Hepatitis B Fact Sheet
B V
H
A Publication of the Hepatitis C Support Project
a series of fact sheets written by experts in the field of liver disease
Written by: Christine M. Kukka and Heather Lusk
HBV: Testing Positive for Hepatitis B, Now What?
T esting positive for hepatitis B can be scary, but there is information
that can help you manage your health and well-being, and there is
an online support group to help you understand this infection and the
Hepatitis B surface antigen
(HBsAg):
This antigen covers the virus.
available treatments. When you test positive for this, it
means you are currently infected.
Take the time to learn about hepatitis B to make the right decisions for If you test positive for surface an-
yourself. Don’t make any snap decisions. In fact, you shouldn’t make tibodies (HBsAb), it means your
any important decisions right away – you may still be in shock. There immune system has successfully
may be some days when you feel balanced and ready to take steps fought the infection. This antibody
towards a healthier life, and other days when you don’t want to deal with is also present if you have been
your hepatitis – this is normal. immunized against hepatitis B.
Hepatitis B “e” antigen (HBeAg):
You doctor should get your medical history, find out if there This antigen is often present when
the virus is reproducing rapidly.
is a family history of hepatitis B or liver disease and cancer,
and conduct a complete physical examination. If you have the “e” antibody (HBe-
Ab), it means that your immune
system has cleared this antigen,
This fact sheet explores what testing positive means, and what you can but you need surface antibodies
do about it. Don’t panic – the knowledge you now have will help you in order to completely clear or
vanquish the infection.
make healthy decisions. It’s important to educate yourself and to find a
doctor who is knowledgeable about hepatitis B.
Once you have been diagnosed,
your doctor should take the fol-
Your doctor probably ordered a lab test performed on your blood sam-
lowing steps in order to carefully
ple to see if you have any signs of a current or past hepatitis B virus
(HBV) infection. The lab test generally looks for two key antigens, or
proteins, that make up the virus:
[Link]
Hepatitis B Fact Sheet HBV Fact Series 2
Testing Positive for Hepatitis B
monitor your health and deter- Suggested follow-Ups checked every six to 12 months.
mine if you need treatment: Patients who don’t immediately re- • If ALT levels are slightly elevated
• Your doctor should get your quire treatment, who are HBeAg- to twice normal, the doctor should
medical history, find out if there positive, have HBV DNA levels check HBV DNA levels, and ex-
is a family history of hepatitis B of 20,000 international units/mL clude other causes of liver dis-
or liver disease and cancer, and (20,000 IU/mL) or less, and nor- ease. Consider a liver biopsy if
conduct a complete physical ex- mal ALTs: ALT remains borderline or mildly
amination. • Your ALT levels should be elevated on serial tests or if HBV
• Your doctor will order a blood checked every three to six months, DNA persistently is at or exceeds
sample and a laboratory will ana- and more often if ALT becomes 20,000 IU/mL. Your doctor should
lyze it for signs of liver damage elevated. consider treatment if a biopsy
by measuring ALT levels (which • If ALT levels are between twice shows moderate/severe inflam-
become elevated when liver cells and four-times normal, they should mation or significant fibrosis.
are damaged), complete blood be rechecked every one to three • And, your doctor should screen
counts with platelets, prothrom- months, and then a liver biopsy for liver cancer regularly.
bin time, and other liver-related should be considered if you are
tests. age 40 or older and your ALT con- These recommendations are
• The lab will also look for the an- tinues to be borderline or mildly based on the American Associa-
tigens that make up the hepati- elevated over a period of time. tion for the Study of Liver Diseas-
tis B virus, and also antibodies, Treatment should be considered es Practice Guidelines for Hepati-
which fight the antigens, to see if the biopsy reveals moderate to tis B, issued September 2009.
what stage of infection you are severe inflammation or significant
at. The lab will also look at HBV fibrosis. If your doctor does not test you
DNA (viral load), the viral par- • If your ALT levels are twice nor- as frequently as these guide-
ticles found in your blood. mal for three to six months, you lines recommend, you may want
are HBeAg-positive, and your to print out the AASLD practice
• The doctor may also test for
HBV DNA exceeds 20,000 IU/ guidelines for hepatitis B, found
other viruses that infect the liver,
mL, a liver biopsy and treatment a t : h t t p : / / w w w. h b v a d vo c a t e.
