When it comes to Hepatitis B Viral infection, Biomarkers are Vital

According to a 2015 published fact sheet from World Health Organization (WHO), 257 million people suffered from hepatitis-B virus (HBV) infection. The biomarkers of hepatitis-B infection can detect this infection at an early stage and can prevent the associated complications from arising in chronic hepatitis B infection. Just like many disease processes in our body, the vast majority of HBV infections are silent (asymptomatic) and patients seek medical help when some liver damage is already present.

Overview of HBV infection

HBV infection has been one of the main public health concerns for many countries due to its high prevalence (endemic in many areas and regions of the world) and long term health and economic consequences. HBV infection can be acute or chronic, and both carry very heavy burdens to both our personal health and to society.

Although it is the case that most people with acute HBV infection do not require medical treatment, at least 30% of those that do suffer the clinical symptoms will be out of work for potentially weeks or months. For chronic infection sufferers, it isn’t just the number of months being unavailable for work, but lifelong treatment and potential health consequences of cirrhosis and liver cancer.

The good news is that we have a vaccine available that is 95% effective and widely available in the developed world (not so much in the less fortunate nations); that we have a blood test that is fast and simple to perform, and highly specific and sensitive for detecting HBV infections (acute and chronic); that if picked up early (that means before you get the clinical signs and symptoms) then the prognosis and long term health and survival are greatly improved (can prevent cirrhosis and cancer).

You may ask yourself: how can I detect the disease before symptoms and sings lead me to take a blood test or seek medical help? Well the answer is simple: proactively and regularly check and track some of these biomarkers that can make such a difference to my health if I detect the disease early!

Signs and Symptoms to look out for in HBV infection

Around 70% of acute HBV infection are subclinical (that means do not have symptoms and are unaware they have the disease). The other 30% will suffer non-specific symptoms such as:

  • Loss of appetite, nausea, or vomiting
  • Abdominal discomfort or pain
  • Body aches, particularly joint pains
  • Jaundice in some cases (yellowing of the skin and sclera of the eyes, dark urine)

In normal adults, less than 5% will develop the chronic HBV infection, whereas for children under 6 the figures are closer to 50%. The symptoms include

  • Yellowish coloration of skin and eyes
  • Dark colored urine
  • Extreme weakness
  • Abdominal cramps
  • Nausea
  • Vomiting

20-30% of adults with chronic HBV infection will develop complications, including liver cirrhosis or hepatic cancer leading to liver failure.


The infection can be transferred from an infected to a healthy person through

  • Transfusion of infected blood or blood products
  • Sharing of infected syringes
  • Exposure to infected body fluids like saliva, seminal fluid, and vaginal discharge (sexual transmission)
  • An infected mother can also transmit the HBV infection during birth to the newborn (perinatal transmission)
  • Acupuncture, piercing, tattooing with contaminated tools

Prevention: Vaccine and others

A vaccine against HBV has been available since 1982. This is the cornerstone of prevention against HBV infection. The vaccine is 95% effective in preventing infection and the development of chronic disease and liver cancer due to HBV infection. Being vaccinated, however, should not provide that false sense of security in one’s lifestyle and behaviour, as there are other types of deadlier microorganisms transmitted sexually, or through those media mentioned above. Furthermore, there is a significant number of people who fail to complete the 3 dose schedule of the vaccine as recommended by the WHO. Please ensure that you see your physician and follow the strict vaccine guidelines to be truly vaccinated. If unsure, ask your doctor to order a biomarker for HBV immunity (HBsAb) to see if you are really vaccinated.

The HBV also has the ability to stay alive even outside the living body for almost one week. This makes the virus so much more dangerous. Hygiene (both personal and food preparation) is also a big part, as is practicing safe sex (avoid polygamy, promiscuity, use barrier protection).

Management and Treatment

Non-medical Treatment

  • Consumption of alcohol and smoking should be strictly avoided.
  • For acute HBV infection, no medical treatment is recommended but rest, proper nutrition and fluid intake highly needed to recover. In severe form of acute infection, drug treatment may be required.
  • At the initial stage of chronic infection, the physical exercise is restricted for three months to decrease the level of liver enzyme. But in the later phase, exercise is essential to maintain body weight, appetite and boost immunity.
  • The diet should include whole grains (oatmeal, brown rice, whole-wheat products), plenty of fresh, seasonal fruits and vegetables (green leafy vegetables, baby carrots, and cherry tomatoes).
  • Have sufficient proteins to maintain the natural healing process.
  • Avoid deep fried, spicy, salty food items and high fat dietary items
  • Have sufficient fluid to detoxify the body. (victoria please link to this detoxify word to our article on detoxifiying your body)

Medical Treatment

  • Most of the acute HBV infections do not require medical assistance. Dietary measures and healthy lifestyle alone (mentioned above) often boost immunity to help recovery.
  • For chronic HBV infections, treatment is often lifelong. Doctors use several antiviral drugs to decrease the viral load and control the liver damage. This helps prevent development of liver cancer and cirrhosis.
  • Interferon alfa-2b injection is prescribed for children to avoid long-term medical treatment. It is also effective for women who want to become pregnant after fast recovery.
  • A liver transplant may be recommended to patients with resulting liver cirrhosis.

HBV Infection Biomarkers

Hepatitis B surface antigen (HBsAg) – When HBV infects our system, the virus attacks us with various weapons called antigens. These are different expressions on the viral cells that we can detect in a blood test. The most useful test to screen the general population for HBV infection is indeed the hepatitis B surface antigen (HBsAg). In fact the WHO defines HBV infection as someone who tests positive to this HBsAg test. When you test positive for this test, you have HBV infection (either acute or chronic).

Hepatitis B Surface Antibody (HBsAb) – The presence of HBsAb combined with the absence of HBsAg in blood sample denotes the absence of HBV infection. This occurs either in someone who has recovered from the acute infection (and acquired an immunity to it as a result), or has been successfully vaccinated against HBV.

Hepatitis B Viral DNA Quantitative (HBVDNA)- Although HBSAg is useful for detecting HBV infection, your doctor will prefer to measure a biomarker called HBV DNA level to see if the viral load in your blood is in a reducing trend during your course of antiviral treatment. This biomarker is currently the most accurate way of tracking the progress of your HBV infection.

Liver Function Test (LFT)

Since HBV infection attacks primarily the liver, anyone infected with HBV should monitor their liver function with a blood test called LFT. It incorporates three parts of the liver function: the bilirubins, the proteins and the enzymes. Altogether the elements tell you and your doctor how much liver damage is present due to HBV infection. It also guides the doctor for further investigations of the liver (such as liver imaging, biopsy).

Acute and chronic HBV infections are common and potentially deadly. WHO recommends screening with HBsAg for presence of infection. Acute HBV infection is generally managed with balanced diet avoiding intake of liver-toxic substances and sticking to a liver-friendly diet. For Chronic HBV infection, these dietary and lifestyle measures are even more important in combination with proper medical treatment. Your doctor should be involved in all stages of HBV infection. You and your doctor will rely on biomarkers during the screening, treatment and recovery phases of an HBV infection. Start before its too late.

If you’re interested in learning more about Hepatitis B and how it can harm your body, read on more about it in our biomarker post here!

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