Hepatitis B diagnostic criteria: Difference between revisions

	Hepatitis Main Page
	Hepatitis B
Home
Patient Information
Overview
Historical Perspective
Pathophysiology
Causes
Differentiating Hepatitis B from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
CT
MRI
Ultrasound
Treatment
Medical Therapy
Surgery
Primary Prevention
Hepatitis B Vaccination;
Hepatitis B Vertical transmission;
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Hepatitis B diagnostic criteria On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Hepatitis B diagnostic criteria All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Hepatitis B diagnostic criteria
CDC on Hepatitis B diagnostic criteria
Hepatitis B diagnostic criteria in the news
Blogs on Hepatitis B diagnostic criteria
Directions to Hospitals Treating Hepatitis B
Risk calculators and risk factors for Hepatitis B diagnostic criteria

VisualWikitext

Revision as of 15:00, 6 August 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

Diagnosis of hepatitis is made by biochemical assessment of liver function. Diagnosis is confirmed by demonstration in sera of specific antigens and/or antibodies. Three clinical useful antigen-antibody systems have been identified for hepatitis B, such as: 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).^[1]

Diagnostic Criteria

Hepatitis B viral antigens and antibodies detectable in the blood following acute infection.

Hepatitis B viral antigens and antibodies detectable in the blood of a chronically infected person

Diagnosis is confirmed by demonstration in sera of specific antigens and/or antibodies. Three clinical 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)


Antigens	Description
HBsAg	Hepatitis B surface antigen is the earliest indicator of acute infection and is also indicative of chronic infection if its presence persists for more than 6 months. It is useful for the diagnosis of HBV infection and for screening of blood. Its specific antibody is anti-HBs. HBsAg indicates that the person is potentially infectious.
HBcAg	Hepatitis B core antigen is derived from the protein envelope that encloses the viral DNA, and it is not detectable in the bloodstream. When HBcAg peptides are expressed on the surface of hepatocytes, they induce an immune response that is crucial for killing infected cells. The HBcAg is a marker of the infectious viral material and it is the most accurate index of viral replication. Its specific antibody is anti-HBc.
HBeAg	Hepatitis B e antigen appearing during weeks 3 to 6 indicates an acute active infection at its most infectious period, and means that the patient is infectious. Persistence of this virological marker beyond 10 weeks shows progression to chronic infection and infectiousness. Continuous presence of anti-HBe indicates chronic or chronic active liver disease. HBeAg is not incorporated into virions, but is instead secreted into the serum. Mutant strains of HBV exist that replicate without producing HBeAg. HBeAg’s function is uncertain. Its specific antibody is anti-HBe.
HBxAg	Hepatitis B x antigen is detected in HBeAg positive blood in patients with both acute and chronic hepatitis. HBxAg is a transcriptional activator. It does not bind to DNA. Its specific antibody is anti-HBx.
HBV DNA	HBV DNA is detectable by PCR as soon as 1 week after initial infection, but the test is generally only performed for research purposes or to detect mutants that escape detection by current methods.
HBV DNA Polymerase	Tests for the presence of HBV DNA polymerase, detectable within 1 week of initial infection, are only performed for research purposes.


Antibodies	Description
Anti-HBs	This is the specific antibody to hepatitis B surface antigen. Its appearance 1 to 4 months after onset of symptoms indicates clinical recovery and subsequent immunity to HBV. Anti-HBs can neutralize HBV and provide protection against HBV infection.
Anti-HBc	This is the specific antibody to hepatitis B core antigen. Antibodies to HBc are of class IgM and IgG. They do not neutralize the virus. The presence of IgM identifies an early acute infection. In the absence of HBsAg and anti-HBs, it shows recent infection. IgG with no IgM may be present in chronic and resolved infections. Anti-HBc testing identifies all previously infected persons, including HBV carriers, but does not differentiate carriers and non-carriers.
Anti-HBe	This is the specific antibody to hepatitis B e antigen. During the acute stage of infection the seroconversion from e antigen to e antibody is prognostic for resolution of infection. Its presence in the patient’s blood along with anti-HBc and in the absence of HBsAg and anti-HBs indicates low contagiousness and convalescence.
Anti-HBx	This is the specific antibody to hepatitis B x antigen. It appears when other virological markers are becoming undetectable.

The tests, called 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.^[2]

Hepatitis B assay results Adapted from *World Health Organization*^[3]

References

↑ "Hepatitis B".
↑ Bonino F, Chiaberge E, Maran E, Piantino P (1987). "Serological markers of HBV infectivity". Ann. Ist. Super. Sanita. 24 (2): 217–23. PMID 3331068.
↑ "http://www.who.int/en/". External link in |title= (help)

Template:STD/STI

Template:WH Template:WS

[WHO1-1] "Hepatitis B".

