Hepatitis B: Test and Diagnosis

1st order laboratory parameters – obligatory laboratory tests.

  • Serology – detection of hepatitis B-specific antigens* .
    • Hepatitis B surface antigen (HBsAg) [becomes positive before the onset of clinical symptoms].
    • Hepatitis B core antigen (HBcAg).
    • Hepatitis B e antigen (HBeAg)
    • IgM and IgG antibodies (anti-HBs, anti-HBc, anti-HBe).
      • Anti-HBc ELISA (parameter for a fresh or chronic, possibly also healed infection; detection ≥ 1 week later than HBs antigen detection) Note: Anti-HBc ELISA is not positive after vaccination!
      • Anti-HBc IgM ELISA (parameter for an acute infection; detection often possible before the appearance of HBs-Ag; persistence: up to 12 months).
  • If necessary, detection of hepatitis B PCR (HBV DNA or HBV PCR) – marker of infectivity (contagiousness).
  • Liver parameters – alanine aminotransferase (ALT, GPT), aspartate aminotransferase (AST, GOT), glutamate dehydrogenase (GLDH), and gamma-glutamyl transferase (γ-GT, gamma-GT; GGT) [ALT > AST].

* In accordance with the Protection Against Infection Act, suspected illness, illness, and death from acute viral hepatitis must be reported by name.Testing for HDV should be performed in all persons who have newly diagnosed HBV infection; this should also be followed up in those with known HBV and untested HDV.

Stepwise Diagnostics

Suspicion of positive negative
Late incubation phase HBs antigen1, HBV DNA Anti-HBs
Acute infection HBs antigen1 + anti-HBc Anti-HBs
HBe antigen2, anti-HBc IgM, if applicable.
Chronic inactive hepatitisSeroconversion of HBe antigen to anti-HBe. HBs antigen (positive for longer than 6 months), anti-HBe, anti-HBc IgG, HBe antigen2, anti-HBs.
HBV DNA (few copies), if necessary.
Chronically active hepatitisMissing seroconversion! HBs antigen (positive for longer than 6 months), HBe antigen2, anti-HBc IgG, HBV DNA. anti-HB, anti-HBs
Infection with healing Anti-HBs3 (usually persists for life), anti-Hbc IgG4. HBs antigen, HBe antigen
Infectivity (contagiousness) HBe antigen2 or HBV DNA Anti-HBe5
Vaccination (see below) Anti-HBs3 Anti-HBc IgG

Legend

  • 1 Routine marker of a fresh infection.
  • 2 markers of viral replication (positive during acute and chronic active infection).
  • 3 markers for healing and vaccination (see below).
  • 4 markers for infection taken place (“seroscar”; lifelong persistence).
  • 5 Marker for declining viral load (transition to the nonreplicative phase; considered a prognostically favorable sign; positive after acute, cured infection for months to (at most) several years and in chronic infections without significant viral replication).

Serological parameters in hepatitis B infection

HBV DNA HBsAg Anti-HBs Anti-HBc Anti-HBc IgM Infection status
positive negative / positive negative negative negative Acute infection (very early stage)
positive positive negative positive positive acute infection
negative positive negative positive positive acute infection
negative / positive negative negative positive positive Acute infection (late stage)
negative / positive negative positive positive positive post-acute infection
negative negative positive positive negative Expired, immunologically controlled infection
negative / positive positive negative positive negative chronic infection
positive negative negative positive negative chronic infection (“occult” infection)
negative negative negative positive negative expired infection
negative negative positive negative negative Immunity after HBV vaccination

Overview of possible constellations of laboratory diagnostic results and their evaluation.

Vaccination status-checking vaccination titers

Vaccination Laboratory parameters Value Rating
Hepatitis-B Anti-HBs-ELISA ≤ 100 U/ml No sufficient vaccination protection → booster required
> 100 U/ml Sufficient vaccination protection

2nd order laboratory parameters – depending on the results of the medical history, physical examination, etc. – for differential diagnostic clarification

  • Antibodies against hepatitis virus A, C, D, E.
  • HIV test – hepatitis B is considered an indicator disease for HIV.
  • Bacteria
    • Borrelia
    • Brucella
    • Chlamydia
    • Gonococcus
    • Leptospires
    • Mycobaterium tuberculosis
    • Rickettsiae (e.g., Coxiella burnetii)
    • Salmonella shigella
    • Treponema pallidum (lues)
  • Helminths
    • Ascaris
    • Bilharzia (schistosomiasis)
    • Liver fluke
    • Trichinae
  • Protozoa
    • Amoebae
    • Leishmania (leishmaniasis)
    • Plasmodia (malaria)
    • Toxoplasmosis
  • Viruses
    • Adeno viruses
    • Coxsackie viruses
    • Cytomegalovirus (CMV)
    • Epstein-Barr virus (EBV)
    • Yellow fever virus
    • Herpes simplex virus (HSV)
    • Mumps virus
    • Rubella virus
    • Varicella zoster virus (VZV)
  • Autoimmune diagnostics: ANA, AMA, ASMA (anti-SMA = AAK against smooth muscle), anti-LKM, anti-LC-1, anti-SLA, anti-LSP, anti-LMA.
  • Gamma-glutamyl transferase (γ-GT, gamma-GT; GGT) – for suspected alcohol abuse.
  • Aspartate aminotransferase (AST, GOT), alanine aminotransferase (ALT, GPT) [↑ only in case of liver parenchyma damage].
  • Carbodeficient transferrin (CDT) [↑ in chronic alcoholism]* .
  • Transferrin saturation [suspected in men > 45%, pre-menopausal women > 35%] – in suspected hemochromatosis (iron storage disease).
  • Coeruloplasmin, total copper, free copper, copper in urine – if Wilson’s disease (copper storage disease) is suspected.