Investigations

Diagnostic tests for acute HBV infection include:

• HBsAg
• anti-HBc lgM and anti-HBs
• HBV DNA
• ALT
• bilirubin
• INR (1)

Arrange the following tests in primary care for patients who are hepatitis B surface antigen (HBsAg) positive:

• hepatitis B e antigen (HBeAg)/antibody (anti-HBe) status
• HBV DNA level
• IgM 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
  • prothrombin time
• tests for hepatocellular carcinoma (HCC), including hepatic ultrasound and alpha-fetoprotein testing.

Investigations carried out in the secondary care include:

• transient elastography
• liver biopsy (2)

Reference:

1. World Gastroenterology Organization (WGO) 2015. World Gastroenterology Organisation Practice Guideline. Hepatitis B
2. NICE. Hepatitis B (chronic): diagnosis and management. Clinical guideline CG165. Published June 2013, last updated: 20 October 2017