Laboratory Testing for Past Hepatitis Infection Screening
To screen for past hepatitis infection, order hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc), hepatitis B surface antibody (anti-HBs), and hepatitis C antibody (anti-HCV) tests. 1
Hepatitis B Screening Panel
A complete hepatitis B screening panel should include:
- Hepatitis B surface antigen (HBsAg): Indicates current acute or chronic HBV infection
- Hepatitis B core antibody (anti-HBc) total: Indicates past or present HBV infection
- Hepatitis B surface antibody (anti-HBs): Indicates recovery from past infection or successful vaccination
Interpretation of Hepatitis B Serologic Markers
| HBsAg | Anti-HBc | Anti-HBs | Interpretation |
|---|---|---|---|
| Positive | Positive | Negative | Chronic HBV infection |
| Negative | Positive | Positive | Resolved HBV infection |
| Negative | Positive | Negative | Isolated core antibody (possible occult HBV infection) |
| Negative | Negative | Positive | Immunity from vaccination |
| Negative | Negative | Negative | No prior exposure or immunity |
Hepatitis C Screening
- Hepatitis C antibody (anti-HCV): Initial screening test for HCV exposure
- If positive, confirm with HCV RNA testing to determine if infection is current or resolved 1
Interpretation of Hepatitis C Serologic Markers
| Anti-HCV | HCV RNA | Interpretation |
|---|---|---|
| Positive | Positive | Current HCV infection |
| Positive | Negative | Past, resolved HCV infection or false antibody positivity |
| Negative | Not tested | No HCV antibody detected |
Additional Considerations
- For patients with risk factors for hepatitis D (HDV), test for total anti-HDV antibody in HBsAg-positive individuals 1
- For patients with potential immunosuppression or who will undergo immunosuppressive therapy, consider testing for occult HBV infection with HBV DNA testing, particularly in anti-HBc positive patients 1
Special Populations
- Patients with history of blood product exposure: All individuals exposed to clotting factor concentrates or blood products should be tested at least once for both HBV and HCV markers 1
- Patients with chronic liver disease: Should be screened for both HAV and HBV immunity to determine vaccination needs 2
- Immunocompromised patients: May require additional testing including HBV DNA to detect occult infection 3
Clinical Pitfalls to Avoid
- Incomplete testing: Ordering only HBsAg without anti-HBc and anti-HBs can miss past infection or occult HBV
- Missing follow-up testing: Positive anti-HCV requires confirmatory HCV RNA testing
- Misinterpreting isolated anti-HBc: May indicate occult HBV infection, especially in immunocompromised patients
- Overlooking recent exposure: For suspected recent exposure (<6 months), include HBV DNA or HCV RNA testing as antibodies may not have developed 1
By following this comprehensive screening approach, clinicians can accurately identify past hepatitis infections and determine appropriate follow-up care to reduce morbidity and mortality associated with chronic liver disease.