Assessment of hepatitis B and referral criteria from primary care

Assessment and referral

The following tests should be arranged in primary care for adults who are hepatitis B surface antigen (HBsAg) positive:

• hepatitis B e antigen (HBeAg)/antibody (anti-HBe) status
• HBV DNA level
• lgM antibody to hepatitis B core antigen (anti-HBc lgM)
• hepatitis C virus antibody (anti-HCV)
• hepatitis delta virus antibody (anti-HDV)
• HIV antibody (anti-HIV)
• lgG antibody to hepatitis A virus (anti-HAV)
• additional laboratory tests including alanine aminotransferase (ALT) or aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), serum albumin, total bilirubin, total globulins, full blood count and prothrombin time
• tests for hepatocellular carcinoma (HCC), including hepatic ultrasound and alphafetoprotein testing.

Include the results of the initial tests with the referral

Refer all adults who are HBsAg positive to a hepatologist or to a gastroenterologist or infectious disease specialist with an interest in hepatology

Pregnant women who test HBsAg positive at antenatal screening

• refer pregnant women who are HBsAg positive to a hepatologist, or to a gastroenterologist or infectious disease specialist with an interest in hepatology, for assessment within 6 weeks of receiving the screening test result and to allow treatment in the third trimester

Adults with decompensated liver disease

• Refer adults who develop decompensated liver disease immediately to a hepatologist or to a gastroenterologist with an interest in hepatology. Symptoms of decompensated liver disease include (but are not limited to) ascites, encephalopathy and gastrointestinal haemorrhage

Refer all children and young people who are HBsAg positive to a paediatric hepatologist or to a gastroenterologist or infectious disease specialist with an interest in hepatology

Reference:

• 1) NICE (October 2017). Hepatitis B (chronic) Diagnosis and management of chronic hepatitis B in children, young people and adults