Hepatitis B tests for people at high risk

This is an automatically translated article.

The article is professionally consulted by Doctor Vo Thi Thuy Trang, Department of Medical Examination & Internal Medicine - Vinmec International Hospital Da Nang.
Hepatitis B accounts for a high rate in the community and is also one of the most infectious diseases in our country today. Most people who are sick do not know they are sick, they unknowingly become a source of infection in the community. Therefore, testing for hepatitis B is essential, especially for people at high risk such as contact with the patient's blood, stepping on strange needles...

1. Importance of Hepatitis B Screening Test

The majority of people infected with hepatitis B have no symptoms, which means that a large proportion of people infected with hepatitis B do not know they have the disease. That is the cause of the disease transmission in the community. Therefore, healthy people and people at risk should both be tested for hepatitis B, the purpose is to:
Diagnose acute and chronic hepatitis B to monitor and treat the disease in time. may already have protective immunity to prevent vaccination. Minimize unnecessary vaccination. If the screening test confirms that the patient has already had hepatitis B , already has protective immunity (due to vaccination or previous hepatitis B infection), vaccination is no longer needed. Help the infected person take measures timely protection of health, avoiding economic costs, declining health or unresponsiveness to treatment

2. Tests to diagnose hepatitis B

2.1 HBsAg (surface antigen)

The HBsAg test is the most important and decisive test in the diagnosis of hepatitis B. It is both a qualitative test and a quantitative test:
Qualitative test: A test that shows that the patient has have hepatitis B or not Quantitative test shows more or less viral (antigen) levels, valuable for monitoring treatment Test results are concluded as follows:
HBsAg test (-) proves not infected with the virus. However, it is possible that during this period the virus has just entered, the body has not yet created antibodies, so the result is negative. If the examiner suspects that the risk of infection is high, the test should be repeated after 6 months. The results will then accurately reflect the condition of the disease. Testing for HBsAg (+) on the first test indicates that the virus is present in the body and is most likely in the chronic stage. The second HBsAg (+) test is more than 6 months apart from the first, which means that the patient has chronic hepatitis B. However, because the majority of hepatitis B patients in Vietnam are infected with the virus at birth or in childhood, a positive HBsAg test usually means that they have chronic hepatitis B. People with HBsAg (+) need regular counseling and examination to reduce the risk of disease progressing to chronic hepatitis, cirrhosis and liver cancer.

2.2 Anti-HBs

Anti-HBs test: Anti-HBs is produced after vaccination or due to previous infection with hepatitis B virus and self-healing. So this test is used to check if the body has produced protective immunity.
HBsAb (+) test results show that a healthy person has responded to the vaccine after being vaccinated or a person infected with hepatitis B virus has recovered from an acute viral infection. A HbsAg (-) result means that the user is currently unresponsive to the vaccine or has never been exposed to the virus. Normally, Anti-HBs levels > 10 mUI/ml are considered protective.

2.3 Other hepatitis B tests

Total anti-HBc: Actually total anti-HBc or anti-HBc, anti-hBc IgG is a test. Anti-HBc is an antibody against the core of hepatitis B virus, they appear very early and persist for life in the body. Therefore, this test is used to determine whether the patient has been exposed to the hepatitis B virus. This test is useful in screening blood transfusions but does not identify people who are currently chronically infected with hepatitis B or have recovered and have protective immunity to hepatitis B. IgM anti-HBc: Anti-HBc IgM are antibodies present during acute hepatitis B or acute exacerbation of chronic hepatitis B. Therefore, the test for IgM anti-HBc is a test to determine the status of hepatitis B virus infection. Only do the IgM anti-HBc test if it is suspected that the patient has recently been infected with hepatitis B virus (due to a needle stick when injecting. or from having unprotected sex with someone who has hepatitis B). HBeAg: HBeAg is an antigen that appears when the virus is multiplying and is highly contagious. If the results show that HBeAg (+) is an indicator that the virus is active and HBeAg (-) there are 2 possibilities that the virus is dormant or the virus is mutated. To know if the virus has a mutation, it is necessary to do additional tests for HBV DNA and HBV genotyping. Anti-HBe: Anti-HBe is an antibody against HBeAg. Anti-HBe test (+) indicates partial immunity. Anti-HBe test (-) shows that the body is not immune to hepatitis B virus.

