidase (GGT), as well as liver function tests (LFTs) that include total and direct serum bilirubin, albumin, and the measurement of the international normalized ratio (INR). […] Serologic tests for hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti-HBc) immunoglobulin M (IgM) are required for the diagnosis of acute hepatitis B virus (HBV).

• #1 Hepatitis B (HBV, Hep B): Symptoms, Vaccine, Diagnosis, Tests & Treatment

  https://www.emedicinehealth.com/hepatitis_b/article_em.htm

  How Is Hepatitis B Diagnosed? Hepatitis B infection is diagnosed with blood tests. These tests can detect pieces of the virus in the blood (antigens), antibodies against the virus, and viral DNA (’viral load’). Blood tests for HBV are often done when routine blood work shows abnormal liver function tests or in patients who are at an increased risk for exposure. If a patient has had a large amount of vomiting or has not been able to take in liquids, blood electrolytes may also be checked to ensure that the patient’s blood chemistry is in balance. […] If a patient is diagnosed with chronic hepatitis B, they will need regular visits to their healthcare practitioner. Blood tests can help determine how active the infection is and whether there has been damage to the liver. […] Blood tests alone may not be enough to guide treatment in chronic HBV. Other tests include: CT scan or ultrasound: These diagnostic imaging tests are used to detect the extent of liver damage and may also detect cancer of the liver caused by chronic hepatitis B. Liver biopsy: This involves removal of a tiny piece of the liver. It is usually done by inserting a long needle into the liver and withdrawing the tissue. The tissue is examined under a microscope to detect changes in the liver. A biopsy may be done to detect the extent of liver damage or to evaluate how well a treatment is working.

• #1 Hepatitis B – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hepatitis-b/diagnosis-treatment/drc-20366821

  Diagnosis involves the steps that your healthcare professional takes to find out if you have hepatitis B. Your healthcare professional gives you a physical exam and looks for symptoms of liver damage. These symptoms can include yellowing skin and stomach pain. Tests that can help diagnose hepatitis B or its complications are: […] Blood tests can detect the hepatitis B virus in your body. They also can tell your healthcare professional if the infection is acute or chronic. A simple blood test also can find out if you’re immune to the condition. […] A special ultrasound called transient elastography can show the amount of liver damage. […] Your healthcare professional might remove a small sample of your liver for testing to check for liver damage. This is called a liver biopsy. During this test, your healthcare professional inserts a thin needle through your skin and into your liver. The needle removes a tissue sample for the lab to check. […] Healthcare professionals sometimes test certain healthy people for hepatitis B. This is called screening. Screening is done because HBV can damage the liver before the infection causes symptoms.

• #1 A critical review of diagnostic and prognostic markers of chronic hepatitis B infection

  https://www.degruyter.com/document/doi/10.1515/mr-2024-0022/html?lang=en

  Anti-HBc, or the hepatitis B core antibody, is frequently used to diagnose or confirm hepatitis B infection. It could be IgM, which denotes an acute infection, or IgG, which denotes a persistent or healed illness. When diagnosing CHB infection, anti-HBc is essential. […] Elevated alanine transaminase (ALT) levels are indicative of liver inflammation and are used to gauge the severity of liver disease. Normal ALT values do not, however, rule out serious liver disorders in CHB patients. […] The significance of these prognostic markers in risk stratification, disease monitoring, and treatment decision-making for patients with chronic hepatitis B infection is illustrated in Figure 1. It is essential to regularly monitor and assess their levels to ensure optimal patient care and improve clinical outcomes.

• #1 Hepatitis B – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/127

  Investigations to consider include abdominal ultrasound, liver biopsy, transient elastography, serum liver fibrosis biomarkers, aspartate aminotransferase-to-platelet ratio index (APRI), alpha-fetoprotein, CT/MRI abdomen, testing for hepatitis D coinfection, testing for other co-infections, drug resistance testing, and HBV genotype.

• #1 Hepatitis B, Chronic – Hepatic and Biliary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/hepatitis/hepatitis-b-chronic

  Hepatitis B is a common cause of chronic hepatitis. […] Diagnosis is by serologic testing. […] The diagnosis of chronic hepatitis B is suspected in patients with any of the following: […] Diagnosis is confirmed by finding positive hepatitis B surface antigen (HBsAg) and IgG antibody to hepatitis B core (IgG anti-HBc) and negative IgM anti-HBc […] If chronic hepatitis B is confirmed, testing for hepatitis B e antigen (HBeAg) and antibody to hepatitis B e antigen (anti-HBe) is usually done to help determine the prognosis and to guide antiviral therapy. […] Quantitative HBV-DNA tests (viral load) are also used before and during treatment to assess response. […] Noninvasive assessment of fibrosis (FIB-4 index, ultrasonography, and elastography) is done to evaluate degree of fibrosis after chronic hepatitis B is diagnosed.

