Polymerase chain reaction is a type of blood test that allows you to accurately detect the hepatitis B virus. A special feature of the method is that it is able to show HBV in the early stages - within a month after infection, while a specific antigen in a patient is detected only after 2 months . PCR can detect not only a regular DNA virus, but also mutant strains that no other analysis can detect.

When deciphering PCR for hepatitis B, the results are compared with standard values. Based on this, conclusions are drawn about the presence of the disease (positive result), the concentration of the virus (activity) or the absence of the disease (negative result). Data processing takes 2 weeks.

There are 2 types of diagnostics that are prescribed for hepatitis B. Qualitative PCR makes it possible to say with 100% accuracy whether HBV is in the blood or not. Quantitative PCR shows the activity of the virus, that is, how many HBV DNA fragments are contained in 1 ml of blood.

Qualitative PCR and its interpretation

A blood test for hepatitis B using the PCR method can only reveal the presence of DNA fragments. It is prescribed when the patient suspects infection with HBV or when other diagnostic methods, such as serological tests, do not provide a clear answer. Decoding the results when conducting a qualitative analysis is very simple:

• negative result - there is no virus;
• positive result - the virus has been detected.

The purpose of high-quality PCR is to confirm or refute the presence of the hepatitis B virus, as well as to conduct early diagnosis. If HBV is detected within 1-2 weeks after infection, then treatment will be most effective. With the active development of HBV for 2 months or more, the disease becomes chronic and cannot be completely cured.

In the case when qualitative PCR for hepatitis shows the presence of the virus, the next step is quantitative diagnosis.

Quantitative PCR

To prescribe effective treatment or evaluate the results of therapy, simply knowing that the patient has HBV is not enough. It is necessary to quantify the DNA value of the hepatitis B virus in 1 ml of blood, that is, the viral load on the body. This type of PCR for hepatitis B is carried out in the following cases:

1. Before prescribing treatment.
2. To assess the effectiveness of therapy.
3. To determine the development of virus resistance to drugs taken.
4. To determine the stage at which the disease is located.

The unit of measurement for the virus is international units (IU/ml) or the number of DNA copies/ml, that is, the number of DNA fragments per 1 ml of blood. The ratio between the two units depends on the test system chosen and ranges from 2 to 7 copies/ml in 1 IU/ml. If the system is unknown, then the average value is used for recalculation:

1 IU/ml = 5 copies/ml

If a quantitative analysis is immediately done, then the limit norm for diagnosing the disease is 75 IU/ml. If the result is higher than this indicator, a diagnosis of HBV is made; if the result is lower, HBV is not detected.

Interpretation of quantitative PCR

For hepatitis B, PCR standards are the following values ​​of viral load (viremia), copies/ml:

• < 10^3 - нагрузка очень низкая, вирус ведет себя неактивно;
• from 10^4 to 10^5 - the load is low, the virus is usually inactive;
• 10^6 - the load is moderate, the virus is active;
• 10^7 - high viremia, the virus is highly active.

Knowing quantitatively how the virus behaves in the body, you can determine the form of the disease (chronic, acute or carriage), the need for additional research, the reaction of the body and the virus to treatment:

1. Chronic hepatitis B is diagnosed if the transaminase value is higher than normal, the virus activity is more than 4, and the concentration of DNA copies per milliliter of blood is 10^5 copies.
2. Carriage is determined by the following picture that the results give - concentration< 10^5 копий/мл, а уровень трансаминазы равен стандартному значению.
3. HBV resistance is constantly monitored during treatment. Tests are taken every 3 months. If at one point the viremia during hepatitis increases 10 times, this means that HBV has adapted to the drugs used - it has become resistant.
4. A favorable course of treatment will show a decrease in viremia by 85% 3 days after the start of therapy.
5. The patient receives a referral for a liver biopsy only when the ALT (alanine aminotransferase) level exceeds the normal value no more than 2 times in 6 months, and the PCR for hepatitis B shows viremia > 10^5 copies/ml. When, with high viral activity, an increase in ALT levels is observed more than 2 times in six months, then antiviral therapy is immediately prescribed.

To find out how DNA hepatitis will behave in terms of chronicity, that is, the transition to a chronic form from an acute form, the results of PCR diagnostics are also used:

• HBV DNA< 2 х 10^4 копий/мл означает, что острая стадия не перейдет в хроническую форму;
• HBV DNA ranges from 2 x 10^4 to 2 x 10^6 copies/ml, which means that every 4th patient will have chronic HBV, that is, chronicity is 25-30%;
• HBV DNA > 2 x 10^6 copies/ml means that the acquisition of a chronic form of the disease is inevitable.

Preparing for the examination

To determine the presence of HBV using PCR, a blood test from a vein is performed. The procedure is always carried out strictly on an empty stomach and it is best to get to the laboratory in the morning, when the natural rest time from food is 8 hours. In order for the examination results to be correct, you need to know in advance how to prepare for going to the clinic correctly. The additional steps are:

1. Avoid fatty foods, smoking, alcohol and sports 12 hours before the procedure.
2. Rest for 20 minutes immediately before donating blood.
3. Before starting the procedure, you must inform the nurse about the medications you are taking.

Attention! If the diagnosis is carried out on a child under 5 years old, then half an hour before the procedure he should be given 1 glass of boiled water every 10 minutes.

Summing up

Today, PCR diagnostics for detecting hepatitis B is the most accurate method. The method allows you to see hidden and mutated forms of the disease, identify the disease in the first weeks after infection and, accordingly, carry out effective treatment. Depending on the situation, qualitative or quantitative PCR is carried out, which are aimed at identifying HBV and establishing its activity. To undergo an examination, you need to contact a virologist, infectious disease specialist or hepatologist.

HBV, DNA quantitative [real-time PCR]

A test to identify the causative agent of hepatitis B (HBV), during which real-time polymerase chain reaction (RT-PCR) is used to determine the presence of genetic material (DNA) of the virus and its amount (viral load) in a blood sample.

HBV DNA may be detected at concentrations below the lower limit of the linear concentration range. The linear concentration range is the range within which the copy number of a pathogen can be accurately counted. For this assay, the linear range of HBV DNA concentrations detected by the test system is 75.0 - 1.0*10^8 IU/ml.

Synonyms Russian

Hepatitis B virus (HBV), DNA quantification.

English synonyms

Hepatitis B Virus DNA, Quantitative, Real-Time PCR, Blood; HBV Viral Load; Hepatitis B Virus DNA Quant.

Research method

Real-time polymerase chain reaction.

Units

IU/ml (international unit per milliliter).

What biomaterial can be used for research?

Venous blood.

How to properly prepare for research?

• Do not smoke for 30 minutes before the test.

