A Chronic Hepatitis B Diagnosed? What Does the Viral Load Test Results Indicate about Your HBV DNA?
Your doctor has most likely ordered multiple blood tests to determine the stage of your infection and whether your liver is being harmed by your chronic hepatitis B infection. All of these findings are taken into account by doctors when determining whether you require therapy and how frequently you should be checked.
We’ll look at how the HBV DNA or viral load test, one of the tests, can provide you with an early indication of your health and hepatitis B infection. A blood sample is used for the HBV DNA test, and the Polymerase Chain Reaction (PCR) method quickly produces HBV DNA fragments for measurement. International units per millilitre (IU/mL) are commonly used to quantify viral load nowadays. Still, it is measured in certain labs and areas using the previous unit of measurement, copies per millilitre (copies/mL).
A single international unit has roughly 5.6 copies, therefore 5,000 copies/mL is equivalent to 893 IU/mL if you ever need to convert copies into international units. In order to monitor your progress, don’t forget to maintain copies of your lab records on hand. A spreadsheet in Excel is quite useful.
Using the same lab for your test is a good idea because the sensitivity of HBV DNA tests can differ throughout labs. Less than 200 IU/mL is typically measured in labs. Everyone suffering from chronic hepatitis B should be informed that the viral load is deemed “undetectable” when it falls below the threshold.
Method Name: Real-Time Polymerase Chain Reaction (qPCR) based on TaqMan probe.
Reporting Name: HBV DNA Detect/Quant
Specimen Type: Plasma
Specimen Minimum Volume: 1.5 mL
Specimen Stability Information
Specimen Type | Temperature | Time | Special Container |
Plasma | Frozen (preferred) | 84 days | |
Refrigerated | 6 days |
Clinical Information
Hepatitis B surface antigen (HBsAg) and hepatitis B core IgM antibody (anti-HBc IgM) are examples of HBV serologic markers that can be used to diagnose acute or chronic hepatitis B virus (HBV) infection. Molecular assays can also be used to detect HBV DNA. While serologic techniques are typically utilised to diagnose acute and chronic HBV infection, HBV DNA detection and quantification in serum can be helpful in the following ways:
- Identify a few examples of early acute HBV infection (before HBsAg appears).
- Identify active from inactive HBV infections
- Track a patient’s reaction to anti-HBV treatment
Serum HBV DNA is a consistent indicator of active HBV replication. Within 30 days of infection, HBV DNA levels can be found; they typically peak during acute hepatitis and then progressively decline and vanish when the illness clears up on its own. Testing for HBV DNA in serum can be helpful in diagnosing acute HBV infection in cases of acute viral hepatitis when HBsAg test findings are unclear. This is because HBV DNA can be found around 21 days before HBsAg usually emerges in the blood.
Chronic HBV infection patients do not get rid of the virus and continue to test positive for HBsAg. These cases can be further divided into two groups: chronic inactive (nonreplicative) HBV (low or undetectable HBV DNA levels, HBeAg-negative) and chronic active (replicative) HBV (high HBV levels, hepatitis Be antigen [HBeAg]-positive). By distinguishing between active and inactive disease phases, serum HBV DNA levels can be used to assess the status of a chronic HBV infection. Compared to patients with an inactive HBV infection, those with a chronic active infection are more contagious and have a higher chance of developing a more serious liver condition. It is possible for a dormant chronic HBV infection to reactivate (becoming HBeAg-negative) with or without the serum HBeAg resurfacing. Among patients with HBeAg-negative illness, HBV DNA detection is the sole trustworthy indicator of active HBV.
For patients who test positive for HBeAg, the long-term suppression of viral replication with undetectable HBV DNA, HBe seroconversion, and elimination of HBeAg is the therapeutic aim of anti-HBV therapy. In individuals with HBeAg-negative illness, long-term viral suppression is usually the aim of therapy. Treatment with nucleoside/nucleotide analogues (e.g., lamivudine, adefovir, entecavir, tenofovir) can lead to the emergence of drug-resistant strains of HBV, which are characterised by the return of HBV DNA in serum after it had become undetectable or the increase of HBV DNA levels after a decline.
Reference Values
Undetected
- The quantification range of this assay is 10 to 1,000,000,000 IU/mL (1.00 log to 9.00 log IU/mL).
- An “Undetected” result indicates that hepatitis B virus (HBV) DNA was not detected in the serum specimen.
- A result of “<10 IU/mL (<1.00 log IU/mL)” indicates that HBV DNA is detected, but the HBV DNA level present cannot be quantified accurately below this lower limit of quantification of this assay. When clinically indicated, follow-up testing with this assay is recommended in 1 to 2 months.
- A quantitative result expressed in IU/mL and log IU/mL indicates the degree of active HBV viral replication in the patient. Monitoring HBV DNA levels over time is important for assessing disease progression or monitoring a patient’s response to anti-HBV therapy.
- A result of “>1,000,000,000 IU/mL (>9.00 log IU/mL)” indicates the presence of active HBV viral replication, and the HBV DNA level present cannot be quantified accurately above this upper limit of quantification of this assay.
- An Inconclusive result with the comment “Submit a new specimen for testing if clinically indicated” indicates that inhibitory substances may be present in the specimen. When clinically indicated, collection and testing of a new specimen is recommended.
Clinical Reference
- Bonino F, Piratvisuth T, Brunetto MR, Liaw YF: Diagnostic markers of chronic hepatitis B infection and disease. Antivir Ther. 2010;15 Supply 15:35-44
- World Health Organization: Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection. World Health Organization; March 2015. Accessed May 12, 2023. Available at www.who.int/publications/i/item/9789241549059
- Terrault NA, Bzowej NH, Chang KM, Hwang JP, Jonas MM, Murad MH: AASLD guidelines for treatment of chronic hepatitis B. Hepatology. 2016;63(1):261-283
- World Health Organization: Guidelines on hepatitis B and C testing. World Health Organization; February 2017. Accessed May 12, 2023. Available at www.who.int/publications/i/item/9789241549981
Day(s) Performed
Monday through Saturday
Report Available
1 to 3 days
Test Code Information
Test ID | Test Order Name | Order LOINC Value |
HBVQN | HBV DNA Detect/Quant | 3500 |