• #1 A critical review of diagnostic and prognostic markers of chronic hepatitis B infection

  https://www.degruyter.com/document/doi/10.1515/mr-2024-0022/html?lang=en

  Predicting the course of liver disease can be aided by measuring liver inflammation and fibrosis using a tissue sample from the liver or non-invasive testing methods like FibroScan. The prognosis of a CHB infection can be predicted more accurately by non-invasive diagnostics than by liver biopsy. […] The presence of HBeAg is a significant predictive factor. Patients who test positive for HBeAg are more likely to have increased infectivity and active viral replication. An inverse relationship exists between the advancement of liver disease and HBeAg seroconversion to anti-HBe. […] Variations in HBV genotype can affect how an antiviral treatment works and how quickly the disease progresses. For instance, in certain groups, genotype C is linked to an increased risk of hepatocellular cancer (HCC).

• #1 Hepatitis B, Chronic – Hepatic and Biliary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/hepatitis/hepatitis-b-chronic

  Biopsy is occasionally done to evaluate the extent of liver damage and to exclude other causes of liver disease. […] Liver tests are needed if not previously done; they include serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase. […] Patients with chronic HBV infection should be screened every 6 months for hepatocellular carcinoma with ultrasonography and serum alpha-fetoprotein measurement.

• #1 Hepatitis B differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Hepatitis_B_differential_diagnosis

  Hepatitis B must be differentiated from other diseases that cause fever, nausea, vomiting, jaundice, hepatomegaly, icteric sclera, elevated ALT, and elevated AST, such as other types of viral hepatitis, alcoholic hepatitis, and autoimmune hepatitis. […] The table below summarizes the findings that differentiate hepatitis B from other conditions that cause fever, nausea, vomiting, jaundice, hepatomegaly, and icteric sclera. […] Serologic testing will help differentiate these two conditions. […] Elevated serum aminotransaminases and evidence of acute HBV infection on serologic testing confirm the presence of the HBV.

• #1 Hepatitis B Differential Diagnoses

  https://emedicine.medscape.com/article/177632-differential

  When evaluating a patient with suspected hepatitis B virus (HBV) infection, also consider the other viral hepatitides and etiologies that can lead to cirrhosis and liver failure, such as drug hepatotoxicity. […] In addition, because a major mode of transmission of this disease is sexual, also consider the possibility of infection with human immunodeficiency virus (HIV) or other sexually transmitted diseases. […] Diagnostic Tests […] Radiologic Studies […] Liver Biopsy and Histologic Features […] Staging

• #1 Hepatitis B Foundation: Understanding Your Hepatitis B Test Results

  https://www.hepb.org/prevention-and-diagnosis/diagnosis/understanding-your-test-results/

  Understanding your hepatitis B blood tests can be confusing. It is important to talk to your health care provider, so you understand your test results and your hepatitis B status. The Hepatitis B Panel of blood tests includes 3 tests and all three results must be known to confirm your status. […] During an acute infection, it can take up to six months for a person to get rid of the hepatitis B virus from their blood. So, it can take up to six months for a hepatitis B blood test to show whether a person has recovered from an acute infection or has developed a chronic infection. […] According to the CDC, a hepatitis B blood test result (or serologic marker) varies depending on whether the infection is a new (acute) infection or a chronic infection. […] HBsAg (hepatitis B surface antigen) is the first serologic marker to appear in a new acute infection, which can be detected as early as 1 week and as late as 9 weeks (range: 6-60 days), with an average of one month after exposure to the hepatitis B virus (HBV).

• #1 Hepatitis B, Acute – Hepatic and Biliary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/hepatitis/hepatitis-b-acute

  Hepatitis B is caused by a DNA virus that is often parenterally transmitted. […] Diagnosis is by serologic testing. […] If acute viral hepatitis is suspected, the following tests are done to screen for hepatitis viruses A, B, and C: Hepatitis B surface antigen (HBsAg). […] If any of the hepatitis B tests are positive, further serologic testing may be necessary to differentiate acute from past or chronic infection. […] HBsAg characteristically appears during the incubation period, usually 1 to 6 weeks before clinical or biochemical illness develops, and implies infectivity of the blood. […] In 5 to 10% of patients, HBsAg persists and antibodies do not develop; these patients develop chronic hepatitis B. […] Anti-HBc is a sensitive marker of acute HBV infection and occasionally is the only marker of recent infection, reflecting a window between disappearance of HBsAg and appearance of anti-HBs.

• #1 Hepatitis B, Acute – Hepatic and Biliary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/hepatitis/hepatitis-b-acute

  HBeAg tends to suggest more active viral replication and greater infectivity. […] Chronic infection develops in 5 to 10% of patients with acute hepatitis B and often leads to cirrhosis and/or hepatocellular carcinoma. […] Diagnose by testing for hepatitis B surface antigen and other serologic markers.

• #1 Hepatitis B: diagnosis and monitoring – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/hepatitis-b-diagnosis-and-monitoring

  During the natural course of an infection, the HBeAg is sometimes cleared with a corresponding rise in its antibodies (anti-HBe). This is usually associated with a dramatic decline in viral replication and indicates resolution of acute hepatitis B infection. […] Chronic HBV infection develops in 90% of those who are infected at birth. It is diagnosed by the persistence of HBsAg in a patient’s bloodstream for more than six months. […] The clinical features of hepatitis B are a result of the interaction between HBV and the host’s immune system. […] Patients with chronic HBV infection can progress through up to five phases of disease. Understanding these phases is critical to determining the risk of liver damage and the need to begin treatment. […] Patients’ blood results should be monitored every three to six months to identify when their condition progresses.

