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HelpTest ID: CHSBP Chronic Hepatitis B Monitoring Profile, Serum
Reporting Name
Chronic Hepatitis B Profile, SUseful For
Evaluating and monitoring individuals with known chronic hepatitis B
Monitoring hepatitis B viral infectivity after resolution of acute hepatitis B
Clinical Information
Hepatitis B virus (HBV) is a DNA virus that is endemic throughout the world. The infection is spread primarily through percutaneous contact with infected blood products (eg, blood transfusion and sharing of needles among injection drug users) and body fluids (eg, sexual contact). The virus is found in virtually every type of human body fluid and is known to be spread through oral and genital contact. HBV can be transmitted from mother to child during delivery through contact with blood and vaginal secretions; it is not commonly transmitted transplacentally.
After a course of acute illness, HBV persists in approximately 10% of exposed individuals (ie, chronic hepatitis B). Some of these carriers or chronically infected individuals remain asymptomatic, while others develop chronic liver disease, including cirrhosis and hepatocellular carcinoma.
Serum levels of both hepatitis B e antigen (HBeAg) and hepatitis B surface antigen rise rapidly during the period of viral replication. The presence of HBeAg in serum correlates with viral infectivity, the number of infectious virions, and the presence of HBV core antigen in the infected hepatocytes.
During recovery from acute hepatitis B, HBeAg level declines and becomes undetectable in the serum, while HBe antibody (anti-HBe) appears and becomes detectable in the serum. Anti-HBe usually remains detectable for many years after recovery from acute HBV infection.
In HBV carriers and patients with chronic hepatitis B, positive HBeAg results usually indicate presence of active HBV replication and high infectivity, while a negative HBeAg result indicates very minimal or no HBV replication. Positive anti-HBe results usually indicate inactivity of the virus and low infectivity, and such positive results in the presence of detectable HBV DNA in serum also indicate active viral replication in these patients.
Interpretation
Hepatitis B surface antigen (HBsAg) is the first serologic marker appearing in the serum 6 to 8 weeks following hepatitis B virus (HBV) infection. In acute cases, HBsAg usually disappears 1 to 2 months after the onset of symptoms. Persistence of HBsAg for more than 6 months indicates development of either chronic carrier state or chronic liver disease.
HBs antibody appears with the resolution of acute hepatitis B after the disappearance of HBsAg. Anti-HBs also appears as the immune response following a course of inoculation with the hepatitis B vaccine.
Hepatitis B core (HBc) IgM and total antibodies appears shortly after the onset of symptoms of HBV infection, and HBc total antibodies may be the only serologic marker remaining years after exposure to hepatitis B.
The presence of hepatitis B e antigen correlates with infectivity, the number of viral Dane particles, the presence of core antigen in the nucleus of the hepatocyte, and the presence of viral DNA polymerase in serum. HBe antibody-positivity in a carrier is often associated with chronic asymptomatic infection.
If the patient has a sudden exacerbation of disease, testing for anti-hepatitis C and anti-hepatitis D virus (HDV) total is recommended.
If HBsAg converts to negative and patient's condition warrants, consider testing for HBs antibody.
If HBsAg is confirmed positive, testing for anti-HDV total is recommended.
For more information see:
-Hepatitis B: Testing Algorithm for Screening, Diagnosis, and Management
Report Available
1 to 4 daysDay(s) Performed
Monday through Saturday
Clinical Reference
1. LeFevre ML, U.S. Preventive Services Task Force. Screening for hepatitis B virus infection in nonpregnant adolescents and adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;161(1):58-66. doi:10.7326/M14-1018
2. Jackson K, Locarnini S, Gish R. Diagnostics of hepatitis B virus: Standard of care and investigational. Clin Liver Dis. 2018;12(1):5-11. doi:10.1002/cld.729
3. Coffin CS, Zhou K, Terrault NA. New and old biomarkers for diagnosis and management of chronic hepatitis B virus infection. Gastroenterology. 2019;156(2):355-368. doi:10.1053/j.gastro.2018.11.037
4. WHO guidelines on hepatitis B and C testing. World Health Organization; 2017. Accessed December 19, 2023. Available at www.who.int/publications/i/item/9789241549981
5. Conners EE, Panagiotakopoulos L, Hofmeister MG, et al. Screening and testing for hepatitis B virus infection: CDC recommendations - United States, 2023. MMWR Recomm Rep. 2023;72(1):1-25. doi:10.15585/mmwr.rr7201a1
Method Name
Electrochemiluminescence Immunoassay (ECLIA)
Specimen Type
Serum SSTNecessary Information
1. Date of collection is required.
2. Indicate "Type B"
Specimen Required
Patient Preparation: For 24 hours before specimen collection, patient should not take multivitamins or dietary supplements (eg, hair, skin, and nail supplements) containing biotin (vitamin B7).
Supplies: Sarstedt Aliquot Tube, 5 mL (T914)
Collection Container/Tube: Serum gel (red-top tubes are not acceptable)
Submission Container/Tube: Plastic vial
Specimen Volume: 1.2 mL
Collection Instructions:
1. Centrifuge blood collection tube per manufacturer's instructions (eg, centrifuge and aliquot within 2 hours of collection for BD Vacutainer tubes).
2. Transfer serum into a plastic vial.
Specimen Minimum Volume
0.9 mL
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| Serum SST | Frozen (preferred) | 90 days |
| Refrigerated | 6 days | |
| Ambient | 72 hours |
Reference Values
HEPATITIS B SURFACE ANTIGEN:
Negative
HEPATITIS Be ANTIGEN:
Negative
HEPATITIS Be ANTIBODY:
Negative
Interpretation depends on clinical setting. See Viral Hepatitis Serologic Profiles.
Test Classification
This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.CPT Code Information
86707
87340
87350
87341 (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| CHSBP | Chronic Hepatitis B Profile, S | 95148-3 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| EAG | Hepatitis Be Ag, S | 13954-3 |
| HEAB | HBe Antibody, S | 33463-1 |
| H_BAG | HBs Antigen, S | 5196-1 |
Testing Algorithm
If the hepatitis B surface antigen (HBsAg) result is reactive, then HBsAg confirmation will be performed at an additional charge.
For more information see Hepatitis B: Testing Algorithm for Screening, Diagnosis, and Management
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| HBGNT | HBs Antigen Confirmation, S | No | No |
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| HBAG | HBs Antigen, S | Yes | Yes |
| EAG | Hepatitis Be Ag, S | Yes | Yes |
| HEAB | HBe Antibody, S | Yes | Yes |
Special Instructions
Forms
If not ordering electronically, complete, print, and send 1 of the following:
mml-hepatitis