3. Who needs a hepatitis B screening test?

Because Vietnam has a high prevalence of hepatitis B, everyone should be tested at least once to see if they have hepatitis B or have protective immunity. Subjects that should definitely be screened include pregnant women who are screened early to minimize the risk of transmitting the disease to their babies, people with HIV because they have a weak immune system, health care workers or industries. Other occupations often come in contact with sharp objects,...

4. How are tests performed sequentially?

First of all, everyone who comes to the clinic is tested for HBsAg.
If HBsAg (-) indicates that the patient does not have hepatitis B. To be more certain, do an Anti-HBc test. And perform more anti-HBs test to know if the patient is immune to hepatitis B or not for vaccination:
Anti-HBs (+) proves that the patient is immune to hepatitis B, no need for vaccination. Anti-HBs vaccine (-) indicates that the patient is not immune to hepatitis B, and should be vaccinated. If HBsAg (+): The patient is scheduled to test again, if the results are still positive, they are asked to do biochemical and hematological tests to evaluate liver function. Patients also need to do molecular biology tests such as HBV-DNA, HBV genotyping. The quantification of HBsAg, Anti-HBs (HBsAb), HBeAg, Anti-HBe (HBeAb), Anti-HBc, Anti-HBcIgM. HBsAg quantification for treatment monitoring. Anti-HBs testing may not be needed if HBsAg levels are high.
Next, the patient needs to do more tests for HBeAg and Anti-HBe to analyze the 4 possibilities of the virus developing in the body to accurately determine the stage of the disease and take timely treatment measures:
HBeAg (+) and Anti-HBe (-): Virus is replicating, hepatitis is progressing, spreading strongly. HBeAg (-) and Anti-HBe (+): Virus stops replicating, has partial immunity, the ability to spread is reduced. HBeAg (+) and Anti-HBe (+): Balanced antigens and antibodies or immune complexes. HBeAg (-) and Anti-HBe (-): Pre-C variant or window stage of seroconversion. Finally, Anti-HBc and Anti-HBc IgM tests are performed to determine whether patients with acute or chronic hepatitis.

Currently, Vinmec International General Hospital has packages of hepatobiliary screening performed by a team of highly qualified and experienced doctors in the field of hepatobiliary disease screening with the support of equipment, Modern medical facilities will help to accurately identify liver related problems.
Hepatobiliary screening package helps customers:
Assess the liver's ability to work through liver enzyme tests; Evaluation of bile function; vascular nutrition; Early screening for liver cancer; Performing tests such as Total blood cell analysis, blood clotting ability, screening for hepatitis B, C; Assessment of hepatobiliary status through ultrasound images and diseases that have the potential to affect liver disease/exacerbation of liver disease; In-depth analysis of parameters to evaluate hepatobiliary function through laboratory and subclinical tests; the risk of affecting the liver and early screening for hepatobiliary cancer. Specialist Doctor I Vo Thi Thuy Trang is trained in gastroenterology, hepatobiliary tract and gastrointestinal endoscopy; continuously updated and received advanced endoscopic training from professors and endoscopy experts from Switzerland and Japan; participated in many domestic and international gastroenterology and endoscopy conferences.
With nearly 20 years of working at Da Nang General Hospital in the field of gastrointestinal endoscopy - hepatobiliary disease, every year, Doctor Vo Thi Thuy Trang participates in endoscopy more than 1500 cases including: endoscopic diagnosis of diseases stomach, colon such as: detecting inflammation, ulcers, polyps, cancer, finding HP bacteria, detecting cancer early in the digestive tract...; Endoscopic treatment such as: Hemostasis in gastrointestinal bleeding, esophageal varices ligation in cirrhosis, endoscopic gastrointestinal polypectomy...

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