Hepatitis B virus (HBV) (Guidelines)

HBV serology

• Hepatitis B surface antigen (HBsAg)
  A positive surface antigen suggests active disease
• Hepatitis B surface antibody (HBsAb/anti-HBs)
  A positive surface antibody suggests development of immune response either through vaccination or active hepatitis B infection
• Hepatitis B core antibody (HBcAb/anti-HBc)
  This suggests exposure to the Hepatitis B virus, but not necessarily active infection.
• Hepatitis B DNA PCR (HBV DNA)
  A positive result suggests active Hepatitis B disease and it can be used to assess need for antiviral treatment and to monitor response to therapy

HBV screening requests

• Hepatitis B surface antigen (HbsAg) testing is performed as the initial screening test for current HBV infection (brown capped gel tube).
• The laboratory will reflexively test for HBcAb IgM / IgG and HbsAb on those who are HbsAg positive and send the sample to the West of Scotland Virology laboratory in Glasgow for HBV DNA and HBV markers.

Who to refer:

• Refer all those with a confirmed HBsAg positive (detectable) result
• Pregnant women who are HbsAg positive should be referred for urgent assessment.

Please obtain: Confirmatory sample, PLUS:

• HBV DNA (7.5mL EDTA to virology)
• HIV
• HCV
• Coagulation
• AFP
• And a full liver screen
• And refer to the Viral Hepatitis service.

HBsAg negative, anti-HBc positive serology: 

• indicates past infection and ongoing follow up is usually NOT required.
• These individuals may be at risk of HBV reactivation if undergoing immunosuppression and will require increased monitoring or prophylactic antiviral therapy (see GG&C guidelines on hepatitis B reactivation in further resources).

How to refer:

• Directly to nhsh.viralhepatitisnurses@nhs.scot or to Gastroenterology via SCI gateway FAO of the Viral Hepatitis team

• HBV drug interaction checker
• GGC Hepatitis B reactivation guideline https://rightdecisions.scot.nhs.uk/ggc-clinical-guidelines/adult-infection-management/blood-borne-viruses/hepatitis-b-reactivation-891/
• EASL HBV guidelines.pdf
• Hepatitis B - British Liver Trust
• NHS Highland Viral Hepatitis (Hepatitis B)

• AFP: alpha-fetoprotein
• EDTA: ethylenediaminetetraacetic acid
• HBV: Hepatitis B virus
• HBsAg: Hepatitis B surface antigen 
• HBcAb/anti-HBs: Hepatitis B surface antibody
• HBcAb/anti-HBc: Hepatitis B core antibody
• HCV: Hepatitis C virus
• HIV: human immunodeficiency virus
• RNA: ribonucleic acid