• #1 Virological techniques for the diagnosis and monitoring of hepatitis B and C | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-virological-techniques-for-diagnosis-monitoring-S1665268119318046

  HBsAg quantification can now be performed by means of a fully automated chemiluminescent micropar-ticle immunoassay. […] Serological and molecular HBV markers are used in clinical practice to diagnose chronic HBV infection, assess the prognosis of the disease, guide therapy and monitor treatment responses. […] The persistence of HBsAg for more than 6 months defines chronic HBV carriage. […] The HBV DNA level and aminotransferase activity provide valuable prognostic information. […] The goal of chronic hepatitis B therapy is to prevent progression of liver disease to its life-threatening complications, cirrhosis and HCC. […] The decision to treat chronic hepatitis B is based on the assessment of multiple parameters including clinical, biological and histologic parameters.

• #1 NCD – Screening for Hepatitis B Virus (HBV) Infection (210.6)

  https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=369&ncdver=1

  A screening test is covered for asymptomatic, nonpregnant adolescents and adults at high risk for HBV infection. „High risk” is defined as persons born in countries and regions with a high prevalence of HBV infection (i.e., 2%), US born persons not vaccinated as infants whose parents were born in regions with a very high prevalence of HBV infection (i.e., 8%), HIV-positive persons, men who have sex with men, injection drug users, household contacts or sexual partners of persons with HBV infection. […] A screening test at the first prenatal visit is covered for pregnant women and then rescreening at time of delivery for those with new or continuing risk factors. […] The determination of „high risk for HBV” is identified by the primary care physician or practitioner who assesses the patient’s history, which is part of any complete medical history, typically part of an annual wellness visit and considered in the development of a comprehensive prevention plan.

• #1 Current Challenges and Future Perspectives of Diagnosis of Hepatitis B Virus

  https://www.mdpi.com/2075-4418/13/3/368

  There are two key categories of HBV biomarker assays: one is serology, a term encompassing the detection and quantification of viral-specific antibodies and/or antigens, and the second is nucleic acid testing (NAT) for the detection and quantification of the HBV genome and its RNA transcripts. […] Serology tests that identify or measure HB surface antigen (HBsAg) serum levels, HB surface antibodies (anti-HBs), and HB core antibodies (anti-HBcs) are used to detect patients who have been exposed to HBV, whereas NAT tests provide information on the level of virus replication, the manifestation of particular variants, and occurrence of virus reservoirs. […] Tests are being advanced to measure levels of intrahepatic HBV replication. […] These biomarkers are to be used to identify patients with HBV infection, follow disease progression, and determine response to therapy and efficacy of new agents in clinical trials.

• #1 Diagnosis of hepatitis B

  https://atm.amegroups.org/article/view/11691/html

  HBsAg is the serological hallmark of HBV infection. […] Monitoring of quantitative HBsAg levels predicts treatment response to interferon and disease progression in HBeAg-negative CHB patients with normal serum alanine aminotransferase levels. […] The diagnosis of chronic infection is based on the persistence of HBsAg for more than 6 months. […] Occult HBV infection is defined by persistence of low level of intrahepatic HBV DNA without detectable HBsAg. […] The detection of HBV DNA in the liver is the gold standard of diagnosis for occult HBV infection, since cccDNA remains in the hepatocytes and HBV DNA is occasionally identified in the liver but not in the serum. […] Real-time PCR for serum HBV DNA detection have been shown with adequate sensitivity to identify occult HBV infection in many cases; thus, HBV DNA testing is widely used to diagnose occult HBV infection. […] Diagnosis of HBV infection is an important tool to determine acute, chronic and occult cases of infection in order to establish preventive remedies and to initiate antiviral treatment.

• #1 Current Challenges and Future Perspectives of Diagnosis of Hepatitis B Virus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9914745/

  HBsAg quantification has prognostic significance and has been incorporated into risk scores to predict the risk of HCC and possibly specify rebound viral risk after stopping NUCs. […] The presence of anti HBc with absence of HBs Ag and presence of anti HBs is also seen in recovered patients, however, HBV DNA is negative in such patients. […] The diagnosis of OBI depends on detection of HBV DNA in the liver (gold standard) or blood (more commonly used), with absence of HBsAg. […] WHOs plan to eliminate viral hepatitis by 2030 can be accomplished by increasing diagnosis, care, and treatment. […] The elimination of hepatitis refers to the reduction of 90% incidence and 65% of deaths from the 2015 baseline. […] Screening and diagnosis should be made available to the people unacquainted with their status of HBV infection or who have not so far entered into care and treatment.

• #1 An Interpretable Machine Learning Approach for Hepatitis B Diagnosis

  https://www.mdpi.com/2076-3417/12/21/11127

  An Interpretable Machine Learning Approach for Hepatitis B Diagnosis […] Hepatitis B is a potentially deadly liver infection caused by the hepatitis B virus. It is a serious public health problem globally. […] In this study, we used SHapley Additive exPlanations (SHAP), a game-based theoretical approach to explain and visualize the predictions of machine learning models applied for hepatitis B diagnosis. […] The algorithms used in building the models include decision tree, logistic regression, support vector machines, random forest, adaptive boosting (AdaBoost), and extreme gradient boosting (XGBoost), and they achieved balanced accuracies of 75%, 82%, 75%, 86%, 92%, and 90%, respectively. […] Consequently, older patients are more likely to die with elevated bilirubin levels. […] Early detection can help reduce its debilitating effects and minimize the risk of transmission through contact with an infected person’s blood and bodily fluids.

