Chronic HBV is diagnosed with a battery of hepatitis B lab tests that includes nearly a dozen different blood tests. The tests will show whether che person is infectious and confirm that the disease is chronic, among other findings. The findings are usually supported with results of imaging studies and a liver biopsy.
Chronic hepatitis B is further categorized as (a) inactive hepatitis B surface antigen (HBsAg) carrier state; (b) chronic hepatitis B, either HBeAg-positive or HBeAg-negative; and (c) resolved chronic hepatitis B.
Patients in the first group, the inactive HBsAg carrier state, typically display no symptoms. They feel fine, their AST and ALT levels are normal, and their livers show no significant damage. Doctors advise these patients to get tested at least once a year and sometimes more frequently. Their viral load (HBV-DNA level) is usually low.
Chronic HBV patients, the second group, carry HBV DNA, usually at a higher level, meaning that whether they test positive or negative for HBeAg, they are contagious, and their AST/ALT levels remain elevated. HBeAg-positive patients have a small chance (up to 15 percent) of seeing a spontaneous remission.
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Those in the third group, individuals diagnosed with resolved chronic HBV, face the most optimistic futures. In patients who resolve, liver enzymes return to normal levels and the risk of developing cirrhosis or liver cancer decreases dramatically. However, if their immune systems ever become deeply suppressed, as happens following chemotherapy or an organ transplant, their chronic hepatitis B can reemerge.
Overall, the long-term prognosis for chronic HBV patients is hopeful: only about 20 percent develop cirrhosis in the five years following their diagnosis. These rates are variable and depend on where the virus was acquired. Patients whose HBV was detected in the early stages seem to fare better, as do those who abstain from alcohol and those who have not also contracted hepatitis C or D.
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Patients diagnosed with HBV will often hear the phrase “HBV genotype,” which refers to the genetic nature or category of a patient’s HBV There are seven different hepatitis B genotypes, labeled genotype A through G, and each is identified with a blood test. In the United States and Europe, genotypes A and D are the most prevalent, while other genotypes are more common in other parts of the world. The significance of HBV genotypes isn’t entirely clear, though researchers are evaluating certain HBV genotypes in terms of the severity of the patients liver disease and response to treatment.
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