Patients with chronic hepatitis B virus infection are managed within the Centre for Liver and Digestive Disorders (CLDD) at the Royal Infirmary of Edinburgh, or the Regional Infectious Diseases Unit (RIDU) at the Western General Hospital.
Testing:
Hepatitis B core antibody (anti-HBc) testing is performed as the initial screening test for chronic infection (4.9mL brown capped gel tube). The laboratory will reflexively test hepatitis B surface antigen (HBsAg) for patients being screened for BBV infection who are anti-HBc positive. It is important that the rationale for testing is clearly documented so that the laboratory can add the correct HBV markers.
| Interpretation of HBV markers | |||||
| Test | Acute HBV | Immunity following infection | Immunity following vaccination | Chronic HBV – active | Chronic HBV – inactive carrier |
| HBsAg | + | – | – | + | + |
| Anti-HBs | – | + | + | – | – |
| HBeAg | + | – | – | +/- | – |
| Anti-HBe | – | – | – | +/- | + |
| Anti-HBc | + | + | – | + | + |
| Anti-HBc IgM | + | – | – | – | – |
| HBV DNA | + | – | – | + | + (low level) |
| ALT | Elevated | Normal | Normal | Elevated | Normal |
If the screening test is negative, but there has been a potential exposure within the window period, then please offer repeat testing at least 3 months after exposure.
Please see the blood borne virus page for additional information on testing, referrals, primary care management and resources.
C.M & E.S/N.B 06-02-24
Who to refer:
All those with chronic hepatitis B virus infection (HBsAg positive for > 6 months).
Who not to refer:
Patients who are HBsAg negative should not be referred. If the HBsAg is negative but anti-HBc is positive this indicates past infection and ongoing follow up is not required. However, these individuals may be at risk of HBV reactivation if undergoing immunosuppression. If the patient is on/being considered for immunosuppressive therapy, the hospital specialty managing the immunosuppression/chemotherapy will usually discuss the need for preventative therapy directly with HBV services.
How and where to refer:
The decision as to where to refer should take into account geography and patient preferences. However, it is usually preferable for patients with established liver disease to be referred to the CLDD at RIE, and if patients who are co-infected with more than 1 BBV are referred to RIDU. Please do not refer to both services concomitantly.
- Regional Infectious Diseases Unit (RIDU)
Wards 41/42/43, Western General Hospital, Edinburgh
Tel. 0131-537 2820/2823 (OPD Reception)
RIDU are happy to see patients with evidence of active infection with HBV or HCV, and people living with HIV.
The on-call Infectious Diseases doctor can be contacted for advice, urgent clinic appointments and admissions – page via WGH switchboard 0131 537 1000.
New referrals can be made by SCI gateway, or by telephone to the on-call doctor where there are urgent concerns.
- Centre for Liver and Digestive Disorders (CLDD)
Royal Infirmary of Edinburgh, Little France
Tel. 0131-242 3063
The CLDD provides care, monitoring and treatment for people, with viral hepatitis with or without liver disease, and is more appropriate for those with advanced disease.
The on-call consultant and registrar can be contacted for advice, urgent clinic appointments and admissions – page via RIE switchboard.
New referrals should be made by SCI Gateway (or letter for those without SCI Gateway access) or urgently by telephone to the registrar or consultant on call.
All patients with HBV infection should be given general lifestyle advice, advice on minimising/stopping alcohol, and weight reduction/healthy eating advice if BMI >25. Patients should be offered testing for HIV and HCV infection, and for immunity to hepatitis A virus (HAV) infection. If there is no evidence of immunity to HAV (HAV IgG negative) then patients should be offered vaccination.
Any patient with an ALT above the upper limit of normal should be encouraged to attend specialist services, as treatment with oral anti-virals may be required.
Patients with chronic hepatitis who do not wish to be referred / do not attend are at risk of complications of cirrhosis / cancer and need to be aware of this. They should be strongly encouraged to accept referral to secondary care and every opportunity taken to prompt this and check LFTs if they present again. Please note that patients with an AST/ALT ratio greater than 1 are at risk of complications of cirrhosis.
If appropriate, patients with cirrhosis can be referred to the CLDD for enrolment into HCC surveillance, consisting of 6 monthly liver ultrasound and serum AFP measurements.
- Hepatitis Scotland – https://www.hepatitisscotland.org.uk/: its main page has an emphasis on Hepatitis C but the site contains Hepatitis B information too, including a Hepatitis B patient booklet.
- British Liver Trust