General information about the study

Hepatitis B virus (HBV) is an infectious liver disease caused by the DNA-containing hepatitis B virus (HBV). Among all the causes of acute hepatitis and chronic viral infection, the hepatitis B virus is considered one of the most common in the world. The actual number of people infected is unknown, since many people have an infection without specific symptoms and do not seek medical help. The virus is often detected during preventive laboratory tests. According to rough estimates, about 350 million people in the world are affected by the hepatitis B virus and 620 thousand die from its consequences every year. In Russia, the number of HBV carriers exceeds 5 million people.

The source of infection is a patient with HBV or an asymptomatic virus carrier. HBV is transmitted through blood and other body fluids. You can become infected through unprotected sexual contact, the use of unsterile syringes, blood transfusions and organ transplants; a child can be infected by the mother during or after childbirth (through cracks in the nipples). The risk group includes: medical workers who may have contact with the patient’s blood, patients receiving hemodialysis, injection drug users, people who are promiscuous, children born to mothers with HBV.

The incubation period of the disease is from 4 weeks to 6 months. Viral hepatitis B can occur either in mild forms, lasting several weeks, or as a long-term chronic infection. The main signs of hepatitis: jaundice of the skin, fever, nausea, fatigue, in laboratory tests - abnormal liver function and specific antigens of the hepatitis B virus. An acute disease can quickly lead to death, develop into a chronic infection or end in complete recovery. It is believed that after suffering from HBV, stable immunity is formed. Chronic viral hepatitis B is associated with the development of cirrhosis and liver cancer.

There are several specific tests to detect existing or past viral hepatitis B. To confirm the presence of infection and clarify the period of the disease, they use the determination of virus antigens, antibodies to them and viral DNA.

The polymerase chain reaction is highly sensitive and specific. The PCR method can determine the DNA of the virus qualitatively or quantitatively. Thanks to the qualitative method, the presence of the hepatitis B virus in the body and its active reproduction are confirmed. Quantitative determination of the viral load allows us to assess the intensity of the disease, the effectiveness of the therapy, or the development of resistance to antiviral drugs.

There is a relationship between the concentration of the virus in the blood and the outcome of acute viral hepatitis B. With a low level of viremia, the likelihood of the infection becoming chronic is close to zero, and the infected person is not dangerous to others. With a high viral load (

The effectiveness of antiviral therapy is assessed by reducing the amount of viral DNA in the blood. 3-6 months after the start of treatment, the viral load with an adequate therapeutic response should decrease by 1-2 orders of magnitude. The absence of a decrease in the amount of virus or its increase during treatment requires a review and change in therapy.

Quantitative determination of hepatitis B virus DNA, together with the clinical picture of the disease and biochemical parameters, markers of infection, as well as the result of liver puncture biopsy, allows us to predict the disease and assess the need for antiviral therapy.

What is the research used for?

• To predict the course of viral hepatitis B.
• To confirm the chronic form of viral hepatitis B.
• To identify carriers of viral hepatitis B and monitor virus replication activity.
• To identify hidden and mutant strains of the hepatitis B virus.
• To assess the effectiveness of antiviral therapy for hepatitis B and make decisions on further treatment tactics.

When is the study scheduled?

• With qualitative detection of hepatitis B virus DNA.
• For acute and chronic viral hepatitis B.
• For mixed hepatitis.
• Before and during antiviral therapy.

What do the results mean?

Reference values: not detected

• “Not detected” – hepatitis B virus DNA was not detected or the value is below the sensitivity limit of the method (50 IU/ml);
• from 75 to 1.2*10^5 IU/ml – hepatitis B virus DNA detected, low viremia;
• from 1.2*10^5 to 1.2*10^6 IU/ml – hepatitis B virus DNA detected, average viremia;
• more than 1.2*10^6 IU/ml – hepatitis B virus DNA detected, high viremia;
• > 1*10^8 IU/ml – hepatitis B virus DNA was detected in concentrations above the linear concentration range.

The linear range of hepatitis B virus DNA concentrations determined by the test system is 75.0 - 1.0*10^8 IU/ml.

Important Notes

• Quantitative determination of hepatitis B virus DNA is a mandatory test before prescribing antiviral therapy. During the course of treatment, the analysis must be repeated after 3-6 months.
• Viral hepatitis B is often combined with viral hepatitis D.

Hepatitis B is a viral infection that affects the liver. Today, about 300 million people around the world are carriers of hepatitis B.

In some, the virus progresses to cirrhosis of the liver or hepatocellular carcinoma (the first stage of cancer). New antiviral disease research strategies have two objectives:

• determine how sensitive the body is to the viral load;
• determine how resistant the virus is to medications and other medical interventions.

Features of tests for hepatitis

Serological tests are aimed at identifying antigens and antibodies in blood serum, but this method is unreliable. Therefore, scientists developed the polymerase chain reaction (PCR) method. It allows you not only to qualitatively determine the presence of the virus (is it present or not), but also quantitatively (how many antibodies are present in the blood serum).

Before collecting blood, the doctor should find out:

In acute hepatitis, a positive result can be detected 1-2 weeks after incubation by PCR.

Blood tests to detect hepatitis B virus (HBV) are taken when:

Tests are also regularly taken from people at risk, these include:

• people who need frequent blood transfusions;
• patients undergoing ongoing blood purification procedures for renal failure;
• people with AIDS or HIV infection;
• pregnant women;
• healthcare workers exposed to blood;
• patients with symptoms of liver disease.
• those being treated for cirrhosis, cancer and other liver diseases.

Preparation for quantitative analysis requires compliance with the following rules:

Effective therapy for the disease affects the reduction of the amount of viral DNA in the serum. Six months after the start of treatment, the amount of virus should decrease by 2-3 orders of magnitude. If the test results have not changed over time, or, on the contrary, have become worse, then the entire therapy must be changed, and acute hepatitis is automatically renamed chronic.

When hepatitis virus DNA enters the body, infection can occur in 2 ways:

How is the blood collection procedure performed? The doctor tightens the patient’s forearm with a tourniquet and inserts a needle into a vein on the elbow, then draws the blood into a syringe and pours it into a special tube. The results will be ready in a few days, the period depends on the place where the patient is tested.

The material is blood serum, lymphocytes, hepatobiopsy, which is placed in a test tube with a well-screwed cap. But the result can be affected by contaminated material for sampling, overexposure of the material (it is stored for up to 24 hours at a temperature of no more than +4 ° C).

Quantitative analysis methods

There are several methods of quantitative analysis, including PCR, ELISA, and biochemistry.

PCR (polymerase chain reaction).

This is a test for the surface antigen protein that makes up part of the outer shell of the virus. After viral particles enter the body, they begin intensive reproduction on the surface of the liver, destroying healthy cells of the organ. New molecules are released into the blood.

Based on this, the level of antibody concentration in the serum is examined and it is determined whether there is infection with hepatitis B or not.

The material for the study is taken on an empty stomach. PCR is carried out in a machine called a cycler.

