Some people live with hepatitis B for many years without knowing it. Unfortunately, they may only become aware of their hepatitis B when they develop serious liver problems. When people know their hepatitis B status they are able to make lifestyle choices to enhance their health. This may enable them to protect their liver and prevent serious liver damage and also prevent further transmission of the hepatitis B virus to others. In some cases, a diagnosis of hepatitis B will explain why a person has been feeling ill or fatigued, or why certain foods or alcohol may make them feel unwell.
People should consider being tested if they * :
- Have ever shared injecting drug equipment (sharing any equipment involved in injecting drug use carries a risk of hepatitis B transmission).
- Have received blood products or transfusion prior to July 1971 in Australia (blood screening for the hepatitis B virus began in 1971).
- Have received blood transfusions or blood products overseas.
- Have had a needle stick or other sharps injury.
- Are a healthcare worker who has engaged in exposure prone procedures.
- Have abnormal liver function tests.
- Have had renal dialysis.
- Have had unprotected sex (ie. didn’t use condoms, dams or gloves and water-based lubricant).
- Have experienced violence involving blood (which may include sexual assault and rape).
- Lived in the same household as someone with hepatitis B.
- Have a mother who had hepatitis B during her pregnancy or around the time of the birth.
- Have ever travelled to countries with a high prevalence of hepatitis B (eg Africa; SE Asia).
*NOTE: a vaccine is available for hepatitis B and is effective for most people. For immunisations, see you GP.
Preparing for Testing
Receiving as much information as possible about hepatitis B before getting tested may reduce any anxiety or fear about the process and the results. Talking with a GP or the Support Officer at HepatitisWA can be helpful and may allay any fears or anxiety a person may have.
Informed Consent
Doctors must obtain a person’s consent before taking a blood test for hepatitis B. It is a doctor’s responsibility to explain the test in terms people can understand. A doctor should explain the purpose of the test; the possible implications of a positive or negative result, and follow-up care and support options. This is referred to as pre and post-test discussion(s) and provides an opportunity for a patient and their doctor to discuss the behaviours and circumstances that present a risk of hepatitis B transmission. It is up to each individual to decide whether or not they wish to be tested and whether they feel they can deal with a diagnosis of hepatitis B.
Testing for hepatitis B is often included in a sexual health screening. If a doctor is recommending a full sexual health check-up or a person is requesting one it is important to ask exactly what tests are being done and why.
Antibody Testing for Hepatitis B
Testing for hepatitis B requires a blood sample to be taken. The sample is then tested for hepatitis B antigens (foreign substances in the body such as viruses) and antibodies (proteins made by the immune system in response to the presence of antigens). Hepatitis B antibodies, produced by the immune system, may take from six weeks to six months from the time of infection to be present in high enough levels in the blood to be detected. This is known as the ‘window period’ and, during this time, it is possible for people who have been infected with hepatitis B virus to have a negative test result. People who clear the virus, either naturally or through treatment, will continue to carry antibodies. The doctor will advise if further testing needs to be carried out.
Test Results
Hepatitis B infection is complex and there are a number of tests that may need to be carried out. The results of these tests can indicate an acute (recent) infection, past resolved infection (immunity) or current chronic (long term) infection. Further tests in chronic HBV infection can indicate whether the virus is actively replicating (active infection) or is in an inactive phase (replicating at a much lower rate). All test results and an explanation of their meaning should be given by the doctor in person, not over the phone.
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TEST
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ABBREVIATION
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WHAT IT MEANS
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Hepatitis B surface antigen
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HBsAg
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A positive result indicates current infection
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Anti-hepatitis B core antigen
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Anti-HBc
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An antibody to the hepatitis B core antigen. The core antigen disappears early in the course of infection. Anti-HBc may indicate acute, chronic or past infection. It does not indicate immunity
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Hepatitis B e-antigen
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HBeAg
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Indicates the presence of virus than can be passed to others. Not all strains of hepatitis B produce e-antigen
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Hepatitis Be antibody
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HBeAb or
Anti-HBe
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Shows that the virus is not actively replicating
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Hepatitis B surface antibody
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HBsAb or
Anti-HBs
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Indicates immunity either through natural clearance of the virus or through vaccination |
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Hepatitis B virus DNA
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HBV DNA
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Measures the amount of virus in the bloodstream and is an indicator of how actively the virus is replicating |
Notification of Results
Hepatitis B is one of the many communicable or infectious diseases notified to the Department of Health of Western Australia. This information allows the Department to allocate future health care resources for affected people in WA and to plan prevention strategies to reduce spread of the virus in the future.
If a person tests positive for hepatitis B, the doctor and the laboratory are required by law to inform the Department of Health. While some personal details will be provided when a notification is made, the law requires that the Department of Health ensures all personal details remain confidential.
Receiving Results
It may take seven to 14 days for the test results to be returned from a laboratory. All test results should be provided by the doctor in person and not over the telephone.
In the case of a confirmed positive result, the doctor should provide basic information about hepatitis B including how the virus affects the body, preventing transmission to others, the long term impact, available treatments, healthy lifestyle information (eg reducing alcohol consumption), and information around disclosure, rights and confidentiality. The doctor may also discuss follow-up care and referral to a liver clinic or liver specialist.
In the case of a negative result, the doctor should take the opportunity for further discussion around transmission and prevention of hepatitis B and to discuss the option of vaccination. Because of the window period, the doctor may recommend further testing at a later date to ensure that infection has not occurred.
Monitoring
- Liver Function Tests
These tests measure the level of enzymes normally produced by the liver and circulating in the blood in low levels. When the enzymes are found in the blood in higher levels it indicates that inflammation of the liver is present and damage may be occurring. Most commonly, a doctor will monitor liver health by testing alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels along with tests relating to clotting times, iron levels and cancer markers (depending on the duration) of infection and other indicators of liver health.
- Liver Biopsy
This involves using a fine needle to remove a very small piece of the liver for microscopic examination for inflammation or liver damage.
- alpha-fetoprotein
Alpha-fetoprotein is a test which can sometimes detect liver cancer.
Privacy and Confidentiality
Most professions are guided by a code of ethics that include protocols for preserving confidentiality. This means that health professionals like doctors and others (such as staff in doctors rooms and testing laboratories) are required to keep a patient’s personal information private. Workers who disregard this can be held answerable to the relevant professional body.
Research suggests that most people do not complain about breaches of confidence by professionals. It is in a patient’s and the profession’s interest that legitimate complaints are made and investigated. Otherwise nothing changes. In rare instances professionals may have a duty to disclose or make known information to an appropriate third party if serious danger to another person is likely.
Support
It can take time to adjust to receiving a positive diagnosis for hepatitis B. Some people will manage this adjustment better than others. For information about hepatitis B, support in dealing with a diagnosis, or the diagnosis of a partner or family member, and treatment options, contact HepatitisWA on (08) 9328 8538 or 1800 800 070 (free call for country callers) and ask to speak to the Support Officer. Support may be provided over the telephone or face-to-face at HepatitisWA.
A free coffee morning for people living with or affected by hepatitis is held on the third Tuesday of each month at:
HepatitisWA
187 Beaufort Street
NORTHBRIDGE
