Intended for healthcare professionals

Practice Rational Testing

Ordering and interpreting hepatitis B serology

BMJ 2014; 348 doi: (Published 17 April 2014) Cite this as: BMJ 2014;348:g2522
  1. Scott A Davison, staff specialist1,
  2. Simone I Strasser, senior staff specialist2, clinical associate professor3
  1. 1Department of Gastroenterology, Liverpool Hospital, Sydney, Australia
  2. 2AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
  3. 3Central Clinical School, University of Sydney, Sydney, Australia
  1. Correspondence to: S I Strasser simone.strasser{at}

The authors explore how doctors in primary care can identify, investigate, and refer patients with hepatitis B infection

Learning points

  • Opportunistic testing for hepatitis B virus (with HBsAg, anti-HBc, and anti-HBs) in people at high risk for hepatitis B virus is essential for diagnosis and appropriate management

  • Most patients found to be positive for HBsAg will have chronic hepatitis B; test for HBeAg, anti-HBe, hepatitis B virus DNA, and ALT to determine the phase

  • Patients with chronic hepatitis B and hepatitis B virus DNA levels >2000 IU/mL, increased ALT level, or any signs of advanced fibrosis or cirrhosis, or pregnant women found to be seropositive for HBsAg require specialist review

  • Patients with inactive hepatitis B may not require specialist referral, but should be monitored at least once a year for change of disease state

Tam is a 41 year old accountant who left Vietnam as a refugee with his mother in 1980. Normally fit and well, he presents to his general practitioner for assessment of heartburn. During the consultation he mentions that his 64 year old mother recently died of liver cancer. He thinks he was told many years earlier that he was a “healthy carrier” of the hepatitis B virus but has never had a follow-up consultation.

Who should be tested for hepatitis B virus?

Hepatitis B infection is a major public health problem around the world. Most cases of chronic infection are acquired through mother to child transmission at birth or through exposure to the virus in early childhood.1 The major complications are hepatocellular carcinoma and decompensated cirrhosis, occurring in 15-25% of people with chronic hepatitis B infection.2 The burden of disease occurs in countries of Asia, Africa, Central America, and eastern Europe. Testing for hepatitis B virus is recommended for all those born in countries with a high and intermediate prevalence (fig 1). …

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