PCR analysis algorithm:

Subsequently, these steps are repeated many times, and in a few hours 35-45 cycles are completed, billions of copies of the desired sample are formed. If there are such copies, then their number is calculated per 1 ml of material for analysis.

ELISA

In addition to PCR, there is an ELISA (enzyme-linked immunosorbent assay) method. It determines not only surface antibodies, but also those located inside and interrelated with previous antigens, as well as their quantity.

Another method of quantitative analysis. When a virus enters the body from damaged liver cells, enzymes are released; if their amount is higher than normal, then we can talk about infection. In addition, you need to determine the viral load (DNA-HBV), take liver tests (for bilirubin with fractions, ALT, AST, alkaline phosphatase, gamma-GT). It is mandatory to visit an infectious disease specialist, who, if necessary, refers the patient to fibroelastometry and selects a course of treatment.

Biochemistry - quantitative analysis

Real-time PCR

In this method, the search for copies occurs after each cycle, and not after 35-45. The method works in the same way as PCR, it allows you to determine the number of copies in a sample for research. Thus, the analysis time is noticeably reduced, while a 100% result is guaranteed.

Hepatitis B DNA detection

Establishing the amount of hepatitis B DNA is very important, since with a low level the prognosis of the disease is more favorable than with a higher level. HBV DNA concentration is measured in copies/ml or me/ml

1 me/ml = 2.83×10 copies/ml

The results of this analysis may be as follows:

If the test result is positive, then the following is diagnosed:

• carriage of the hepatitis B virus;
• chronic hepatitis disease;
• acute hepatitis B disease.

If the result is negative, then:

In rare cases, a negative DNA test result for the hepatitis B virus indicates a rapid and malignant course of the disease.

The decision to get tested for the virus is made by:

• therapist;
• virologist;
• hematologist;
• infectious disease specialist

Quantitative analysis is mandatory when diagnosing the disease and should take place before starting therapy. But it must be remembered that hepatitis B is sometimes closely intertwined with hepatitis D, which can create additional difficulties when conducting such an analysis. Therefore, the following complications should be taken into account:

Viral hepatitis B is widespread in all countries of the world. The disease is characterized by an extremely high degree of contagiousness, annually claims the lives of hundreds of thousands of patients, and is a huge medical and social problem. Hepatitis B virus (HBV) primarily affects the liver. Cirrhosis of the organ and hepatocellular carcinoma are serious complications of the disease. The reservoir and source of infection are patients with acute and chronic forms of the disease, which are asymptomatic. The infectious potential of viruses (infectiousness) is 100 times higher than human immunodeficiency viruses. They have a pronounced ability to mutate, are highly resistant and carcinogenic. Pathogens are found in large quantities in the blood and other biological fluids of the body and cause prolonged viremia.

Hepatitis B is transmitted in many ways, the main ones being parenteral (through transfusion of blood or its components) and intravenous drug use. For infection, 0.1 - 0.5 microns is enough. blood. The main reservoir of infection is chronic carriers of the HBs antigen. The multifactorial nature of transmission methods, the extremely high degree of resistance of viruses in the external environment and the general susceptibility of all population groups to infection contribute to the spread of the disease in all countries of the world. About 2 billion people in the world today have signs of exposure to hepatitis B viruses. More than 400 million of them are chronically infected, 20 - 40% of them will develop cirrhosis or hepatocellular carcinoma. More than 2 million patients die every year from the consequences of the disease. A good immune system leads to recovery of 90% of infected individuals. As a rule, the disease becomes chronic in individuals with congenital and acquired immunodeficiencies.

Rice. 1. Liver cirrhosis is a serious complication of the disease.

History of the discovery of the pathogen

In 1962 - 1964, V. Blumberg (American physician, biochemist, scientist), while studying the blood serum of an indigenous Australian (aboriginal), discovered an unusual protein - preceptive antigen, associated with the disease of viral hepatitis (later called the Australian antigen), for which he was awarded in 1976 Nobel Prize.

In 1968, A. M. Prince discovered this protein in the blood serum of a person who was in the incubation period of a disease that developed as a result of a blood transfusion.

In 1970, D. Dane discovered, under an electron microscope, tiny spherical particles (Dane particles), which turned out to be the causative agents of infectious hepatitis - hepatitis B viruses.

The first vaccine against the disease was developed in 1977 in the USA.

Rice. 2. Baruch Bloomberg (1925 - 2010) first associated the Australian antigen with the hepatitis B virus (not yet isolated at that time), which served as an impetus for the development of an effective vaccine.

Microbiology

Affiliation of the hepatitis B virus:

• Family Hepadnaviridae.
• Type Hepatitis B virus.

The structure of the genome contains deoxyribonucleic acid (DNA).

Rice. 3. HBV virions are round in shape and resemble granules in appearance.

HBV is the smallest virus. Presented in 3 forms:

• Dane particles (virions) have antigenic properties and exhibit pronounced infectivity. They have a spherical shape. The diameter is 42 - 47 nm. They are surrounded by a double lipid-protein shell. The core contains DNA and a DNA-dependent polymerase. They have tropism for liver tissue.
• Particles that do not exhibit infectious properties are often found in blood serum. They don't have a core. Some of them have a spherical shape (diameter is 22 nm), others have a thread-like shape (size 22 x 50 - 230 nm). At high magnification, their transverse striations are visible. The particles are formed from stretches of surface antigen (HBsAg) and are produced in excess when viruses replicate.

Rice. 4. The photo shows nucleocapsids (NC) and particles formed from segments of the surface (Australian) antigen (HBsAg).

The structure of the hepatitis B virus

HBV consists of a nucleocapsid surrounded by an outer envelope. It has a spherical shape. Its diameter ranges from 40 to 48 nm.

HBV supercapsid

The outer shell of the virus (supercapsid) consists of lipids. It contains 3 glycoproteins, or surface antigens (Ags), including the most actively produced S protein, known as HBsAg (Australian surface antigen). HBsAg is produced in huge quantities during the disease. Its fragments - spherical and thread-like particles are present in the blood even in the absence of virions in the blood.

HBV capsid

The capsid has the shape of an icosahedron and consists of 180 capsomers (structural protein subunits). Its diameter is 27 nm. The nucleocapsid contains DNA and DNA polymerase (reverse transcriptase) and protein kinase attached to it.

The genome is surrounded by a core protein - HBcAg (heart-shaped antigen). The structure of the virion also contains nuclear HbcAg and its secreted part HBeAg (infectivity antigen), which is released into the blood during viral replication and the little-studied HBxAg.

Rice. 5. Scheme of the structure of the virus. 1 - DNA polymerase. 2 - DNA. 3 - nuclear HBcAg. 4 - nuclear HBeAg. 5 - surface HBsAg and its fragments (segments) in the form of a spherical and filamentous shape.