• #1 An Interpretable Machine Learning Approach for Hepatitis B Diagnosis

  https://www.mdpi.com/2076-3417/12/21/11127

  Machine learning algorithms have been used effectively as a classification method to extract information from medical data to make accurate predictions for HBV diagnosis. […] The proposed HPV detection method comprises multiple steps summarized in this section. The dataset is preprocessed using the listwise deletion and min-max normalization techniques discussed in Section 2.2. The algorithms discussed in Section 2.3 are used to build machine-learning models. Lastly, the SHAP tool is employed to explain the model’s predictions. […] The performance evaluation metrics used in this study include balanced accuracy, a type of accuracy that account for the class imbalance. […] The Adaboost classifier achieved the best classification performance with a balanced accuracy, specificity, and sensitivity of 92%, 91%, and 93%, respectively.

• #1 An Interpretable Machine Learning Approach for Hepatitis B Diagnosis

  https://www.mdpi.com/2076-3417/12/21/11127

  The interpretation of the machine learning model increases the model’s efficacy transparency and promotes increased confidence in the approach, especially for the medical practitioner or health policy maker. […] This study used demographic and clinical records of patients obtained from the UCI Machine Learning Repository and applied the SHAP interpretable machine learning approach to predict hepatitis B. AdaBoost achieved an accuracy score of 92%, among other models. […] This result indicated that a high bilirubin level positively contributed to a high mortality rate.

• #1 Current Challenges and Future Perspectives of Diagnosis of Hepatitis B Virus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9914745/

  In low-resource settings or countries, collecting blood for HBV testing at a remote location usually requires additional logistic support for transport to the testing facility. […] The proper understanding and interpretation of diagnostic methods is necessary for successful therapy against hepatitis B, because different type of therapies target various markers of hepatitis B infection differently. […] Therefore, diagnosis based on different combinations of markers of hepatitis B infection needs to be carried out to monitor the effectiveness of a therapy. […] In spite of the fact that there are several unresolved and controversial issues in the diagnosis of hepatitis B, there is a necessity for mass testing, especially in areas where hepatitis B is more prevalent and where resources are limited. […] There is, however, an urgent need for the development of sensitive, standardized, and validated test procedures for the detection of HBsAg, HBV DNA (in blood and in liver), and other viral markers.

• #1 Millions of people living with chronic hepatitis B are unaware they have the virus. So why aren’t they getting diagnosed? | GSK

  https://www.gsk.com/en-gb/behind-the-science-magazine/chronic-hepatitis-b-stigma-discrimination-diagnosis/

  Millions of people living with chronic hepatitis B are unaware they have the virus. So why arent they getting diagnosed? […] According to the World Health Organisation(WHO), nearly 300 million people globally are living with chronic hepatitis B. However, the Polaris Observatory estimates that only about 10% of these people are diagnosed, and only 5% receive treatment. […] Underdiagnosis is particularly worrying to healthcare providers because hepatitis B infections can lead to serious consequences over time, says Melanie. […] Infection from HBV is considered chronic when the bodys immune system is unable to fight off the virus, so it persists in the blood and liver putting people at high risk of complications such as cirrhosis and liver cancer, which may lead to death. […] The stigma associated with the hepatitis B virus impacts infection diagnosis, because the fear of being marked out as infected can deter people from coming forward for testing, she says.

• #1 The laboratory diagnosis of hepatitis B virus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2095015/

  Hepatitis B virus (HBV) chronically infects approximately 250,000 Canadians and 350 million people worldwide. […] HBV diagnosis is accomplished by testing for a series of serological markers of HBV and by additional testing to exclude alternative etiological agents such as hepatitis A and C viruses. […] Serological tests are used to distinguish acute, self-limited infections from chronic HBV infections and to monitor vaccine-induced immunity. […] Nucleic acid testing for HBV-DNA is increasingly being used to quantify HBV viral load and measure the effectiveness of therapeutic agents. […] The present guideline addresses tests for the diagnosis and management of HBV. […] The diagnosis of HBV infection in any individual has important management implications, including appropriate counselling, monitoring and/or treating and vaccinating family or at-risk contacts.

• #1 Testing & Diagnostics

  https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hepatitis/testing-and-diagnostics

  WHO estimates that in 2022, 254 million people were living with chronic hepatitis B virus infection. […] By the end of 2022, only 13% of the estimated 254 million people living with hepatitis B had been diagnosed, and less than 3% had received antiviral treatment. […] Testing is an essential entry point in accessing hepatitis B and C prevention, care and treatment services, making it a critical component of national responses. […] Demand creation and awareness raising, cost-effective testing strategies and active case-finding and testing allow early identification of people with chronic hepatitis B and C. […] Viral hepatitis testing services should be included in national essential health benefit packages, supported by adequate financing and coordinated actions to advance universal health coverage and integration in primary health care.

