Investigation

The appropriate investigations for hepatitis B depend on an understanding of the virus itself, how illness occurs and the natural history of the infection. It is best when medical scientist or practitioners look for signs of liver damage, yellowing of the skin or stomach pain. Thus it is important that tests can help investigate or diagnose hepatitis B in the human body.

The type of tests that can help diagnose hepatitis B includes:

• Hepatitis B Blood Tests

Hepatitis B blood tests can help a doctor detect signs of hepatitis B virus in the body; and it could also help to inform if it is an acute or chronic hepatitis B. No matter how simple the blood test can be, it also helps to determine whether an individual is immune to the condition or not.

A sample of blood is only needed for the hepatitis B test, but this test includes three parts.

1. HBsAg(Hepatitis B surface antigen) - A "positive" or "reactive" HBsAg test result means that the person is infected with hepatitis B. This test can detect the actual 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 HBsAg test result means that one is infected and can spread the hepatitis B virus to others through the blood.
2. Anti-HBs or HBsAb(Hepatitis B surface antibody) - 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 means an individual is “immune” and protected against the hepatitis B virus and cannot be infected or spread the virus to another person.
3. Anti-HBc or HBcAb(Hepatitis B core antibody) - A "positive" or "reactive" anti-HBc (or HBcAb) test result indicates a past or current hepatitis B infection. 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 may require the person speaks to his/her medical doctor for further explanation.

• Liver Ultrasound and Biopsy

A special ultrasound called Transient Elastography can show the amount of liver damage. Doctors could also choose to remove small sample of the liver for testing i.e. biopsy. The test is done by inserting a thin needle through the skin, so as to remove the tissue sample required for the test.

Since the Hepatitis B virus specifically attacks the liver, it is important to health workers and medical doctors to monitor the liver condition of their patients. Some of the most common liver related blood tests are:

1. ALT(Alanine Aminotransferase): This is found almost exclusively in the liver and is monitored most closely in a chronic hepatitis B infection. This test is useful in deciding whether a patient would benefit from treatment or for evaluating how well a person is responding to therapy. The upper limits of normal for ALT in healthy adults is 35 U/L for men and 25 U/L for women.
2. AST(Aspartate Aminotransferase): This is found in the liver, heart and muscle, therefore making it less accurate than the ALT in measuring liver damage. But it is often used to help monitor potential liver damage from the hepatitis B virus.
3. AFP(Alpha-FetoProtein): This is a normal protein produced in the developing fetus, thus, pregnant women will have elevated AFP. Other adults, however, should not have elevated AFP in their blood. This test is used to screen for primary liver cancer patients with chronic hepatitis B. Patients should have their AFP levels monitored at every time since hepatitis B is the leading cause of liver cancer. Whenever the AFP level is high, doctors often advice for more blood tests to be conducted.
4. Ferritin: Ferritin is iron stored in the liver. Whenever there is an increased level of Ferritin, it indicates that a high level of iron is being stored. This could result from an increased iron intake in the diet (vitamin supplements, food cooked in iron pots, etc.). For people living with chronic hepatitis B, a high level can indicate liver damage since Ferritin is leaked into the bloodstream as liver cells are injured by the virus.

Treatment

There is no specific treatment, cure, or medication for an acute HBV infection. Supportive care will depend on the symptoms. Whenever an individual has been exposed to hepatitis B virus or aren’t sure if they have been vaccinated against it, it is important to visit a doctor and get an antibody injection (Immunoglobin) which could help protect such person from getting sick with hepatitis B. And because this antibody injection is for short term protection, it is advised that one get the hepatitis B vaccine at the same time.

People with acute hepatitis B do not require treatment. Rest, drinking lots of fluids and maintaining adequate nutrition are usually all that is needed to manage acute hepatitis B symptoms. In severe cases, hospitalization may be necessary, but this is rare.

Chronic hepatitis B is not curable, but it is treatable, therefore most people diagnosed with chronic hepatitis B needs treatment for the rest of their lives. The lifetime treatment is needed so as to reduce the risk of complications, including premature death. Treatment can help to prevent cirrhosis, liver failure and liver cancer by reducing hepatitis B viral load and the loss of HBeAg (either with or without detection of anti-HBe) while improving liver enzyme levels.

Treatment for chronic hepatitis B may include:

• Antiviral Medications: Several antiviral medications — including entecavir (Baraclude), tenofovir (Viread), lamivudine (Epivir), adefovir (Hepsera) and telbivudine (Tyzeka) — can help fight the virus and slow its ability to damage the liver.
• Interferon injections: Interferon alfa-2b (Intron A) is a man-made version of a substance produced by the body to fight infection. It's used mainly for young people with hepatitis B who wish to avoid long-term treatment or women who might want to get pregnant within a few years, after completing a finite course of therapy. Interferon should not be used during pregnancy. It side effects may include nausea, vomiting, difficulty breathing and depression.
• Liver Transplant: When the liver has been severely damaged, a liver transplant may be an option. During a liver transplant, the surgeon removes the damaged liver and replaces it with a healthy liver. Most transplanted livers come from deceased donors, though a small number come from living donors who donate a portion of their liver.

[Next Week: Prevention of HBV Infection]