HBV DNA

The HBV DNA molecule is ring-shaped, double-stranded: one chain is complete - (-) thread, the second is of shorter length (shorter by 20 - 30%) - (+) thread. The long strand contains about 3200 nucleotides and has a polymerase molecule attached to it. The short strand contains 1700 - 2800 nucleotides. Regulatory DNA sequences are responsible for the replication of viral particles and protein synthesis. The S DNA gene encodes HBsAg, the C gene encodes HBcAg, the P gene encodes polymerase, and the X gene encodes a protein that regulates gene expression.

Rice. 6. In the photo on the left are viral particles that resemble granules in appearance. The outer shells of the nucleocapsids are clearly visible. Two of them have no outer shell (indicated by arrows). In the photo on the right, formations resembling spikes are clearly visible on the outer shell of viruses.

Virus replication

HBV replication (reproduction) occurs in liver cells - hepatocytes. During this process, a huge amount of HBsAg is formed in their cytoplasm. The protein enters the blood, which is detected by laboratory diagnostic methods. Viruses replicate less intensively in the cells of the pancreas, kidneys, lymphocytes and bone marrow. HBcAg is practically undetectable in blood serum. They are localized in the cell nuclei. HBeAg (a subunit of HBcAg) enters the blood. Its detection indicates active replication of viruses and their high resistance. Virus replication in the figure below.

Rice. 7. Replication of the hepatitis B virus. 1 - penetration of the virus into the cytoplasm of the cell. 2 - completion of an incomplete strand of the DNA genome and the formation of a complete double-stranded circular DNA. 3 - maturation of the genome and its penetration into the cell nucleus. 4 - in the nucleus, the cellular DNA-dependent RNA polymerase begins to produce various mRNAs (necessary for protein synthesis) and RNA pregenome (template for replication of the viral genome). 5 - Movement of mRNA into the cytoplasm of the cell and their translation with the formation of viral proteins. Assembly of viral core proteins around the pregenome. Synthesis of (-) DNA strand on the pregenome template under the influence of RNA-dependent DNA polymerase. 6 - formation of (+) DNA strand. 7 - formation of the virion shell. Exit of the virion from the cell by exocytosis.

Hepatitis B virus antigens

Antigens are foreign proteins that, when introduced into the body, cause the formation of antibodies. The antigens of the hepatitis B virus are the Australian (surface) antigen HBsAg and two nuclear antigens HBcAg and HBeAg.

Australian antigen (surface) HBsAg

The Australian antigen was discovered by the American scientist Baruch Bloomberg in 1964. It was named Australian (old name) because it was first discovered in the blood serum of an indigenous Australian. HBsAg is part of the supercapsid, is produced during the disease in huge quantities from the end of the incubation period, persists during the period of jaundice and in most cases disappears only during the recovery period. Its segments in the form of spherical and thread-like particles are present in the blood even in the absence of virions in the blood and do not have infectious properties.

• Surface antigen consists of a glycoprotein and a lipid. Its particles contain 3 proteins (pre-S1, pre-S2 and S), carbohydrate and lipid components. There is also a receptor sensitive to polymerase albumin, which facilitates the penetration of the virus into the cell.
• HBsAg is adsorbed on the membranes of hepatocytes, there are many of them in the blood, they are present in the urine, semen and saliva of sick and healthy antigen carriers.
• The Australian antigen has relatively low immunogenicity. It is capable of persisting in the patient’s body for a long time.
• HBsAg is resistant to detergents (surfactants), including proteases (proteolytic enzymes).
• There are several subtypes of the Australian antigen (ayw, ayr, adr and adw). Their distribution is different in different territories, which can serve as a relative epidemiological marker of viral hepatitis B.

HBcAg (HBcorAg)

HBc antigen is localized in the nuclei of hepatocytes. It is a nucleoprotein. Its secreted part is HBeAg, which is formed during the conversion of the precore protein into the structural core protein. Found in liver biopaths, it is not secreted into the blood. It has pronounced immunogenicity. It is a marker of viral replication. Detected by ELISA.

HBeAg

HBe is a nuclear antigen. It is a protein. It is immunogenic. Its presence in the blood serum indicates infectivity. High levels of HBe antigen in the blood correlate with increased levels of Dane particles and a high titer of HBs antigen. HbeAg can only be detected by ELISA in the cytoplasm of liver cells. Using the RIA method, Hbe antigen in case of disease is detected in blood serum in 100% of cases.

HBxAg

HBx antigen is poorly understood today. It is thought to play a role in viral replication and the development of hepatocellular carcinoma, a primary malignant tumor of the liver (liver cancer).

Rice. 8. The photo shows spherical HBV virions in the form of granules and particles that do not exhibit infectious properties, spherical and filamentous (HbsAg segments).

Virus genotype

Currently, 10 genotypes of the hepatitis B virus have been identified: A, B, C, D, E, F, G, H, I and J. Their determination helps to identify the relationship between the source of infection and the patient, since the genotypes have different geographical distributions. Genotypes differ from each other in nucleotide sequence by an average of 8%. The most common and studied genotypes are A, B, C and D.

• HBV genotypes A and D are ubiquitous.
• Genotype A is most common in Europe, Russia, Southeast Asia, the Philippines and Africa. Subtype A1 - in Africa, Asia and the Philippines, A2 - in Europe and the USA.
• Genotypes B and C are common in Japan and Southeast Asia.
• Genotype D is common in the Middle East, India and the Mediterranean region.
• Genotype E is common in sub-Saharan African countries.
• Genotype F is common in Alaska, South and Central America
• Genotype G occurs in sporadic cases in Germany, France and the USA.

Different genotypes of viruses respond differently to treatment, have different effects on the liver and duration of the disease. Thus, hepatitis B, caused by viruses of genotypes B and C, often occurs with liver damage, genotype A is easily cured with antiviral drugs.

Rice. 9. Jaundice in a patient with hepatitis.

HBV stability

The hepatitis B virus is highly resistant:

• Remains viable for 4 weeks on different surfaces and in dried blood on clothing.
• It remains active for about 5 hours when exposed to chloroform and ether, 18 hours when exposed to acids (pH = 2-3).
• Withstands repeated freezing and thawing. Remains active for up to 7 days when dried at a temperature of 25° C.
• Viruses are inactivated only after 10 hours from the moment of exposure to t about 60, after 10 - 20 minutes from the moment of boiling, after 1 hour from the moment of treatment with dry heat.
• When exposed to modern disinfectants, the virus is inactivated after 60 minutes.
• Viruses persist on medical equipment and equipment for several days and even weeks. In syringes contaminated with infected blood, the DNA of the virus persists for up to 8 months.
• HBsAg is not destroyed on razor blades, manicure devices, gauze, cotton wool, linen, napkins and towels for up to 6 months.