• #1 Hepatitis B: Nursing Diagnosis & Interventions | Nurse.com

  https://www.nurse.com/clinical-guides/hepatitis-b/?srsltid=AfmBOoruPYbA-gADf4QqqgreT-ssVqilzS2N9tcO5RuDk1hhMtTAMtxh

  A diagnosis of hepatitis B cannot be made by examination only. There are multiple blood tests available that can not only diagnose hepatitis B but determine if it is acute or chronic. A blood test is also available to determine if someone is immune to hepatitis B. A liver ultrasound and biopsy may be performed to assess the amount of liver damage. […] The majority of individuals with acute hepatitis B resolve the infection spontaneously and may not need any treatment. […] Nursing interventions will vary among individuals. Some of the most common nursing interventions include: Educate individual on ways to conserve energy. Use infection control techniques to prevent infection. Assess for signs and symptoms of infection. Perform lab tests to assess for fluid balance and liver function. […] The individual with hepatitis B and their household should be vaccinated for hepatitis B. Education should include proper preventative practices to avoid the transmission of disease to others. They should be educated on ways of virus transmission and that transmission is possible even when asymptomatic. […] The healthcare provider should be notified of any signs and symptoms of recurrent disease or worsening of current disease.

• #2 Testing & Diagnostics

  https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hepatitis/testing-and-diagnostics

  WHO estimates that in 2022, 254 million people were living with chronic hepatitis B virus infection. […] By the end of 2022, only 13% of the estimated 254 million people living with hepatitis B had been diagnosed, and less than 3% had received antiviral treatment. […] Testing is an essential entry point in accessing hepatitis B and C prevention, care and treatment services, making it a critical component of national responses. […] Demand creation and awareness raising, cost-effective testing strategies and active case-finding and testing allow early identification of people with chronic hepatitis B and C. […] Viral hepatitis testing services should be included in national essential health benefit packages, supported by adequate financing and coordinated actions to advance universal health coverage and integration in primary health care.

• #2 Hepatitis B (HBV, Hep B): Symptoms, Vaccine, Diagnosis, Tests & Treatment

  https://www.emedicinehealth.com/hepatitis_b/article_em.htm

  How Is Hepatitis B Diagnosed? Hepatitis B infection is diagnosed with blood tests. These tests can detect pieces of the virus in the blood (antigens), antibodies against the virus, and viral DNA (’viral load’). Blood tests for HBV are often done when routine blood work shows abnormal liver function tests or in patients who are at an increased risk for exposure. If a patient has had a large amount of vomiting or has not been able to take in liquids, blood electrolytes may also be checked to ensure that the patient’s blood chemistry is in balance. […] If a patient is diagnosed with chronic hepatitis B, they will need regular visits to their healthcare practitioner. Blood tests can help determine how active the infection is and whether there has been damage to the liver. […] Blood tests alone may not be enough to guide treatment in chronic HBV. Other tests include: CT scan or ultrasound: These diagnostic imaging tests are used to detect the extent of liver damage and may also detect cancer of the liver caused by chronic hepatitis B. Liver biopsy: This involves removal of a tiny piece of the liver. It is usually done by inserting a long needle into the liver and withdrawing the tissue. The tissue is examined under a microscope to detect changes in the liver. A biopsy may be done to detect the extent of liver damage or to evaluate how well a treatment is working.

• #2 The laboratory diagnosis of hepatitis B virus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2095015/

  Hepatitis B virus (HBV) chronically infects approximately 250,000 Canadians and 350 million people worldwide. […] HBV diagnosis is accomplished by testing for a series of serological markers of HBV and by additional testing to exclude alternative etiological agents such as hepatitis A and C viruses. […] Serological tests are used to distinguish acute, self-limited infections from chronic HBV infections and to monitor vaccine-induced immunity. […] Nucleic acid testing for HBV-DNA is increasingly being used to quantify HBV viral load and measure the effectiveness of therapeutic agents. […] The present guideline addresses tests for the diagnosis and management of HBV. […] The diagnosis of HBV infection in any individual has important management implications, including appropriate counselling, monitoring and/or treating and vaccinating family or at-risk contacts.

• #2 Hepatitis B: Symptoms, Causes, and Treatment

  https://www.webmd.com/hepatitis/digestive-diseases-hepatitis-b

  Hepatitis B Diagnosis […] But the only way to know if you have hepatitis B is to do blood tests and other tests to check for liver damage and other liver diseases. […] The CDC recommends testing with a triple panel test that includes: […] Hepatitis B surface antigen (HBsAg). Antigens are proteins on the surface of HBV that your immune system recognizes as a foreign invader. If you have HBsAg in your blood, it shows you have been infected with HBV and can infect other people. […] Hepatitis B surface antibody (anti-HBs). Antibodies are proteins your immune system makes to fight HBV. If you have anti-HBs in your blood, it shows that you have fought off HBV and now can’t get it. Or this can show that you have gotten the hepatitis B vaccine. […] Total antibody to hepatitis B core antigen (anti-HBc). This tests for a couple of kinds of antibodies your immune system makes to fight off HBV. If you have anti-HBc in your blood, it shows that you have an ongoing infection or a previous infection with HBV, but your body won’t make this if you’ve gotten the hepatitis B vaccine.

