The Biomarker Handbook is a curated series that seeks to provide readers with insights on each biomarker we cover in our blood test packages and its relation to our body.
Hepatitis B virus (HBV) infection is an infection of the liver (hepatitis). It can cause acute and chronic forms of the disease. According to the WHO, an estimated 257 million people are living with hepatitis B virus infection (defined as hepatitis B surface antigen positive).
Not only is it common, but it can be deadly from the associated liver cirrhosis (scarring of liver which is irreversible) and/or liver cancer. About 70% of HBV infections are asymptomatic or cause mild symptoms which are often unrecognised, and thus do not seek the appropriate medical help or follow up necessary. Many people are diagnosed only when they already have advanced liver disease. This is where regular tracking of this biomarker (HBsAg) comes in useful indeed.
There are two pieces of good news:
- HBV infection can be detected with a simple blood test (HBsAg). Rather than waiting for symptoms to develop – and you know that in 70% of times they do not develop, we recommend actively tracking for HBV infection biomarker (such as HBsAg).
- There is a vaccine since 1982 which is 95% effective against HBV.
HBV infection and its signs and symptoms
Clinical acute hepatitis B (the 30% that have clinical symptoms and signs) has a gradual onset, with:
- abdominal discomfort,
- nausea, vomiting
- arthralgia (joint pains) and rash
- And in some cases jaundice (yellowing of the skin and eyes, dark urine)
Acute HBV infection is a short-term infectious condition which usually lasts for a few weeks. This condition is usually asymptomatic and self-limiting in affected adult individuals. Only a small subset will develop liver failure which can lead to death. The healthy adults most often will get rid of the acute infection without treatment due to their proficient immune system. The same however cannot be said about children: 30-50% of children under 6, and 80-90% of infants (the first year of life) will develop chronic liver infection, unlike in adults where less than 5% will develop the chronic infection. The reason why this chronic infection state is so important: 20-30% of the adults who develop chronic HBV infection will develop cirrhosis and/or liver cancer.
Although there is no specific medical treatment for acute HBV infection, care is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids lost from vomiting and diarrhoea.
Chronic form of the HBV infection on the other hand is generally treated with oral antiviral drugs. Treating chronic HBV infection will lower your risk of developing liver failure from cirrhosis and/or liver cancer, and significantly improve your survival rate.
Hepatitis B Biomarker(s)
HBsAg and HBV DNA
WHO defines the presence of HBV infection (both acute and chronic) with a very simple blood test named hepatitis B surface antigen (or HBsAg). This biomarker detects the presence of a viral cellular expression or antigen. If HBsAg test is positive, you are infected with the virus. There are other types of HBV antigen expressions (HBeAg, HBcAg) your doctor may order, to see the stage of your acute infection.
Since HBV infection affects mainly the liver, both acute and chronic infection sufferers should monitor their liver function, called liver function test (LFT) to track the health of their liver. Any abnormality or deterioration is a cause for concern and you should seek medical advice. You can also use LFT as a tool to monitor progress of liver damage from the HBV infection.
For people with chronic HBV infections it is important to measure the so called viral loading (HBV DNA) in your blood. This is a proxy for the disease activity level and also response to treatment with antiviral. Unlike the HBsAg which screens for the presence or absence of HBV infection, this viral load test lets you and your doctor accurately track the progress of the disease.
The three type of HBV antibody biomarkers that are activated during and after the Hepatitis B infection are Antibody to HBcAg (HBcAb), Antibody to HBeAg (HBeAb) and Antibody to HBsAg (HBsAb). The HBcAb is found prior to appearance of clinical signs and symptoms. HBeAb is detected at the commencement of the recovery stage, whereas HBsAb is found at the later stage of recovery and/or after progression of immunity against Hepatitis B virus.
When you have been in an endemic region, or intimate with someone at risk of being infected, your doctor may choose to order HBcAb early after exposure to check the infection status after exposure to HBV. If positive then you are infected. On the other hand, you may track your HBsAb to see if you have immunity to the HBV. If it is present, then you are immune to HBV infection either through past or recent recovery from infection or triple vaccination.
Who should be screened for HBV infection?
There is one particularly damning reason to screen healthy people for HBV infection: the virus can damage your liver before causing symptoms and signs! Proactively screen for HBV infection IF YOU:
- Are pregnant
- Live with someone who has HBV infection
- Have had many sexual partners (even if you use protection)
- Are a man who has sex with men
- Have a history of STD (sexually transmitted disease)
- Have an abnormal liver function test
- Take meds to reduce your immune system
- Use recreational injected drugs
- Visited an endemic region
- Are jaundiced
Ways to balance your biomarkers during HBV infection
- 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. If 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.
- 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 like entecavir, tenofovir, lamivudine, adefovir, and telbivudine to decrease the viral load and control the liver damage.
- 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.
When to see the doctor
If you are not vaccinated (or unsure) and have been in an endemic area or exposed to HBV, see your doctor immediately for a possible immunoglobulin injection for protection. Or even get vaccinated.
If you have any of the above symptoms or see that you are in the recommended screening group of individuals, then talk to your doctor regarding HBV screening.
Acute HBV infection generally does not need medical treatment, but chronic HBV infection does. See your doctor immediately if you have either type of infection once suspected or confirmed.
Acute and chronic HBV infection is not only common and potentially deadly, but easy to detect and manageable both medically and naturally. WHO recommends screening with HBsAg for presence of infection. This simple blood test can potentially avoid years of pains in taking lifelong medications and suffering from liver failure (from cirrhosis), cancer, even death. Once you have a confirmed acute HBV infection, track your biomarkers to ensure full recovery through non-medical efforts. If chronic, track your biomarkers for a stable recovery and response to treatment to avoid lifelong complications and death.
If you want to find out more about Hepatitis B and how you can balance HBV biomarkers, take a look at our lifestyle article here!
Interested in other biomarkers? Check out the rest of The Biomarker Handbook.
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