The virus is killed by autoclaving for 45 minutes at t o 120, sterilization with dry heat for 1 hour at t o 180, boiling for 30 minutes, heating for 10 hours at t o 60.

The virus is destroyed in alkaline environments. Hydrogen peroxide, formaldehyde, chloramine and phenol have a detrimental effect on HBV.

Rice. 10. Ascites in liver cirrhosis. Multiple hemorrhages are visible on the skin.

Pathogenesis of hepatitis B

When it enters the human body, the virus is fixed on the cell membrane. Then it penetrates into the cell, where its replication occurs. Damage to the liver cell does not occur as a result of the direct cytopathic action of the pathogen, but as a result of the influence of cytotoxic immune complexes involving HLA (histocompatibility complex). Immune complexes (IC) are formed as a result of the interaction of the virus and antibodies (Hbs Ag + AT). They are aimed both at extracellular viruses and infected liver cells.

The death of liver cells leads to organ degeneration and the development of necrotic changes. The pathological process develops in the centers of the hepatic lobules and periportally. Over time, fibrosis of the organ and damage to the bile ducts develop, which leads to the development of cholestasis - a decrease in the flow of bile into the duodenum.

Activation of pro-oxidant and inhibition of antioxidant processes leads to swelling and edema of liver cells, changes in their pH, and disruption of oxidative phosphorylation processes.

The similarity of the virus antigen with the antigens of the human histocompatibility system causes the occurrence of autoimmune (“systemic”) reactions: thyroiditis, Sjögren’s syndrome, idiopathic thrombocytopenic purpura, glomerulonephritis, rheumatoid arthritis, etc.

Powerful humoral and cellular immunity leads to recovery in 90% of cases. When the cellular link of the immune system is weak, the process becomes chronic.

Rice. 11. Fatty liver degeneration due to hepatitis.

Immunity

Post-infectious immunity in hepatitis B is intense and long-lasting, it is possible that it is lifelong. Repeated cases of the disease are extremely rare. The type of immunity is humoral.

Rice. 12. In the photo, hepatocellular carcinoma is a dangerous complication of viral hepatitis.

Prevalence of the disease

The prevalence of hepatitis B is influenced by social and economic conditions.

• Unfavorable regions are Africa, Southeast Asia, the Western Pacific (Philippines, Indonesia) and China, where the frequency of HbsAg carriage reaches 10 - 20%. The largest number of infected people is recorded in regions located south of the Sahara.
• The average level of HBsAg carriage (from 2 to 7%) is observed in the countries of South America, the Eastern Mediterranean, Southern Europe, Middle and Central Asia, Russia and the CIS countries.
• Low levels of HBsAg carriage (from 0.01 to 0.5%) are observed in North America, Australia and Western Europe.
• In Russia, this figure varies from 8 to 10% in Yakutia, Tyva and the North Caucasus, from 4 to 5% in Eastern Siberia and 1% in the European part of the country.

Rice. 13. Prevalence of chronic viral hepatitis B.

How is hepatitis B transmitted?

Transmission of infection occurs in many ways, the main of which is parenteral - through transfusion of blood, its components and intravenous drug use. Liberalization of sexual behavior has led to an increase in the number of people infected with hepatitis B viruses through sexual contact. A large proportion of patients are people infected at home. For infection, 0.1 - 0.5 microns is enough. blood. Medical workers and patients on hemodialysis, drug addicts, people who are promiscuous, and those living in unfavorable living conditions are at risk of infection. The multiplicity of transmission routes ensures the widespread prevalence of infection among the population in many countries around the world. This is facilitated by the high resistance of viruses in the external environment and the high degree of susceptibility of infection among all groups of the population. The causative agent of hepatitis B is 50 to 100 times more contagious than the immunodeficiency virus. In countries with low levels of socio-economic and sanitary-hygienic living conditions of the population, in the absence of widespread HBV vaccination, almost all children become infected.

Source of HBV infection (reservoir of pathogens)

The source of HBV infection are persons with asymptomatic and manifest forms of the disease. Patients with chronic active hepatitis B virus are the main sources of infection for many years and decades. The degree of infectious danger depends on the activity of the pathological process.

Viruses appear in the blood of infected patients 2–8 weeks before liver function tests increase and circulate throughout the acute period and during the period of chronic carriage, which occurs in 5–10% of cases of the disease.

In the world, there are about 400 million patients with chronic forms of hepatitis B - carriers of HbsAg. All of them, as sources of infection, pose a real huge threat. Their degree of infectivity is determined by the activity of the pathological process in the liver and the concentration of viral antigens in the blood serum. Persons with congenital and acquired immunodeficiency are of particular danger: those suffering from autoimmune pathology, malignant neoplasms, chronic diseases of parenchymal organs, and persons receiving immunosuppressive therapy.

• Patients with acute hepatitis B are at risk for 45 - 60 days of the incubation period, 10 - 14 days during the prodrome period and 14 - 21 days in the stage of pronounced clinical manifestations - a total of approximately 65 - 95 days. During the recovery stage, the concentration of HbsAg decreases sharply. Patients infected with acute hepatitis B from patients account for 4 - 6% of all infected people.
• Patients with chronic active hepatitis B virus are more contagious than patients with inactive form of the disease, primary cancer and cirrhosis.

In infected individuals, HBV is found in blood serum, menstrual blood, vaginal secretions, semen, urine, feces, tears, saliva, bile, breast milk, ascitic and amniotic fluid, pancreatic juice, pleural and joint fluid. The real danger is the blood, semen and saliva of a sick person. In other biological fluids the concentration of pathogens is very low.

Rice. 14. Jaundice form of viral hepatitis. The skin and sclera of the eyes become jaundiced.

Routes of transmission

Blood contact is the main mechanism of transmission of hepatitis B.

Routes of transmission of infection are divided into natural and artificial.

• Natural ways of spreading HBV include: sexual, vertical (from mother to child), contact and household contact.
• Artificial ways of spreading HBV include: therapeutic and diagnostic procedures (injections, blood transfusions, hemodialysis, invasive studies, transplantations), the use of unsterile syringes and needles by drug addicts, damage to the skin and mucous membranes during tattooing, piercing, acupuncture, and brushing teeth.

Parenteral route of transmission of infection

The parenteral route (transfusion of blood and its components) previously occupied a leading position in the structure of the main routes of infection transmission (from 50 to 90%). In recent years, this figure in civilized countries has decreased to several percent, which is associated with the introduction of a mandatory procedure for determining HBsAg by ELISA in donors of all categories, followed by exclusion from donating blood of persons with positive test results. Today, infection with hepatitis B through intravenous drug use and the activation of the sexual route of spread of the disease are emerging.

Of no small importance is the widespread provision of medical institutions with disposable instruments and systems.

The risk group includes patients who receive blood and plasma, those on hemodialysis, cancer and hematology patients, and people who have undergone organ transplantation.

