HBV screening requests

• Hepatitis B core antibody (anti-HBc) testing is performed as the initial screening test for chronic infection (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.

Commonly requested HBV investigations include:​

• Hepatitis B surface antigen (HBsAg)​
  • A positive surface antigen suggests active disease
• Hepatitis B surface antibody (HBsAb/anti-HBs)​
  • A positive surface antibody suggests development of immune response either through vaccination or active hepatitis B infection
• Hepatitis B core antibody (HBcAb/anti-HBc)​
  • This is the routine screening investigation and suggests exposure to Hepatitis B virus, but not necessarily active infection
• Hepatitis B DNA PCR (HBV DNA)​
  • A positive result suggests active Hepatitis B disease and it can be used to monitor response to therapy

• Refer all those with chronic hepatitis B virus infection (HBsAg positive for > 6 months). 
• HBsAg negative, anti-HBc positive serology indicates past infection and ongoing follow up is usually not required.
  
  • These individuals may be at risk of HBV reactivation if undergoing immunosuppression.
  • If the patient is on/being considered for immunosuppressive therapy, review local guidelines around HBV prophylaxis and consider discussion with HBV services if management is unclear

The decision as to where to refer should usually be based on geographical zoning unless:

• there is established liver disease (in which case refer to CLDD at RIE)
• there is co-infection with other blood borne viruses (in which case refer to RIDU at WGH)
• there is patient preference to be referred to a specific unit

Required information for referral

• Results of hepatitis B serology and liver function tests - only refer those with active infection
• Has the patient been told of their results and are they expecting an appointment?
• Is an interpreter needed, if so which language?
• Is the patient currently on HBV treatment and if so, when is a further prescription due?
• Is partner/household testing/vaccination underway?

Regional Infectious Diseases Unit (RIDU)

Wards 41/42/43 Western General Hospital

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 registrar 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

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.

A clinically useful, reliable, comprehensive, up-to-date, evidence-based drug-drug interaction resource, freely available to healthcare workers, patients and researchers.

See HBV interaction checker

European Association for the Study of the Liver (EASL) 2017 Clinical practice guidelines on the management of hepatitis B virus infection.