• #2 Core Concepts – HBV Screening, Testing, and Diagnosis – Screening and Diagnosis – Hepatitis B Online

  https://www.hepatitisb.uw.edu/go/screening-diagnosis/diagnosis-hbv/core-concept/all

  The CDC recommends universal HBV screening for all adults (18 years of age and older) using a 3-test panel, which includes: Hepatitis B surface antigen (HBsAg), Antibody to hepatitis B surface antigen (anti-HBs), Total antibody to hepatitis B core antigen (anti-HBc). […] The benefits of using a 3-test panel are that it can identify individuals with current HBV infection, those with prior HBV infection, those with immunity due to prior vaccination, and those who are susceptible to HBV and would benefit from vaccination. […] Chronic HBV is an indolent and often silent disease that over time can lead to serious health consequences, including cirrhosis, decompensated liver disease, hepatocellular carcinoma (HCC), and death. […] Universal screening for HBV has the advantage of averting substantial morbidity and mortality and it has been shown to be cost-effective.

• #2 The laboratory diagnosis of hepatitis B virus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2095015/

  Chronic HBV infection is defined by the continued presence of HBsAg in the blood for longer than six months. […] Test selection should be based on the person’s risk factors, vaccination history and findings from previous tests. […] If negative, chronic HBV infection is typically ruled out. […] If positive, the patient is considered HBV-infected. Chronic infection is diagnosed when the HBsAg remains detectable for greater than six months. […] If negative, past infection with HBV is typically ruled out. […] If positive, the patient has been infected with HBV. […] If negative, the patient has no apparent immunity to HBV. […] If positive, the patient is considered immune to HBV. […] Once an individual has been diagnosed with chronic HBV infection, follow-up testing must be performed for alanine aminotransferase (ALT), a marker of liver cell inflammation.

• #2 Hepatitis B Foundation: Understanding Your Hepatitis B Test Results

  https://www.hepb.org/prevention-and-diagnosis/diagnosis/understanding-your-test-results/

  Acutely infected persons who spontaneously recover from an infection will generally test negative for HBsAg and negative for HBV DNA about 15 weeks after the appearance of symptoms. […] Anti-HBs or HBsAb (hepatitis B surface antibody) becomes detectable on a blood test after the disappearance of HBsAg in persons who are able to get rid of the virus (recover from an acute infection). The presence of anti-HBs following a new acute infection generally indicates recovery and a person is then protected (or immune) from re-infection with hepatitis B. […] HBeAg (hepatitis B e-antigen) is generally detectable in patients with a new acute infection but can also be present in a chronic infection. The presence of HBeAg is associated with higher HBV DNA levels, thus, increased infectiousness. […] IgM anti-HBc a positive blood test result indicates a person has a new acute hepatitis B infection. IgM anti-HBc is generally detectable at the time symptoms appear and declines to sub-detectable levels within 6 – 9 months. […] IgG anti-HBc this blood test remains positive indefinitely as a marker of past HBV infection.

• #2 Core Concepts – HBV Screening, Testing, and Diagnosis – Screening and Diagnosis – Hepatitis B Online

  https://www.hepatitisb.uw.edu/go/screening-diagnosis/diagnosis-hbv/core-concept/all

  Chronic HBV infection can be easily detected before the onset of significant liver disease using reliable and inexpensive tests. […] Multiple safe and effective antiviral options are available for persons who have an indication for treatment and can reduce the morbidity and mortality associated with chronic HBV. […] Screening can identify persons who would benefit from hepatitis B vaccination or those who are at risk for HBV reactivation. […] The serologic hallmark of acute HBV infection is the detection of IgM anti-HBc, which is typically detectable at the onset of symptoms and persists for 6 to 9 months following infection. […] Chronic HBV can be diagnosed by detection of HBsAg, HBeAg, or HBV DNA on two separate samples 6 months apart, or by detection of HBsAg, HBeAg, or HBV DNA on a single sample with a concurrent negative IgM anti-HBc.

• #2 The laboratory diagnosis of hepatitis B virus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2095015/

  Sustained and intermittent elevations in ALT beyond the upper limit of normal are indicative of hepatic inflammation and correlate with an increased risk of progressive liver disease. […] The presence of HBV-DNA in serum or plasma denotes active HBV infection and, depending on the viral load, correlates with the infectivity of the patient. […] Testing for appropriate biochemical and virological markers at defined intervals can be used to follow the progression or resolution of chronic HBV infection. […] The presence of HBeAg is correlated with high levels of viral replication as measured by HBV-DNA and a higher risk of cirrhosis and hepatocellular carcinoma. […] Antiviral therapy has been used only to a limited extent for the treatment of chronic HBV infection; the outcomes of such treatment have not been consistently measured. […] The most important risk factor for hepatocellular carcinoma is prolonged chronic HBV infection for decades, particularly in patients with active disease based on elevated ALT levels.

• #2 Hepatitis B Workup: Approach Considerations, Diagnostic Tests, Radiologic Studies

  https://emedicine.medscape.com/article/177632-workup

  The hallmark of acute hepatitis B is liver cell death. […] The hallmark of chronic hepatitis B infection is lymphoid inflammation, mostly involving the portal tracts. […] Liver biopsy, percutaneous or laparoscopic, is the standard means of assessing the severity of disease in patients with features of chronic active liver disease (ie, abnormal aminotransferase levels and detectable levels of hepatitis B virus [HBV] DNA).

