What is hepatitis?

Early diagnosis and treatment for hepatitis can help to protect you from some kinds of serious liver disease. But what is hepatitis, and how do you know if you need a hepatitis blood test? 

You may be at an increased risk of hepatitis because of your job, certain medications or drugs, excess toxins, or if you visit a high-risk country. Your doctor may also want to check whether you have a hepatitis infection if your Liver Function Blood Test results indicate that you need further investigation.  

To help you understand more about hepatitis and hepatitis blood testing in the UK, we look at: 

• What is hepatitis?
• What are the symptoms of hepatitis?
• Hepatitis A – diagnosis, testing, and treatment
• Hepatitis B – diagnosis, testing, and treatment
• Hepatitis C – diagnosis, testing, and treatment
• Who needs a hepatitis blood test?

What is hepatitis?

Hepatitis is the inflammation of the liver and is usually caused by a viral infection or excess toxins. It can be acute (where the infection lasts six months or less) or chronic (where inflammation lasts longer than six months).  

Your liver is a vital organ that processes nutrients, filters the blood, and fights infections - so identifying the early stages of liver damage can help you to stay well. Heavy alcohol use, toxins, some medications, and certain medical conditions can cause hepatitis.  

The three most common viral types of hepatitis are:  

• Hepatitis A  
• Hepatitis B  
• Hepatitis C  

What are the symptoms of hepatitis?

Usually, acute hepatitis presents no noticeable symptoms, but if symptoms do develop, they can include:  

• Yellowing of the eyes and skin (jaundice)  
• Fatigue  
• Flu-like symptoms  
• Pale stools  
• Dark urine  
• Unexplained weight loss  
• Joint and muscle pains  
• Abdominal pain  
• Loss of appetite  

Hepatitis A - diagnosis, testing, and treatment

Hepatitis A is a short-term disease caused by the hepatitis A virus (HAV).  

Hepatitis A is usually transmitted through food or water contaminated with faeces from an already infected person and is more likely to be found in countries where sanitation is poor.   

Though sometimes severe, hepatitis A usually passes within a few months. There is no treatment for hepatitis, other than relieving the symptoms, such as itching and nausea, but there is a vaccination against the virus for people who are at a high risk of contracting the infection or who are travelling to a high-risk country.  

How is hepatitis A diagnosed?  

You will need a blood test that checks for hepatitis A antibodies to tell you whether the hepatitis A virus is responsible for liver damage. 

A Liver Function Blood Test can indicate whether a hepatitis blood test is necessary by measuring your liver biomarkers as damaged liver cells (either by inflammation or infection) leak their contents. 

Liver cells have two enzymes, aspartate transferase (AST) and alanine transferase (ALT), present in much higher quantities in the liver than in the blood. So, when the liver is damaged, a blood test can detect a rise in many liver enzymes, notably ALT. Although an increase in liver enzymes indicates the liver cells are damaged, this increase alone will not explain the cause of the damage.  

Hepatitis B - diagnosis, testing, and treatment

The hepatitis B virus (HBV) causes hepatitis B, which transmits through contact with infectious body fluids of an infected individual, such as blood, semen, or vaginal secretions. The virus can spread through unprotected sex with an infected partner and from someone pregnant and infected to their baby.  

Usually, adults can fight off hepatitis B and recover within a couple of months - sometimes, they may need the help of antiviral medication. However, if a child is infected, they usually develop a long-term infection (chronic hepatitis B), which can lead to scarring of the liver and liver cancer. This outcome is becoming rarer due to hepatitis B screening during antenatal visits.  

In the UK, a vaccination against hepatitis B is recommended for people in high-risk groups. 

People who are at a high risk of hepatitis B: 

• Healthcare and lab laboratory workers  
• People who inject drugs  
• Men who have sex with men   
• Children born to mothers with hepatitis B  
• People travelling to high-risk countries  

In 2017, the hepatitis B vaccine was added to the routine immunisation programme in the UK to allow all children to benefit from protection from the virus [1].  

We work with employers to offer occupational immunity testing services to their employees to help protect them against this increased risk.  

How is hepatitis B diagnosed?  

Blood tests that look for proteins from the surface of the virus are used for hepatitis B (and C) instead of tests that detect the virus’ DNA.  

The specific DNA the hepatitis B blood tests look for include:  

• Hepatitis B surface antigen (HBsAg) - A positive result for the HBsAg antigen shows a person is infected with the hepatitis B virus and can spread it to others through their blood. Testing for the HBsAg antigen alone does not determine if the infection is acute or chronic.  
• Hepatitis B surface antibody (HBsAb) - A positive result for the HBsAb antibody shows a person is protected/immune against the hepatitis B virus and is, therefore, unable to spread the virus to others. This protection may be due to the hepatitis B vaccine or a successful recovery from a past hepatitis B infection. This test is not routinely included in blood bank screenings.  
• Hepatitis B core antibody (HBcAb) - A positive result for the HBcAb antibody shows a past or current hepatitis B infection. Unlike a positive result for the HBsAb antibody, the hepatitis B core antibody does not protect against the hepatitis B virus. Your doctor will need to test for both the HBsAg and anti-HBs to understand a positive HBaAb result. 

Hepatitis C - diagnosis, testing, and treatment

Within the UK, hepatitis C (HCV) is the most common type of viral hepatitis and, similarly to hepatitis B, is spread through blood-to-blood contact with an infected individual. Recreational drug use and sharing needles play a large part in the spread of the virus.   

Hepatitis C is usually a chronic infection as the virus will remain in the body for several years for most people with HCV. Although there is currently no HCV vaccine, antiviral drugs can treat it.  

Hepatitis C often doesn't have any noticeable symptoms until the liver is significantly damaged. Because of this, many people with HCV are unaware they have the virus and may have only flu-like symptoms, which may also indicate a range of other health issues. The only way to know if you are infected with hepatitis C is to have a blood test.  

How is hepatitis C diagnosed?  

A positive result from a hepatitis C antibody test indicates whether you have been exposed to HCV. But this positive result does not necessarily mean a current infection, as your immune system may have cleared the virus from the body. A second blood test called a Polymerase Chain Reaction (PCR) test is required after a positive result to confirm a current infection.  

Who needs a hepatitis blood test?

You or your doctor may order a hepatitis blood test if you are at an increased risk of contracting the virus or if your Liver Function Blood Test results are abnormal. A blood test can show whether you have a current or past hepatitis infection.  

You may also need a hepatitis test if you are at a higher risk of contracting hepatitis through your work, where you may benefit from occupational immunity testing. 

Related tests 

• Hepatitis A Immunity Home Blood Test – This simple blood test establishes whether you have immunity to Hepatitis A. 
• Hepatitis B Profile Home Blood Test – This blood test not only checks for a hepatitis B infection but differentiates between immunity due to a previous infection or vaccination. 
• Hepatitis C Home Blood Test – This simple blood test tests for the presence of antibodies to the hepatitis C virus. 
• Hepatitis A B and C Profile Blood Test – With this test, you can check for a current or previous infection of hepatitis A, B, or C.  

References 

1. https://www.nhs.uk/conditions/hepatitis/