The group of high professional risk includes surgeons, dentists, oncologists, hematologists, obstetricians-gynecologists, transfusiologists, laboratory assistants and medical personnel working with them. This category of people is subject to priority immunization. Doctors must be vaccinated before starting their studies, patients - before admission to a hematology or oncology hospital.

Rice. 15. For many years, hepatitis B infection occurred mainly through the parenteral route (through transfusion of blood and its components). But in recent years, infection through intravenous drug use and sexual transmission of infection have come to the fore.

In recent years, there has been a significant increase in the transmission of hepatitis B through intravenous drug use. This route of transmission accounts for 30 to 60% of newly infected HBV patients with acute forms of the disease. Infection occurs when using shared syringes, needles and taking narcotic solutions from shared containers.

Rice. 16. Loss of moral principles, alcoholism, drug addiction and sexual promiscuity are the main factors in the transmission of infection among the younger generation.

Instrumental route of transmission of infection

Infection with hepatitis B can occur through the use of non-sterile instruments used during medical and diagnostic procedures, during which the integrity of the skin and mucous membranes is or may be damaged: dental procedures, instrumental examination methods, injections, taking blood for analysis, etc. This The route of infection among newly infected people with HBV is 7 - 30%.

The infection can be transmitted through the use of non-sterile instruments used during cosmetic procedures (shaving, pedicure, manicure, etc.), piercing and tattoos.

Rice. 17. HBV infection can be transmitted through the use of unsterile instruments.

Transmission of hepatitis B from mother to child

Children born to HBV-infected mothers are at risk of infection. If acute hepatitis develops in the 1st and 2nd trimesters of pregnancy, the risk of infection of the fetus is low, and in the 3rd trimester, infection of the fetus occurs in 90% of cases.

Infection of the fetus occurs when the placenta ruptures and during childbirth. According to statistics, intrauterine infection of the fetus accounts for 5 - 10% of cases, infection of the fetus during childbirth accounts for 90 - 95% of cases. Hepatitis in newborns is asymptomatic in most cases, which is why the disease is not diagnosed in them.

Sexual route of infection

In recent years, due to the liberalization of sexual relations, there has been a sharp increase in the number of cases of sexual transmission of HBV infection. In some countries, the proportion of cases of acute hepatitis with sexual transmission of infection is 18 - 21%. Risk groups include prostitutes and homosexuals. The cause of behavioral risk among the younger generation is the loss of moral principles, alcoholism and sexual promiscuity.

Contact and household route of infection

Hepatitis B can spread within families and organized groups of adults and children. Infection is facilitated by non-compliance with the rules of personal and public hygiene, unsatisfactory maintenance of housing (apartments, dormitories, nursing homes, colonies, prisons, orphanages and boarding schools). In foci of chronic carriers of infection, the disease of contact persons occurs in 10 - 86% of cases. Viruses are spread by using other people's toothbrushes, razors, washcloths, towels, massagers, etc. Pathogens enter the human body through microtraumas on the mucous membranes and skin.

Persons visiting hepatitis hyperendemic countries and personnel caring for children are at risk of infection.

The hepatitis B virus is not transmitted by hugging, shaking hands, sneezing, or through cutlery.

Rice. 18. Ascites in a patient with liver cirrhosis is a serious complication of liver cirrhosis.

Diagnosis of hepatitis B

Hepatitis B is potentially life-threatening. Patients with chronic forms are at high risk of developing cirrhosis and primary liver cancer (hepatocellular carcinoma). Timely diagnosis of the disease makes it possible to prescribe adequate etiotropic and pathogenetic therapy. Currently, there are a number of blood tests to diagnose acute and chronic forms of infection, assess the current condition of the patient and determine the prognosis of the disease.

• Laboratory diagnosis of hepatitis B today focuses on the detection of HbsAg (surface antigen, Australian antigen). Examination of all donor blood for HbsAg ensured its safety during further use of this biological material.
• Microbiological diagnosis is based on identifying the virus and identifying the immune response to it.
• To determine the tactics and prognosis of the disease, PCR for hepatitis B (HBV DNA PCR) is performed - a quantitative test and genotype of the virus.
• The “gold standard” in diagnosing hepatitis is a liver biopsy.
• Histological examination of biopsy material makes it possible to establish the nosological form (hepatosis or hepatitis), the severity of the inflammatory process and fibrosis of the organ.
• When examining a patient with suspected hepatitis B, it is mandatory to test blood serum for the presence of hepatitis C, D and HIV viruses and identify concomitant pathologies.

ALT and AST for hepatitis B

The severity of liver damage can be assessed by the level of liver enzymes in the blood serum. Particular attention is paid to the enzyme ALT, which increases by 1.5 - 2 times during the disease. AST activity is slightly lower. The opposite relationship is observed with the progression of the disease and the development of liver cirrhosis. The level of aminotransferases remains normal in patients in the phase of immune tolerance, inactive carriage and in some patients with HBeAg-negative chronic hepatitis.

To assess the performance of basic liver functions, it is mandatory to monitor such biochemical parameters as g-glutamyl transpeptidase (g-GT), alkaline phosphatase, bilirubin, plasma albumin and globulins, prothrombin time.

Decreased albumin levels, increased g-globulins and prolonged prothrombin time (often accompanied by a decreased platelet count) are characteristic signs of liver cirrhosis. A decrease in the prothrombin index level below 40% indicates a critical condition of the patient.

Rice. 19. A terrible consequence of viral hepatitis is cirrhosis of the liver (macrodrug).

Hepatitis B PCR (HBV DNA PCR)

HBV DNA PCR is the first diagnostic marker of the disease. Viral DNA appears in the blood serum within 4 weeks from the onset of the disease, HbsAg - after 2 - 8 weeks. The method has high accuracy, specificity and sensitivity. The indicator is usually expressed in IU/ml. If the result is expressed in copies, then the value in IU/ml is divided by “5”. Quantitative analysis allows you to assess the degree of viral load and is used to assess the effectiveness of treatment.

When infected with mutant strains of HBV (in the precore region of the genome), the secretion of HBeAg is disrupted and the only method in this case that confirms the replication of viruses is PCR of HBV DNA.

Rice. 20. HBV DNA PCR is the first diagnostic marker of the disease.

Liver biopsy

The “gold standard” in diagnosing hepatitis is a liver biopsy. Histological examination of biopsy material makes it possible to establish the nosological form (hepatosis or hepatitis), the severity of the inflammatory process and fibrosis of the organ. If there are clinical signs of cirrhosis or if antiviral treatment is mandatory, regardless of the degree of fibrosis/cirrhosis, a biopsy is not performed.

Rice. 21. Liver biopsy is the “gold standard” for diagnosing hepatitis.

