Hepatitis

553
LECTURE 
ON 
HEPATITIS B PROFILE INTERPRETATION
 BY 
MLS ABUBAKAR B. USMAN
 HELD AT 
MEDICAL LAB. LEARNING WHATSAPP ON SEPTEMBER 24th, 2017

Thank you very much admin for the introdction and for giving me the opportunity to share my little knowledge with my colleagues both seniors and juniors

Hello good evening  to you all. I am Mls Abubakar B. Usman. Tonight, we will discussing on Hepatitis B Profile

Before I go deep into the discussion, I will like to recap on the word Hepatitis. Hepatitis is an inflammation of the liver. The condition can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer. Hepatitis viruses are the most common cause of hepatitis in the world but other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases can also cause hepatitis.

I hope we are flowing together

There are 5 main hepatitis viruses, referred to as types A, B, C, D and E. These 5 types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread. In particular, types B and C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of liver cirrhosis and cancer.

 Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids. Common modes of transmission for these viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B transmission from mother to baby at birth, from family member to child, and also by sexual contact.

 But we are going to discuss more on hepatitis B

As I have mention earlier, Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus (HBV). It is a major global health problem. It can cause chronic both and acute infection and puts people at high risk of death from cirrhosis and liver cancer.

 The hepatitis B virus can survive outside the body for at least 7 days.During this time, the virus can still cause infection if it enters the body of a person who is not protected by the vaccine.

What I mean is the virus survive out site a living body let say your work bench for 7 days only. The incubation period of the hepatitis B virus is 75 days on average, but can vary from 30 to 180 days. The virus may be detected within 30 to 60 days after infection and can persist and develop into chronic hepatitis B.

In highly endemic areas hepatitis B is most commonly spread from mother to child at birth (perinatal transmission), or through horizontal transmission (exposure to infected blood), especially from an infected child to an uninfected child during the first 5 years of life. The development of chronic infection is very common in infants infected from their mothers or before the age of 5 years

Hepatitis B is also spread by percutaneous or mucosal exposure to infected blood and various body fluids, as well as through saliva, menstrual, vaginal, and seminal fluids. Sexual transmission of hepatitis B may occur, particularly in unvaccinated men who have sex with men and heterosexual persons with multiple sex partners or contact with sex workers. Infection in adulthood leads to chronic hepatitis in less than 5% of cases. Transmission of the virus may also occur through the reuse of needles and syringes either in health-care settings or among persons who inject drugs.

In addition, infection can occur during medical, surgical and dental procedures, through tattooing, or through the use of razors and similar objects that are contaminated with infected blood

 I will like some one to explain Acute and chronic infections for the house because I will be using the words regularly. Because it is very important to establish chronic and acute infections when it comes to HBV

Lets move to diagnosis of HBV

It is not possible, on clinical grounds, to differentiate hepatitis B from hepatitis caused by other viral agents and, hence, laboratory confirmation of the diagnosis is essential. A number of blood tests are available to diagnose and monitor people with hepatitis B. They can be used to distinguish acute and chronic infections.

Laboratory diagnosis of hepatitis B infection begin on the detection of the hepatitis B surface antigen (HBsAg). After which a more test is required for confirmation and establishing acute and chronic infection

This test is called HEPATITIS B PROFILE

But do I need to explain how HBsAg is done??? I want to assume we can all do it.
A strip is use in HBsAg: a line in both control and test zone indicates a positive test. While a single line in the control band signifies negative result. Only a person with a positive result to HBsAg is  qualified for Hepatitis profile.

Even though you can do hepatitis B profile to check if you are immune to HBV or not. And if you are, which type it is Natural immunity or Aquired i.e Vaccination?

When some one is immune to HBV, it means you can’t get Hepatitis disease. When I explain how to interpret hepatitis B profile result you will understand how to check for immunity against hepatits B from the profile.