[pmid3331068-2] Bonino F, Chiaberge E, Maran E, Piantino P (1987). "Serological markers of HBV infectivity". Ann. Ist. Super. Sanita. 24 (2): 217–23. PMID 3331068.

[3] "http://www.who.int/en/". External link in |title= (help)

[1]

[2]

[3]

@@ Line 9: / Line 9: @@
 [[Image:HBV serum markers.png|left|thumb|400px|Hepatitis B viral antigens and antibodies detectable in the blood following acute infection.]]
 [[Image:Chronic HBV v2.png|left|thumb|400px|Hepatitis B viral antigens and antibodies detectable in the blood of a chronically infected person]]
-The hepatitis B surface antigen (''HBsAg'') is most frequently used to screen for the presence of this infection. It is the first detectable viral antigen to appear during infection. However, early in an infection, this antigen may not be present and it may be undetectable later in the infection as it is being cleared by the host. The infectious virion contains an inner "core particle" enclosing viral genome. The icosahedral core particle is made of 180 or 240 copies of core protein, alternatively known as hepatitis B core antigen, or ''HBcAg''. During this 'window' in which the host remains infected but is successfully clearing the virus, [[IgM]] antibodies to the hepatitis B core antigen (''anti-HBc IgM'') may be the only serological evidence of disease.
-Shortly after the appearance of the HBsAg, another antigen named as the hepatitis B e antigen (''HBeAg'') will appear. Traditionally, the presence of HBeAg in a host's serum is associated with much higher rates of viral replication and enhanced infectivity; however, variants of the hepatitis B virus do not produce the 'e' antigen, so this rule does not always hold true. During the natural course of an infection, the HBeAg may be cleared, and antibodies to the 'e' antigen (''anti-HBe'') will arise immediately afterwards. This conversion is usually associated with a dramatic decline in viral replication.
+[[Diagnosis]] is confirmed by demonstration in [[serum|sera]] of specific [[antigens]] and/or [[antibodies]]. Three clinical useful antigen-antibody systems have been identified for [[hepatitis B]]:
+*[[HBsAg|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)
-If the host is able to clear the infection, eventually the HBsAg will become undetectable and will be followed by [[IgG]] antibodies to the hepatitis B surface antigen and core antigen, (''anti-HBs'' and ''anti HBc IgG'').<ref name=Baron />  A person negative for HBsAg but positive for anti-HBs has either cleared an infection or has been vaccinated previously.
+{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
+|+
-Individuals who remain HBsAg positive for at least six months are considered to be hepatitis B carriers.<ref name="pmid17256718">{{cite journal |author=Lok AS, McMahon BJ |title=Chronic hepatitis B |journal=Hepatology |volume=45 |issue=2 |pages=507–39 |year=2007 |pmid=17256718 |doi=10.1002/hep.21513}}</ref>  Carriers of the virus may have chronic hepatitis B, which would be reflected by elevated serum [[alanine aminotransferase]] levels and inflammation of the liver, as revealed by biopsy. Carriers who have seroconverted to HBeAg negative status, particularly those who acquired the infection as adults, have very little viral multiplication and hence may be at little risk of long-term complications or of transmitting infection to others.<ref name="pmid17935720">{{cite journal |author=Chu CM, Liaw YF |title=Predictive factors for reactivation of hepatitis B following hepatitis B e antigen seroconversion in chronic hepatitis B |journal=Gastroenterology |volume=133 |issue=5 |pages=1458–65 |year=2007 |pmid=17935720 |doi=10.1053/j.gastro.2007.08.039}}</ref>
+! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Antigens}}
+! style="background: #4479BA; width: 500px;" | {{fontcolor|#FFF|Description}}
-More recently, [[PCR]] tests have been developed to detect and measure the amount of viral nucleic acid in clinical specimens. These tests are called [[viral load]]s and are used to assess a person's infection status and to monitor treatment.<ref name="pmid17051445">{{cite journal |author=Zoulim F |title=New nucleic acid diagnostic tests in viral hepatitis |journal=Semin. Liver Dis. |volume=26 |issue=4 |pages=309–17 |year=2006 |pmid=17051445 |doi=10.1055/s-2006-951602}}</ref>
+|-
-The three standard blood tests for hepatitis B can determine if a person is currently infected with [[HBV]], has recovered, is a chronic carrier, or is susceptible to [[HBV infection]]:<ref name=WHO1>{{cite web | title = Hepatitis B | url = http://www.who.int/csr/disease/hepatitis/whocdscsrlyo20022/en/index3.html }}</ref>
+| style="padding: 5px 5px; background: #DCDCDC;" | '''[[HBsAg]]'''
+| style="padding: 5px 5px; background: #F5F5F5;" | Hepatitis B surface antigen is the earliest indicator of acute infection and is also indicative of chronic [[infection]] if its presence persists for more than 6 months. It is useful for the diagnosis of [[HBV]] infection and for [[screening]] of blood. Its specific [[antibody]] is anti-HBs. [[HBsAg]] indicates that the person is potentially [[infectious]].