Antigens

Antigens are foreign proteins that, when introduced into the body, cause the formation of antibodies. The antigens of hepatitis B viruses are Australian (surface) HBsAg and two nuclear (core) HBcAg and HBeAg. An enzyme-linked immunosorbent assay (ELISA) is used to detect antigens.

HBsAg (surface, Australian antigen)

HbsAg (protein) is a marker of infection with hepatitis B viruses. A huge amount of it is formed in the cytoplasm of infected cells. The presence of this antigen in blood serum is determined by laboratory diagnostic methods. HbsAg has 2 polypeptide fragments. One of them, the preS fragment, has immunogenic properties (causes the formation of antibodies, is used for the preparation of vaccines), the second is the preS2 fragment (polyglobulin receptor, promotes the adsorption of HBV on hepatocytes).

• HbsAg begins to be detected in the patient’s blood serum during the acute period 2 - 8 weeks after infection (at the end of the incubation period), is determined during the anicteric and icteric periods and then disappears during the recovery period, which occurs after 2 - 6 months in case of successful completion of the disease . A decrease in the concentration of antigens in the blood serum occurs under the influence of immune reactions.
• In severe forms of hepatitis B, surface antigens in the blood serum are determined during the period of the first symptoms of jaundice.
• Registration of HbsAg for more than 6 months indicates chronicity of the infectious process, which is observed in 10 - 20% of patients.

HBcorAg (HBcAg)

Core HBcorAg (nucleoprotein) is localized only in the nuclei of hepatocytes. HBcorAg indicates viral replication and is highly immunogenic.

This type of antigen is found only in liver biopsies and autopsy material and is not secreted into the blood. The secreted part of HBcorAg is HBeAg, which is formed during the conversion of the precore protein into the structural core protein.

HBeAg

HBeAg (nuclear antigen) indicates active replication of the virus and a high degree of infection in the patient’s blood. It appears in parallel with HbsAg in the blood serum during the acute period of the disease, already from the end of the incubation period, exists for a short time, as it is eliminated under the influence of the formed antibodies, which is considered a good prognostic sign. In case of viral mutation, nuclear HbeAg is absent.

HBxAg

HBxAg is the least studied. It is assumed that their presence indicates malignant transformation of liver cells.

• Acute hepatitis B is characterized by the appearance in the blood serum of the Hbs antigen and IgM antibodies to HBcAg (nuclear antigen). The appearance of antibodies to the nuclear HBe antigen indicates a high level of replication of the hepatitis B virus (HBV) and is a marker of high infectivity of the patient.
• In chronic hepatitis, a stable (at least 6 months) presence of HbsAg is noted. During this period, this antigen is a marker of the risk of chronicity of the process.

Rice. 22. Nucleocapsids (NC) and particles formed from segments of the surface (Australian) antigen HBsAg.

Antibodies

The immune response of the body of an infected person is manifested by the production of antibodies to certain antigens of the pathogenic microorganism. Hepatitis B produces antibodies against antigens such as HBcAg, HBeAg and HbsAg. The appearance of antibodies (seroconversion) indicates a favorable course of the infectious process.

Antibodies to surface antigen (Anti-HBs, anti-Hbs)

Anti-Hbs appear in the patient’s blood serum after the disappearance of Hbs antigens after 2-6 months. The absence of Anti-Hbs antibodies is explained by their active binding to HBsAg antigens. In some cases, there is a period when there are no antigens or antibodies in the blood (the serological window period).

• As soon as only antibodies to the surface antigen Anti-Hbs begin to be registered in the blood serum, they speak of the formation of immunity against HBV.
• In the presence of clinical symptoms of the disease and negative HBsAg results, the presence of antibodies is an important diagnostic marker of infection.
• IgM immunoglobulins indicate an acute stage or exacerbation of chronic hepatitis. They are determined within 1 - 2 months. IgG class immunoglobulins appear during the recovery stage and are present in the blood serum after recovery for many years.
• A delay in the production of antibodies or their absence indicates a weak immune response and chronicity of the process.
• The detection of only Anti-Hbs in the blood serum indicates a previous disease.
• Antibodies to the HbsAg preS1- and preS2 fragments are protective (indicate the development of post-infectious or post-vaccination immunity).

Antibodies to HBcAg (Anti-HBcor IgM and IgG)

Antibodies to the nuclear antigen HBc IgM are the most informative and reliable markers of acute infection or activation of a chronic form of the infectious process along with HbsAg. They are detected in parallel with HbsAg from the end of the incubation period and persist throughout the entire period of clinical manifestations of hepatitis B and even, in some cases, remain in the blood serum in the form of a weakly positive response over the next 1 - 2 years. Their disappearance indicates the reorganization of the body, or the development of the integrative phase of the disease.

Antibodies to the nuclear antigen HBc IgG remain in the blood serum for many years after elimination of viruses. They do not perform a protective function. Their presence indicates a current infection or a past illness. In patients with chronic hepatitis, the appearance of antibodies to HBcAg (HBcorAg) IgG indicates the completion of the disease.

Antibodies to HBeAg (Anti-HBeAg)

Antibodies to HBeAg appear during the recovery stage and in some cases persist for 10 to 20 years (sometimes more) after acute hepatitis B.

Rice. 23. Antibodies are produced by cells of the patient’s immune system in response to pathogen antigens. The higher the immune response, the higher the concentration of antibodies in the blood serum.

Main markers of viral hepatitis B (table)

Periods of the disease	Main markers of viral hepatitis B
Incubation period	PCR for hepatitis B is the first diagnostic marker of the disease. The reaction becomes positive after 4 weeks from the onset of the disease.
	HbsAg begins to be determined in the patient’s blood serum during the acute period of the disease - 2 - 8 weeks after infection (at the end of the incubation period), is determined during the anicteric and icteric periods and then disappears during the recovery period, that is, after 2 - 6 months in case of successful cure.
	By the end of the incubation period, HbeAg and Anti-HBcor IgM can be detected in the blood serum.
Acute period	In the acute period, the main markers of infection are HbsAg and HBeAg, as well as Anti-HBcor IgM, HBV DNA and DNA polymerase.
	In the absence of HbsAg in the patient’s blood serum, the diagnosis is established based on the detection of class M antibodies: Anti-HBcor IgM and Anti-HBe IgM.
	In severe forms of hepatitis B, HbsAg in the blood serum is determined with the appearance of the first symptoms of jaundice.
	↓T-lymphocytes, ↓T-suppressors, T-helpers. With the development of cholestatic syndrome, biochemical cholestasis syndrome (+). During the acute anicteric period, ALT.
Convalescence period	(+) analysis for HBcIgG and HBeIgG antibodies. After 1 - 3 months. From the onset of the disease, ALT normalization begins.
Chronization of the process	The chronicity of the process is evidenced by the long-term (more than 6 months) persistence of antigens: HBsAg and HbeAg.
Curing chronic hepatitis B	In patients with chronic hepatitis, the appearance of HBcAg IgG antibodies indicates the completion of the disease.
Previous infection	A marker of past early disease is the detection of HBc IgG and Anti-HBs antibodies.
Carriage of HBV (previously treated hepatitis or reaction to the hepatitis B vaccine).	Detection of Anti-HBs.

