About Hepatitis

Hepatitis B - Testing

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, and
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 your GP.

Preparing for Testing

Learning 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 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.

Hepatitis B testing is included in 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 six weeks to six months, from the time of initial infection, to be present in levels high enough to be detected. This is known as the ‘window period’ and during this time it is possible for someone who has been infected with hepatitis B virus to have a negative test result. The doctor will advise if further testing needs to be carried out.

Test Results

Hepatitis B infection is complex and a number of tests may need to be carried out. The results of these tests can indicate an acute (recent) infection, resolved infection (immunity) or chronic (long term) infection. Further tests in chronic hepatitis B infection can indicate whether the virus is actively replicating (active infection) or ‘inactive’ (replicating at a much lower rate). All test results and an explanation of their meaning should be provided by the doctor in person, not over the phone.

Test	Abbreviation	What it means
Hepatitis B surface antigen	HBsAg	A positive result indicates current infection
Anti-hepatitis B core antigen	Anti-HBc	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
Hepatitis B e-antigen	HBeAg	Indicates the presence of virus than can be passed to others. Not all strains of hepatitis B produce e-antigen
Hepatitis Be antibody	HBeAb or Anti-HBe	Shows that the virus is not actively replicating
Hepatitis B surface antibody	HBsAb or Anti-HBs	Indicates immunity either through natural clearance of the virus or through vaccination
Hepatitis B virus DNA	HBV DNA	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 many communicable or infectious diseases notified to the Department of Health WA. This information allows the Department to allocate future health care resources for affected people in WA and to plan prevention strategies to reduce the 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 at that time, the law requires that the Department of Health ensures all personal details remain confidential.

Receiving Results

It may take up 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, 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 regarding disclosure, rights and confidentiality should be provided. The doctor may also discuss follow-up care and referral to a liver clinic or specialist.

In the case of a negative result, the doctor should take the opportunity for further discussion around transmission, prevention of hepatitis B and vaccination. Because of the window period, the doctor may recommend further testing at a later date to ensure infection has not occurred.

Privacy and Confidentiality

Health professionals like doctors and others (such as staff in doctors rooms and testing laboratories) are guided by a code of ethics that include protocols for preserving confidentiality and are required to keep a patient’s personal information private. Workers who disregard these can be held answerable to the relevant professional body.

Research suggests 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 more easily 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 speak to the Support Officer. Support may be provided over the telephone or face-to-face at HepatitisWA.

Page last updated: Wednesday 15 September, 2010