From the Guidelines
To confirm past Hepatitis C (HCV) and Hepatitis B (HBV) infections are treated and not active, order the following bloodwork: Hepatitis C antibody (anti-HCV), Hepatitis C RNA (HCV RNA), Hepatitis B surface antigen (HBsAg), Hepatitis B surface antibody (anti-HBs), and Hepatitis B core antibody (anti-HBc). These tests should be performed at least 6 months after any exposure to evaluate for chronic viral hepatitis, as recommended by the European Association for Haemophilia and Allied Disorders, European Haemophilia Consortium, ISTH, and World Federation of Hemophilia 1. The hepatitis C antibody will remain positive, indicating past infection, while a negative HCV RNA confirms successful treatment and no active infection. For hepatitis B, a negative HBsAg with positive anti-HBs indicates immunity (either from past infection or vaccination), while a positive anti-HBc confirms past infection. If HBsAg is positive, it suggests active infection, and further evaluation would be necessary, such as determining the level of HBV replication with a sensitive polymerase chain reaction (PCR) assay for serum HBV DNA 1. This panel provides a comprehensive assessment of both past infection status and current hepatitis activity, allowing for confident clinical decision-making regarding the patient's hepatitis status. Key points to consider when interpreting these results include:
- A positive anti-HCV indicates past HCV infection, while a negative HCV RNA confirms the infection is not active 1.
- A negative HBsAg with positive anti-HBs indicates immunity to HBV, while a positive anti-HBc confirms past HBV infection 1.
- The presence of HBsAg suggests active HBV infection, and further evaluation is necessary to determine the level of HBV replication and guide therapeutic strategies 1. It is essential to note that the management of liver disease in people with congenital bleeding disorders requires regular monitoring, and these tests should be performed at least once in their lifetime, with follow-up testing as needed to assess for chronic viral hepatitis 1.
From the Research
Bloodwork for Confirming Past HCV and HBV Infections
To confirm that past Hepatitis C (HCV) and Hepatitis B (HBV) infections are treated and not active, the following bloodwork is recommended:
- For HCV:
- Anti-HCV testing to detect antibodies against HCV, which indicates past or current infection 2
- HCV RNA testing to confirm active infection, as anti-HCV testing does not discriminate between active and past infection 2
- HCV core antigen assay, which can be used as a cost-effective and reflex test to confirm HCV infection in anti-HCV positive individuals 2
- For HBV:
- Testing for hepatitis B surface antigen (HBsAg) and antibodies to HBsAg (anti-HBs) to screen for hepatitis B serologic markers 3
- Testing for antibodies to hepatitis B core antigen to distinguish between immunity due to vaccination and immunity due to past infection 3
- Hepatitis B virus core-related antigen (HBcrAg) and HBV RNA, which are new biomarkers that may reflect intrahepatic cccDNA status and can be used to monitor treatment response 4
Interpretation of Test Results
The interpretation of test results is crucial in determining the status of HCV and HBV infections.
- A positive anti-HCV test result indicates past or current HCV infection, while a negative result indicates no infection or a very early infection 2
- A positive HCV RNA test result indicates active HCV infection, while a negative result indicates no active infection 2
- A positive HBsAg test result indicates current HBV infection, while a negative result indicates no current infection or immunity due to vaccination or past infection 3
- A positive anti-HBs test result indicates immunity to HBV due to vaccination or past infection, while a negative result indicates no immunity 3