such as hepatitis C and D, and
should be considered. org/hepatitis/fac tsheets_pdf/
also HIV infection to make sure
AASLD%20HBV%20Practice%20
there is no coinfection occurring. • Liver cancer screening should
Guidelines%[Link], a n d
• In order to rule out liver cancer, also be considered.
present them to your physician.
doctors will also test your blood
for alpha fetoprotein (AFP), which Follow-up for patients who are
Disclosure: Telling others you
may become elevated when liver HBeAg-negative, have tested
positive for the “e” antibody, have have hepatitis B
tumors are present. Doctors may
normal ALT levels, and HBV DNA You may be wondering how to tell
also order an ultrasound of your
levels less than 2,000 IU/mL: others that you have tested posi-
liver. A liver biopsy, during which
tive for hepatitis B. First, you don’t
a small sliver of liver tissue is ex- • Have your ALT levels tested have to tell anyone until you are
tracted with a needle, may be every three months for one year, ready; however, it is important to
recommended depending on the if they remain persistently nor- tell your healthcare provider (who
liver test results. mal, ALT levels should then be will keep it confidential) because
[Link]
Hepatitis B Fact Sheet HBV Fact Series 3
Testing Positive for Hepatitis B
days. Even when blood is pres-
having hepatitis C may influence ent, there also has to be an open-
the medications and tests you Commonly Used Terms
ing for the blood to get into the
get. AFP (alpha fetoprotein): a pro-
other person’s body. HBV is also
tein, measurable in the blood,
transmitted from a mother to her that is often (but not always)
There are two main reasons to tell baby during pregnancy or birth. elevated in people with liver
others: You cannot transmit HBV through cancer.
• To get support for yourself hugging, kissing, sharing eating
or drinking utensils, or sharing a ALT (alanine aminotransferase):
• Because you think they should
an enzyme released into the
get tested for hepatitis B. bathroom. It is very important that
bloodstream when mem-
family and household members branes of liver cells break
Think about whom you want to and sexual partners are immedi- down. ALT levels are usu-
tell, why you want to tell them, ately immunized against hepatitis ally (but not always) elevated
how you will tell them, and when B, and that you practice safer sex when there is inflammation or
and where you will tell them. to prevent transmitting the infec- damage in the liver.
tion.
HBV Antigens: substances
Make sure you have support by such as the hepatitis B virus
first telling someone who will be Getting support or different proteins of the vi-
there for you. If you have hepatitis B, you are not rus. There are three HBV an-
alone. There are approximately 2 tigens – surface antigen (HB-
Preventing transmission million others in the U.S. with HBV. sAg), “e” antigen (HBeAg)
and core antigen (HBcAg).
to others Some people like to join support
While it is important to take care of groups to learn more about HBV HBV Antibodies: substances
yourself, you may also have ques- and feel supported by others go- produced by the body when
tions about how to make sure you ing through some of the same ex- it encounters the hepatitis B
don’t transmit HBV to someone periences. Others like to talk with virus. There are three HBV
people on the Internet who also antibodies – surface anti-
else. HBV is transmitted through
have hepatitis B. Talk with people body (HBsAb), “e” antibody
direct blood contact – someone (HBeAb) and core antibody
else has to get your blood or who care about you. Ask them
(HBcAb).
body secretions directly into their for their support. You can join an
blood through sex or sharing a email hepatitis B support list at HBV DNA: the genetic blue-
needle, a razor, nail clippers, a [Link] print of the virus, also called
HBV viral load.
toothbrush, or anything that may
have your blood on it. HBV has
been found to survive outside the
body in dried blood for several
HCSP • VERSION 4 • December 2011
The information in this fact sheet is designed to help you understand and man- Executive Director,
age HBV and is not intended as medical advice. All persons with HBV should Editor-in-Chief, HCSP Publications
consult a medical practitioner for diagnosis and treatment of HBV. Alan Franciscus
For more information about hepatitis B, visit the following websites. Managing Editor / Webmaster
Hepatitis B Foundation: [Link] • [Link] C.D. Mazoff, PhD
This information is provided by the Hepatitis C Support Project a nonprofit organization for HCV education, support and advocacy.
Reprint permission is granted and encouraged with credit to the Hepatitis C Support Project. ©2011 Hepatitis C Support Project
[Link]
