Hepatitis B

Also Known As

HBV

Hep B

Hepatitis B

Anti-HBs

Hepatitis B surface antibody

HBsAg

Hepatitis B surface antigen

HBeAg

Hepatitis B e-antigen

Anti-Hbe

Hepatitis e antibody

Anti-HBc

Hepatitis B total core antibody

Anti-HBc IgM

Hepatitis B core IgM

HBV DNA

Formal Name

Hepatitis B virus

This article was last reviewed on

13 June 2023.

This article waslast modified on 13 June 2023.

At a Glance

Why Get Tested?

To find out whether you have an infection with hepatitis B virus (HBV) or to check how well your treatment is working if you do have the disease. Another reason for a test would be after you had the vaccine against hepatitis B to make sure it has produced the desired level of immunity

When To Get Tested?

You will be tested for to see if you have HBV if you have symptoms suggesting you might have a viral hepatitis infection or are likely to have been exposed to the Hepatitis B virus; if you have chronic liver disease (possibly due to some other cause), if you were born to a mother who was HBV positive or if you are being treated for HBV. If you have recently received the vaccine, you will have a different test to check you have responded to it.

Sample Required?

A blood sample taken from a vein in your arm

Test Preparation Needed?

No test preparation is needed

On average it takes 7 working days for the blood test results to come back from the hospital, depending on the exact tests requested. Some specialist test results may take longer, if samples have to be sent to a reference (specialist) laboratory. The X-ray & scan results may take longer. If you are registered to use the online services of your local practice, you may be able to access your results online. Your GP practice will be able to provide specific details.

If the doctor wants to see you about the result(s), you will be offered an appointment. If you are concerned about your test results, you will need to arrange an appointment with your doctor so that all relevant information including age, ethnicity, health history, signs and symptoms, laboratory and other procedures (radiology, endoscopy, etc.), can be considered.

Lab Tests Online-UK is an educational website designed to provide patients and carers with information on laboratory tests used in medical care. We are not a laboratory and are unable to comment on an individual's health and treatment.

Reference ranges are dependent on many factors, including patient age, sex, sample population, and test method, and numeric test results can have different meanings in different laboratories.

For these reasons, you will not find reference ranges for the majority of tests described on this web site. The lab report containing your test results should include the relevant reference range for your test(s). Please consult your doctor or the laboratory that performed the test(s) to obtain the reference range if you do not have the lab report.

For more information on reference ranges, please read Reference Ranges and What They Mean.

What is being tested?

Hepatitis B is a liver infection caused by the hepatitis B virus (HBV). It is one of several various causes of hepatitis, a condition characterized by inflammation and enlargement of the liver. Other causes of hepatitis include, for example, certain drugs, inherited disorders, and autoimmune diseases. HBV is one of five "hepatitis viruses" known to cause disease in humans . The other four are A, C, D, and E.

The course of HBV infections can vary from a mild form (acute) that lasts only a few weeks to a more serious, chronic form lasting years. Sometimes chronic HBV leads to serious complications such as cirrhosis or liver cancer.

HBV is spread through contact with blood or other body fluids from an infected person. Exposure can occur, for example, through sharing of needles for IV drug use or through unprotected sex. People who live in or travel to areas of the world where hepatitis B cases are high are at a greater risk. Mothers can pass the infection to their babies, usually during or after birth. The virus, however, is not spread through food or water, casual contact such as holding hands, or coughing or sneezing.

Some of the various stages or forms of hepatitis B include:

Acute infection
- People recently infected with HBV with a positive screening test. Some people have typical signs and symptoms including high temperature tiredness, pain in their right side and jaundice, but some people do not feel ill at all
Chronic infection
- People who are known to have been infected for more than 6 months with the virus detected by laboratory tests accompanied by inflammation of the liver
Carrier (inactive) state
- persistent infection but no signs of liver inflammation. A carrier may appear to be in good health but they still have the virus and can potentially infect others
"Cleared" infection
- no longer any evidence of infection; viral antigen and DNA tests are negative and no signs or symptoms of liver inflammation (although, in many cases, the virus is present in an inactive state in the liver)

There are several different tests that can be used to detect current or previous HBV infection. Some of the tests detect antibodies produced in response to exposure to the HBV; some detect viral antigens (part of the virus itself) while others detect viral DNA. They can be used to screen for infection in the absence of symptoms, to determine whether infection is acute or chronic, or to monitor a chronic infection.

Common Questions

How is it used?

Hepatitis B tests may be used for a variety of reasons. Some of the tests detect antibodies produced in response to HBV infection; some detect antigens produced by the virus, and others detect viral DNA. This allows determination of whether a patient has an acute or chronic infection, past infection now cleared or simply whether or not vaccination has been successful. The following table gives an overview of what tests are used:

Test	Description	Use
Hepatitis B Surface antigen (HBsAg)	Protein present on the surface of the virus, present in both acute & chronic infections.	Used to screen for & detect infection – it is the earliest indicator of acute infection & may be present before symptoms appear. Also present in patients with chronic infection.
Hepatitis B surface antibody (anti-HBs)	Antibody produced in response to HBsAg: levels rise during recovery phase of infection	Indicates previous exposure to the HBV but virus no longer present and can’t be passed on. It also protects against future infection. Antibodies can also be acquired from vaccination. This antibody will be detected after successful vaccination.
Anti-Hepatitis B core (Anti-HBc), IgM	IgM antibody to the hepatitis B core antigen (The hepatitis B core antigen is present only in infected liver cells; it cannot be detected in the blood.)	First antibody produced after infection with HBV; used to detect acute infection
Anti- Hepatitis B core (Anti-HBc) total	Both IgM and IgG antibodies to hepatitis B core antigen	Can be used to help detect acute and chronic HBV infections; it is produced in response to the core antigen and usually persists for life. Also used to detect past infection but now immune in combination with Anti-HBs.
Hepatitis B e Antigen (HBeAg)	Protein produced and released into the blood by actively replicating hepatitis B virus	The e-antigen is found in the blood only when the HBV virus is actively replicating. HBeAg is often used as a marker of ability to spread the virus to other people (infectivity). It may also be used to monitor the effectiveness of treatment. If the virus is “in –hiding” the eAg will no longer be present in the blood. *There are some types (strains) of HBV that do not make e-antigen; these are especially common in the Middle East and Asia. In areas where these strains of HBV are common, testing for HBeAg is not very useful.
Anti-hepatitis B e antibody (Anti-HBe)	Antibody produced in response to the hepatitis B e antigen	In those who have recovered from acute hepatitis B infection, anti-HBe will be present along with anti-HBc and anti-HBs. In those with chronic hepatitis B, anti-HBe can be used to monitor the infection and treatment.
Hepatitis B DNA (HBV DNA)	Detects hepatitis B viral genetic material (DNA)	Can detect an active HBV infection; its primary use is to monitor antiviral therapy in patients with chronic HBV infections.

*Sometimes, HBV goes into “hiding” in the liver and other cells and does not produce new viruses that can infect others, or produces them in such low amounts that they cannot be found in the blood. People who have this form are said to be carriers. In other cases, the body continues to make viruses that can further infect the liver and can be spread to other people. In both these cases, HBsAg will be positive. The HBeAG and Anti-HBe tests help in this diagnosis

.

When is it requested?

A test for anti-HBs is used to determine whether the vaccine has produced the desired level of immunity. If levels of the antibody are over 10 mIU/mL, the person has good protection against infection with HBV. In a patient with acute hepatitis, IgM anti-HBc and HBsAg are usually requested together to detect recent infection by HBV. In persons with chronic hepatitis, or with elevated ALT or AST, HBsAg and anti-HBc are usually done to see if the liver damage is due to HBV. If so, HBsAg and HBeAg are usually measured on a regular basis (every 6 months to a year), since in some people HBeAg (and, less commonly, HBsAg) will go away on its own. In those who are being treated for chronic HBV, HBeAg and HBV DNA can be used to determine whether the treatment is successful.

All donated blood is tested for the presence of the HBsAg before being distributed.

What does the test result mean?

Hepatitis B results are often requested in combination with tests for other viruses and other markers of disease, depending on the reason for testing. The results therefore will be evaluated together. Not everyone will need to have all the tests described here, so it is helpful to know which tests your doctor is requesting for you and why.

The table below summarises some of the results and what they mean. It is not fully comprehensive but covers the majority of common results.

Hep B surface antigen (HBsAg)	Hep B surface antibody (Anti-HBs)	Hep B core antibody (Anti-HBc IgM)	Hep B core antibody Total (Anti-HBc IgG+IgM)	*Hep B e antigen (HBeAg) see note below**	Hep B e antibody (Anti-HBe)	Interpretation / Stage of Infection
Negative	Negative		Negative			No active or prior infection; not immune - may be good candidate for vaccine
Negative	Negative/low positive	Positive	Positive	Negative	Positive	Acute infection, now resolving
Negative	Positive	Negative	Positive	Negative*	Positive	Infection resolved: immunity due to natural infection
Negative	Positive		Negative			Immunity due to vaccination
Positive	Negative	Negative	Negative	Positive	Negative	Early acute infection
Positive	Negative	Positive or Negative	Positive or Negative	Positive	Negative	Acute infection – usually with symptoms: contagious
Positive	Negative	Positive	Positive	Negative*	Positive	Late in acute infection (seroconversion)
Negative	Negative	Positive	Positive	Negative*	Positive	Acute infection is resolving (convalescent)
Positive	Negative	Negative	Positive	Negative*	Positive	Chronic infection but low risk of liver damage – carrier state
Positive	Negative	Negative	Positive	Positive	Negative	Indicate active chronic infection – liver damage possible

* Note: There are some types (strains) of HBV that do not make e-antigen. In areas where these strains of HBV are common (in the Middle East and Asia), testing for HBeAg is not very useful. In these cases, a negative HbeAg result does not necessarily mean that the antigen is not present or that the person is not infectious; it may be that the person is infected with a strain that does not make the e-antigen.

Is there anything else I should know?

While the tests described above are specific for HBV, other liver function tests such as AST, ALT, and gamma-glutamyl transferase (GGT) may be used to monitor the progress of the disease. In some cases, a liver biopsy may be performed for confirmation.
If it is possible that I have an HBV infection, will I need to have all of these tests done?

No. Your doctor will determine which test(s) will be appropriate for your symptoms and history.
Should I have the HBV vaccine?

Yes. Unless there is something in your medical history to the contrary, it is prudent to have the series of vaccinations. In the UK pregnant women are routinely tested for infection and, if positive, immunoglobulin and vaccination of the newborn baby is offered. Periodic measurement of anti-HBs in persons who have developed immunity to HBV is not needed; even if their antibody level falls below 10 mIU/mL, they still appear to be protected if exposed to the virus.
Can I test myself for immunity?

No. These tests must be performed by trained laboratory staff in an accredited laboratory.

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Hepatitis B Virus Antibodies