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" | '''HBcAg'''
+| style="padding: 5px 5px; background: #F5F5F5;" |Hepatitis B core antigen is derived from the protein envelope that encloses the [[viral]] DNA, and it is not detectable in the [[bloodstream]]. When HBcAg peptides are expressed on the surface of [[hepatocytes]], they induce an [[immune]] response that is crucial for killing infected cells. The HBcAg is a marker of the infectious viral material and it is the most accurate index of [[viral replication]]. Its specific [[antibody]] is anti-HBc.
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" | '''HBeAg'''
+| style="padding: 5px 5px; background: #F5F5F5;" |Hepatitis B e antigen appearing during weeks 3 to 6 indicates an acute active infection at its most [[infectious]] period, and means that the patient is [[infectious]]. Persistence of this virological marker beyond 10 weeks shows progression to chronic infection and infectiousness. Continuous presence of anti-HBe indicates chronic or chronic active liver disease. HBeAg is not incorporated into [[virions]], but is instead secreted into the [[serum]]. Mutant strains of HBV exist that replicate without producing HBeAg. HBeAg’s function is uncertain. Its specific [[antibody]] is anti-HBe.
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" | '''HBxAg'''
+| style="padding: 5px 5px; background: #F5F5F5;" |Hepatitis B x antigen is detected in HBeAg positive blood in patients with both acute and chronic hepatitis. HBxAg is a transcriptional activator. It does not bind to [[DNA]]. Its specific [[antibody]] is anti-HBx.
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" | '''HBV DNA'''
+| style="padding: 5px 5px; background: #F5F5F5;" |HBV DNA is detectable by PCR as soon as 1 week after initial infection, but the test is generally only performed for research purposes or to detect mutants that escape detection by current methods.
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" | '''HBV DNA Polymerase'''
+| style="padding: 5px 5px; background: #F5F5F5;" |Tests for the presence of [[HBV]] [[DNA polymerase]], detectable within 1 week of initial infection, are only performed for research purposes.
+|-
+|}
+{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
+|+
+! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Antibodies}}
+! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Description}}
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Anti-HBs]]'''
+| style="padding: 5px 5px; background: #F5F5F5;" | This is the specific [[antibody]] to hepatitis B surface antigen. Its appearance 1 to 4 months after onset of [[symptoms]] indicates clinical recovery and subsequent immunity to HBV. Anti-HBs can neutralize HBV and provide protection against HBV infection.
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" | '''Anti-HBc'''
+| style="padding: 5px 5px; background: #F5F5F5;" |This is the specific [[antibody]] to hepatitis B core antigen. [[Antibodies]] to HBc are of class IgM and IgG. They do not neutralize the [[virus]]. The presence of [[IgM]] identifies an early acute [[infection]]. In the absence of [[HBsAg]] and anti-HBs, it shows recent [[infection]]. IgG with no IgM may be present in chronic and resolved infections. Anti-HBc testing identifies all previously infected persons, including [[HBV]] carriers, but does not differentiate carriers and non-carriers.
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" | '''Anti-HBe'''
+| style="padding: 5px 5px; background: #F5F5F5;" |This is the specific [[antibody]] to hepatitis B e antigen. During the acute stage of infection the [[seroconversion]] from e antigen to e antibody is [[prognostic]] for resolution of [[infection]]. Its presence in the patient’s blood along with anti-HBc and in the absence of HBsAg and anti-HBs indicates low contagiousness and convalescence.
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" | '''Anti-HBx'''
+| style="padding: 5px 5px; background: #F5F5F5;" |This is the specific [[antibody]] to hepatitis B x antigen. It appears when other [[virus|virological]] markers are becoming undetectable.
+|}
 The tests, called [[assay]]s, for detection of hepatitis B virus infection involve [[blood plasma|serum]] or [[blood test]]s that detect either viral antigens (proteins produced by the virus) or [[antibody|antibodies]] produced by the host. Interpretation of these assays is complex.<ref name="pmid3331068">{{cite journal |author=Bonino F, Chiaberge E, Maran E, Piantino P |title=Serological markers of HBV infectivity |journal=Ann. Ist. Super. Sanita |volume=24 |issue=2 |pages=217–23 |year=1987 |pmid=3331068 |doi=}}</ref>
 [[File:HepB Assay Results.jpg|thumb|center|700px|Hepatitis B assay results <SMALL> Adapted from ''[http://www.who.int/en/ World Health Organization]''<ref>{{Cite web | title = http://www.who.int/en/ | url = http://www.who.int/en/}}</ref></SMALL>]]

Hepatitis B diagnostic criteria: Difference between revisions

Revision as of 15:00, 6 August 2015

Overview

Diagnostic Criteria

References

Navigation menu