What is the check-up process to follow and how should I be treated?” – WWN

Due to the persistent alteration of transaminase values, my doctor prescribed me hepatitis B and hepatitis C tests. After testing positive for the HBsAg test, I was asked for a second test: HBV-DNA. This also tested positive (3,460 IU/ml). However, hepatitis C tests are negative. What is my situation?

He replies Roberta D’Ambrosiohead of Gastroenterology and Hepatology Clinics, Ospedale Maggiore Policlinico, Milan (GO TO THE FORUM)

The HBsAg test (ex-Australia antigen) is used to demonstrate the presence of the hepatitis B virus (HBV) in the body and is the test that is used in the first level (screening or post-exposure to risk factors). This virus is localized in the blood, in other biological fluids (for example saliva, seminal fluid) and in the liver, where it can cause inflammation (hepatitis) And fibrosisi.e. the scar that replaces the diseased cells damaged by the virus. The HBV-DNA test, however, indicates the quantity of virus circulating in HBsAg positive subjects. Having this information is extremely important, because it not only allows us to estimate the risk of transmission of the infection following contact with blood or other biological fluids, but it allows us to evaluate the need for antiviral therapies. Currently anti-HBV treatment is based on the use of oral medications – nucleos

The investigations

This therapy must be taken for an indefinite period (for life), under medical supervision, and it is not burdened by significant side effects. In cases where the hepatitis B virus does not cause disease (hepatitis and/or fibrosis), treatment is not necessary. One of these conditions is that of the so-called «inactive carrier», which shows persistently normal transaminase and Fibroscan values ​​and extremely low viremia values ​​(HBV-DNA). To diagnose liver disease – and regardless of the HBV-DNA values ​​- it is necessary to complete the tests by carrying out some specific serological tests (HBeAg, anti-HBe) and routine biochemical tests (bilirubin, transaminase, ALP, gGT, complete blood count). It is also essential to look for any co-infections, which may share the same modes of transmission as HBV: not only that HCV (anti-HCV), but also HIV (anti-HIV) e HDV (anti-HDV). The virusdelta hepatitis (HDV), in particular, infects only HBV-infected individuals and may be responsible for severe forms of the disease even at a young ageif not diagnosed and treated.

Vaccination

Lastly, Fibroscan and ultrasound allow us to understand the severity of the liver disease, as already mentioned. Regardless of the form (mild or severe) of HBV-related liver disease, It is essential to remember the very important role of anti-HBV vaccination. The risk of contagion (parenteral or sexual) is proportional to the viral load; vaccination is the only tool we have for abolish the risk of transmission of infection, especially in the presence of detectable viremia or where anti-HBV treatment is not indicated due to the absence of liver damage. In fact, in subjects in whom high viral loads are not accompanied by liver disease, the need for anti-HBV treatment is debated, although reducing the viral load could reduce the risk of contagion. It seems clear that anti-HBV vaccination plays an even more fundamental role.