Silent Passenger: Incidental Hepatitis B in Abnormal Liver Function Workups

Abstract

Background: Hepatitis B virus (HBV) infection affects more than 296 million people worldwide and remains a leading cause of chronic liver disease and hepatocellular carcinoma. Many individuals remain asymptomatic, leading to incidental detection during routine evaluations. Screening individuals with abnormal liver function tests (LFTs) can provide an opportunity for early diagnosis and intervention. Methods: This descriptive study was conducted over one year (September 2023-September 2024) at a tertiary care center in Tamil Nadu. A total of 175 adult patients with abnormal LFTs detected during the routine master health checkups were screened for HBV surface antigen (HBsAg) using lateral flow immunochromatography (ICT) and chemiluminescent immunoassay (CLIA). Patients with known HBV infection, those under 18 years, and recently vaccinated individuals were excluded. Results: Of 175 samples, 11 (6.3%) tested positive by ICT, while 14 (8.0%) were positive by CLIA. All ICT-positive samples were confirmed by CLIA. The additional three cases detected only by CLIA highlight its superior sensitivity. Among positives, 9 were male and 5 were female. Age distribution showed most cases were in the 30–50 years group. Conclusion: Incidental detection of HBV in patients with abnormal LFTs during health checkups is valuable for identifying asymptomatic carriers. CLIA demonstrated better sensitivity compared to ICT, suggesting its preferred use in screening. Routine inclusion of HBsAg testing in health checkups can improve early diagnosis, reduce transmission, and guide appropriate follow-up and management.