Rice. 24. Liver cirrhosis is an extremely unfavorable outcome of the chronic form of the disease.

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Alya asks:

Good afternoon.
I have hr. hepatitis B virus
It was not detected by quality tests for several years.
Now I am pregnant and have passed a quantitative test:
Hepatitis B virus (quantitative analysis 1.2*10_4 IU/ml
It's a lot? Do I need treatment?

The level of hepatitis B found in your body is quite low. Only your attending infectious disease specialist can determine the need for treatment in the situation you describe. Most likely, you will be asked to undergo a re-examination in a month; if the amount of virus in the body increases, you will need to undergo a course of antiviral treatment. You can read more about the diagnosis and treatment of viral hepatitis in our section: Hepatitis.

Svetlana asks:

Hello! Help me decipher the tests. I passed quantitative PCR (2.7x10*2 IU DNA). Is treatment necessary and what kind? AST and ALT (32.6 and 32.9), and bilirubin 38.1. What does this mean, please tell me. Hepatitis B virus since childhood (I’m now 29 years old), it was always just a carrier state, no treatment was prescribed, I just took tests and an ultrasound and that’s it!!

Please specify the units of measurement for transaminases and bilirubin for correct interpretation of the data. Quantitative diagnostics using the PCR method indicates the presence of the hepatitis B virus; in your case, viral activity is minimal, i.e. you are a carrier of this virus, the virus is in an inactive form. It is recommended to take liver markers to determine the degree of activity of the process and whether there is any replication of the virus at the moment. Read more about viral hepatitis in a series of articles by clicking on the link: Hepatitis.

Irina asks:

Good afternoon.
Help me decipher the analysis. I tested blood for hepatitis B, PCR (quantitative method). Analysis response: 16.801 MEHBV/ml was detected (the letters seemed to be written correctly, the answer was written by hand). Waiting for your reply. Thanks in advance!

This conclusion indicates that you have previously suffered from viral hepatitis B. You can obtain additional information on the issue you are interested in in the appropriate section of our website by clicking on the following link: Polymerase chain reaction (PCR). In order to decide whether treatment is necessary, I recommend that you take a biochemical blood test, liver tests and personally consult with a hepatologist who will conduct an examination and prescribe treatment if necessary. Read more about this disease in the series of articles on our website: Hepatitis

Yulia asks:

I'm pregnant right now, I took tests for geratitis, the result came back HBsAg 20.78 IU/l
what does this mean?

This conclusion indicates that you have previously suffered from viral hepatitis B. If there are no complaints, only preventive treatment is required; a hepatologist can prescribe it for you. You can obtain additional information in the following section of our website: Hepatitis

Anna asks:

Good afternoon. Please help me decipher the tests for hepatitis B.
HBs Ag negative,
HBe Ag negative,
anti HB core total positive,
anti HBe negative,
anti HBs (quantity) 8 mU/ml (Lack of immune response: = 10.

I am 29 years old and 13 weeks pregnant, do I have hepatitis and could it affect my baby?
Thank you.

This conclusion indicates that you have previously been vaccinated against hepatitis B or have had viral hepatitis B in the past. To obtain more detailed information, you need to personally visit an infectious disease specialist. You can get more detailed information on the issue you are interested in in the corresponding section of our website by clicking on the following link: Hepatitis Laboratory diagnostics

Tanya asks:

Hello. Help me decipher the DNA test for hepatitis B 5540IU/ml

This conclusion means that you have been diagnosed with viral hepatitis B, the viral load is quite high, so primary infection or an exacerbation of a chronic disease cannot be ruled out. We recommend that you personally visit an infectious disease specialist for an examination and prescription of adequate treatment, as well as a blood test for biochemical liver tests.

You can obtain more detailed information on the issue you are interested in in the corresponding section of our website by clicking on the following link: Viral hepatitis C - diagnosis and prevention. You can also obtain additional information in the following section of our website: Biochemical liver tests and in the series of articles: Laboratory diagnostics

Tanya comments:

I donated blood for biochemistry. They said the test was good. The liver copes with the virus. No treatment is required. What does this mean? and in the city where I live there is no infectious disease specialist.

Given the high viral load, antiviral treatment is mandatory, so we recommend that you visit an infectious disease specialist who, after an examination, will prescribe you adequate treatment. You can get more detailed information on the issue you are interested in in the appropriate section of our website by clicking on the following link: Hepatitis. You can also get additional information in the following section of our website: Laboratory diagnostics

Ruslan asks:

386 MO/ml (656 DNA copies/ml) fresh analysis
or
5.06x10*4 copies/ml (1.69x10*4 IU/ml) previous analysis.

Please specify which test you took.

Ruslan comments:

indicators 386 MO/ml (656 copies of DNA/ml) analysis was taken on 08/28/14
indicators 5.06x10*4 copies/ml (1.69x10*4 IU/ml) was taken a year ago
I can’t understand which indicators are greater, since the units of measurement are different.
Help me understand where there is more?

Please specify what kind of examination you underwent (hepatitis B, hepatitis C).

Ruslan asks:

Passed PCR quantitative determination of hepatitis B

There is probably an error in the result of 386 IU/ml, since the units of measurement in this case may be IU/ml. According to the latest result, there is a positive trend. To conduct an examination and determine further monitoring tactics, we recommend that you personally visit your attending infectious disease specialist.

Marina asks:

Good afternoon. Help me decipher the tests
Hepatitis B HbsAg - sex.
Hepatitis B Anti-HbeAg – sex.
Hepatitis B Anti-HB-cor IgG – sex.
Hepatitis B HbeAg – negative
Hepatitis B Anti-HB-cor Ig M - negative

According to the report provided, you have previously suffered from viral hepatitis B; a chronic course of the disease cannot be ruled out. In this situation, we recommend that you take a biochemical blood test (liver samples), do an ultrasound, and personally consult with your attending infectious disease specialist to conduct an examination and determine further tactics for observation and treatment.

Marina asks:

Good afternoon. Help decipher the tests Hepatitis B HbsAg - gender. Hepatitis B Anti-HbeAg – sex. Hepatitis B Anti-HB-cor IgG – sex. Hepatitis B HbeAg – negative Hepatitis B Anti-HB-cor Ig M - negative
HBV-DNA (PCR-quantitative) - 1.6x10*3 IU/ml

This conclusion means that you are infected with viral hepatitis B. We recommend that you additionally undergo an ultrasound of the liver and take biochemical liver tests. After receiving the results, you need to personally consult with your attending infectious disease specialist, who will conduct an examination and prescribe you adequate treatment.