• #2 Diagnosis of hepatitis B

  https://atm.amegroups.org/article/view/11691/html

  HBsAg is the serological hallmark of HBV infection. […] Monitoring of quantitative HBsAg levels predicts treatment response to interferon and disease progression in HBeAg-negative CHB patients with normal serum alanine aminotransferase levels. […] The diagnosis of chronic infection is based on the persistence of HBsAg for more than 6 months. […] Occult HBV infection is defined by persistence of low level of intrahepatic HBV DNA without detectable HBsAg. […] The detection of HBV DNA in the liver is the gold standard of diagnosis for occult HBV infection, since cccDNA remains in the hepatocytes and HBV DNA is occasionally identified in the liver but not in the serum. […] Real-time PCR for serum HBV DNA detection have been shown with adequate sensitivity to identify occult HBV infection in many cases; thus, HBV DNA testing is widely used to diagnose occult HBV infection. […] Diagnosis of HBV infection is an important tool to determine acute, chronic and occult cases of infection in order to establish preventive remedies and to initiate antiviral treatment.

• #2 Hepatitis B: diagnosis and monitoring – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/hepatitis-b-diagnosis-and-monitoring

  During the natural course of an infection, the HBeAg is sometimes cleared with a corresponding rise in its antibodies (anti-HBe). This is usually associated with a dramatic decline in viral replication and indicates resolution of acute hepatitis B infection. […] Chronic HBV infection develops in 90% of those who are infected at birth. It is diagnosed by the persistence of HBsAg in a patient’s bloodstream for more than six months. […] The clinical features of hepatitis B are a result of the interaction between HBV and the host’s immune system. […] Patients with chronic HBV infection can progress through up to five phases of disease. Understanding these phases is critical to determining the risk of liver damage and the need to begin treatment. […] Patients’ blood results should be monitored every three to six months to identify when their condition progresses.

• #2 Testing for Hepatitis B | Hepatitis B | CDC

  https://www.cdc.gov/hepatitis-b/testing/index.html

  CDC recommends HBV screening at least once during a lifetime for all adults 18 and older. […] CDC recommends HBV screening for all pregnant women during each pregnancy, preferably in the first trimester. […] CDC recommends HBV testing for all people with a history of increased risk for HBV infection, regardless of age and periodic testing for those who are still at increased risk for exposure. […] Your doctor will order blood tests that look for signs of hepatitis B in your body. […] The tests detect proteins that indicate the presence of HBV infection in your body. […] If you have hepatitis B, your doctor will test your liver for damage with an ultrasound, which produces an image of your liver using sound. […] Depending on the results of the blood test, your doctor will be able to tell whether you have acute or chronic hepatitis B.

• #2 Are there blood tests for hepatitis B? | Asian Liver Center | Stanford Medicine

  https://med.stanford.edu/liver/education/screening.html

  Are there blood tests for hepatitis B? Yes. Many chronically infected persons show no outward signs of hepatitis B infection. Therefore, screening for hepatitis B is important and necessary. Ask your doctor for the following blood tests: HEPATITIS B SURFACE ANTIGEN (HBSAG): Tells if you have chronic hepatitis B. Only the HBsAg blood test can tell if you have chronic hepatitis B. HEPATITIS B SURFACE ANTIBODY (ANTI-HBS): Tells if you are protected against hepatitis B. […] Who should get screened for hepatitis B? The U.S. Centers for Disease Control calls for HBV screening of all foreign-born persons from regions where hepatitis B is common (Asia, Africa, South America, the Pacific Islands, Eastern Europe, and the Middle East) regardless of their vaccination history. Additionally, all pregnant women should be screened for HBV at an early prenatal visit during each pregnancy, even if they have been previously tested or vaccinated. Other groups recommended for HBV screening include: Anyone seeking protection from the HBV infection, Healthcare and public safety workers, Household, sex, or needle-sharing contacts of persons infected with HBV, Intravenous drug users, Those with more than one sex partner, Men who have sex with men, Those infected with HIV and/or other sexually transmitted diseases, Those with end-stage renal disease or chronic liver disease, Travelers to regions where hepatitis B is common (Asia, Africa, South America, the Pacific Islands, Eastern Europe, and the Middle East).

• #2 Millions of people living with chronic hepatitis B are unaware they have the virus. So why aren’t they getting diagnosed? | GSK

  https://www.gsk.com/en-gb/behind-the-science-magazine/chronic-hepatitis-b-stigma-discrimination-diagnosis/

  We know that vaccination is an important step in preventing many types of infection. However, for those who already have the hepatitis B infection, to get ahead of the virus we must focus on early diagnosis, monitoring and treatment to reduce the risk for future liver-related complications. […] With more than half of people with hepatitis B undiagnosed or unaware of their infection, increasing both knowledge and access to screening is crucial. […] The U.S. Centers for Disease Control and Prevention (CDC) recently issued new recommendations for screening and testing for hepatitis B, stating all adults should be screened for HBV infection at least once in their lifetime. […] The ultimate treatment goal for someone living with CHB is functional cure. This is achieved when the virus is undetectable in the blood and the liver, the infection is fully controlled by the immune system without daily medication, and liver function has returned to normal. […] And, along the way, its also crucial to work towards improving education and awareness of CHB to remove barriers to diagnosis and tackle the stigma associated with this condition.