Now Hepatitis B profile
The parameters investigated in Hepatitis B profile Are

  1. HBsAg(Hepatitis B srface antigen)
  2. HBsAb( Hepatitis B surfqce Antibody)
  3. HBcAb (Hepatitis B core antibody)
  4. HBeAg (Hepatitis B e Antigen)
  5. HBeAb(Hepatitis B e antibody.

All the literature I have consulted none gave any name to the e. But I called it envelope.

So now if you look well you will understand that the virus will have 3 antigen in the blood and in return the body will produce 3 antibodies

The antigens are Surface antigen, Core antigen and envelope antigen.

Now when the virus is in the system the first antigen that will be detectted is Surface, followed by the core and then the envelope

So when you run a profile test and the HBsAg shows positive that is to further confirm your earlier test using the strip and HBsAb shows positive that is to show that your body is already fighting and you have produce antibodies against the virus surface antigen.

 The profile kit doesn’t contain core antigen but for the sake of understanding you body can’t produce antibody without an antigen. It only contain core ab.

Now when you are positive to core antibody meaning the virus has replicated in your system and your system has already produce antibody against the core antigen.

So it goes to the envelope. So see how easy this is. I have a picture I want to share with the class so that we will collectively interpret.

Item 1 says that person is susceptible why?
Because he is negative to the virus and he has no antibody against the three antigens of the virus.
Are we all clear?

 Item 2 says Immune due to natural immunity because he has antibodies agaist the surface Ag and core Ag and envelope. It is natural because the vaccine does not contain core and envelope ag.

 Item 3 says immune due to vaccination. The vaccine contain only surface Ag so he can only prodce surface anbody but not core or envelope.

 Item 4 says it is in incubation period but I believe I don’t have to explain this as the class is understanding and I know you know why. Is because all the antigens are positive and none of the antibody is positive. So from our basic immunology we know that the immune system is not even aware of the virus hence we say it is in incubation.

The test should be repeated after 3 months

Now Acute. It is accute because surface Ag is positive
Core Ab is positive meaning core antigen is postive
The body is not fighting becase no surface Ab
Envelope Is positve meaning virus is actively replicatin

Last item is chronic because the last antigen to apper i.e envelop is presnt and atibodies are already been produce against it.

It is important to note that the body can only produce atibodies against the surface antigen when the virus is not actively replicatin and the body is in recovery.

Are we all good?

 I will now open room for Question and answer and also invite my oga at the top in person of @⁨Kenneth Ijere⁩ To help in further explanation.

Question

Please, can you correlate Hepatitis B profile test with HBV viral load?

Ans: You some times interprete ur profile using viral load result as control But since viral load is expesive it cost nothin less than 20k in government hospital U only request for viral load  wen u establish actute or chronic infection usin profile. Since we knw viral load is jst to check the copies of viral particles / ml of the blood.

 Is it advisable to start treatment after the the strip test is positive without other parameters?

Ans: No it is not, After strip test do profile to be sure of the stage
Some acute stage can be cured by the body without treatment

 Is the liver at higher risk in this stage or is it at the acute stage?

Ans: Liver is more at risk when the there is no surface ab

Can it be used to monitor tx?

Ans: You use LFT and USS for monitoring. You can as well use viral load but remember cost implication and also accessability

God bless you sir.  Why is it necessary to carry out the profile? After the HBsAg test positive can’t treatment commence immediately?

Ans: It tell you the stage of the infection so as to know how to treat.
Treatment of accute and chronic differs

Pls sir, can HBsAg be positive and all LFT parameters

  • HBsAg :   +
  • HBsAb:     –
  • HBeAg :   –
  • HBeAb :   +

 What would be your remark/comment on the above profile result. More than 70% if cases in my Lab are shown above.

Ans: This is basically a chronic stage there is antibody against the e and c antigen bt no surface antiboy so that shows is a long infection and the body is fighing but not winning since no ab on surface so the patient need to be treated wit drugs
In this case VL is recommended with LFT of course

 Pls can HbsAg be positive and all the liver functions test are within the reference ranges?

Ans: Yes at acute stage and incubation period. Chronic stage

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