• #2 Current Challenges and Future Perspectives of Diagnosis of Hepatitis B Virus

  https://www.mdpi.com/2075-4418/13/3/368

  HBV can be diagnosed by various HBV markers such as hepatitis B surface antigens (HBsAgs), hepatitis B surface antibodies (anti-HBs), hepatitis B e-antigen (HBeAgs), hepatitis B e-antibodies (anti-HBes), and hepatitis core antigens (anti-HBcs). […] The elimination of hepatitis refers to the reduction of 90% incidence and 65% of deaths from the 2015 baseline. […] Screening and diagnosis should be made available to the people unacquainted with their status of HBV infection or who have not so far entered into care and treatment. […] The presence of anti HBc with absence of HBs Ag and presence of anti HBs is also seen in recovered patients, however, HBV DNA is negative in such patients. […] A resolved HBV infection is defined as a positive HBc antibody without detectable serum HBV DNA or negative HBsAg.

• #2 Virological techniques for the diagnosis and monitoring of hepatitis B and C | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-virological-techniques-for-diagnosis-monitoring-S1665268119318046

  HBsAg quantification can now be performed by means of a fully automated chemiluminescent micropar-ticle immunoassay. […] Serological and molecular HBV markers are used in clinical practice to diagnose chronic HBV infection, assess the prognosis of the disease, guide therapy and monitor treatment responses. […] The persistence of HBsAg for more than 6 months defines chronic HBV carriage. […] The HBV DNA level and aminotransferase activity provide valuable prognostic information. […] The goal of chronic hepatitis B therapy is to prevent progression of liver disease to its life-threatening complications, cirrhosis and HCC. […] The decision to treat chronic hepatitis B is based on the assessment of multiple parameters including clinical, biological and histologic parameters.

• #2 Testing & Diagnostics

  https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hepatitis/testing-and-diagnostics

  Currently serological tests and molecular tests are available for the diagnosis of both hepatitis B and C infections. […] WHO recommends that all assays should meet minimum quality, safety and performance standards. […] Large-scale roll-outs of hepatitis B and C diagnostics and treatment in low- and middle-income countries must be accompanied by efforts to ensure compliance with international quality assurance standards and national regulatory procedures.

• #2 Hepatitis B Testing – Testing.com

  https://www.testing.com/tests/hepatitis-b-test/

  As hepatitis B testing can be used for many different purposes, it’s important to work with a doctor or specialist when interpreting test results, which are typically evaluated together. […] Additional hepatitis B tests help doctors monitor the disease, direct treatment, and determine if you are contagious.

• #2 Diagnosis of hepatitis B

  https://atm.amegroups.org/article/view/11691/html

  Hepatitis B virus (HBV) infection is a major global health problems leading to severe liver disease such as cirrhosis and hepatocellular carcinoma (HCC). […] One significant method to diminish the burden of this disease is timely diagnosis of acute, chronic and occult cases of HBV. First step of HBV diagnosis is achieved by using serological markers for detecting antigens and antibodies. […] In this article, the serological and molecular tests for diagnosis of HBV infection will be reviewed. […] Along with active anti-HBV vaccination, one significant method to diminish the burden of this disease is the diagnosis of acute, chronic and occult HBV infection. In this article, the serological and molecular diagnosis of HBV will be reviewed. […] The identification of serological markers allows: to identify patients with HBV infection; to elucidate the natural course of chronic hepatitis B (CHB); to assess the clinical phases of infection; and to monitor antiviral therapy.

• #3 Current Challenges and Future Perspectives of Diagnosis of Hepatitis B Virus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9914745/

  It is estimated that approximately 260 million people worldwide are infected with the hepatitis B virus (HBV), which is one of the leading causes of liver disease and liver cancer throughout the world. […] In spite of the heavy burden caused by hepatitis B virus, 90% of people are still undiagnosed. […] The majority of diagnostic laboratories still use hepatitis B surface antigen (HBsAg)-based tests. […] The aim of the elimination of HBV can only be achieved by detecting all phases of HBV infection, which can be executed by a combined approach of using new marker assays along with advanced pretesting and testing methods. […] The diagnosis and follow-up of chronic infection rely on laboratory viral biomarkers. […] There are two key categories of HBV biomarker assays: one is serology, a term encompassing the detection and quantification of viral-specific antibodies and/or antigens, and the second is nucleic acid testing (NAT) for the detection and quantification of the HBV genome and its RNA transcripts.

• #4 Testing & Diagnostics

  https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hepatitis/testing-and-diagnostics

  WHO estimates that in 2022, 254 million people were living with chronic hepatitis B virus infection. […] By the end of 2022, only 13% of the estimated 254 million people living with hepatitis B had been diagnosed, and less than 3% had received antiviral treatment. […] Testing is an essential entry point in accessing hepatitis B and C prevention, care and treatment services, making it a critical component of national responses. […] Demand creation and awareness raising, cost-effective testing strategies and active case-finding and testing allow early identification of people with chronic hepatitis B and C. […] Viral hepatitis testing services should be included in national essential health benefit packages, supported by adequate financing and coordinated actions to advance universal health coverage and integration in primary health care.

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