From the Guidelines
For hepatitis screening, I recommend ordering a comprehensive panel including Hepatitis B surface antigen (HBsAg), Hepatitis B surface antibody (anti-HBs), Hepatitis B core antibody (anti-HBc), Hepatitis A antibody (anti-HAV), Hepatitis C antibody (anti-HCV), and liver function tests (ALT, AST, bilirubin, alkaline phosphatase) as the initial evaluation. This combination provides a complete assessment of hepatitis A, B, and C status. HBsAg indicates active hepatitis B infection, while anti-HBs shows immunity from vaccination or past infection. Anti-HBc helps distinguish between past infection and vaccination 1. For hepatitis C, a positive antibody test should be followed by HCV RNA testing to confirm active infection. Hepatitis A antibody testing determines previous exposure or immunity. Liver function tests help assess the degree of liver damage if infection is present.
Key Laboratory Tests
- Hepatitis B surface antigen (HBsAg) to indicate active hepatitis B infection
- Hepatitis B surface antibody (anti-HBs) to show immunity from vaccination or past infection
- Hepatitis B core antibody (anti-HBc) to distinguish between past infection and vaccination
- Hepatitis A antibody (anti-HAV) to determine previous exposure or immunity
- Hepatitis C antibody (anti-HCV) to screen for hepatitis C infection, with follow-up HCV RNA testing for confirmation
- Liver function tests (ALT, AST, bilirubin, alkaline phosphatase) to assess liver damage
Additional Tests for High-Risk Individuals or Abnormal Initial Results
- Hepatitis D antibody for those at risk of coinfection
- Hepatitis B e-antigen (HBeAg) to assess viral replication
- Hepatitis B viral load for monitoring disease activity and treatment response
- Ultrasound and serum α-fetoprotein measurement for hepatocellular carcinoma (HCC) screening in high-risk individuals 1.
Early detection allows for timely treatment and prevention of complications like cirrhosis or liver cancer. It is essential to follow the most recent guidelines for the management of chronic hepatitis B, which emphasize the importance of thorough history-taking, physical examination, and laboratory tests to assess liver disease and HBV replication 1.
From the Research
Hepatitis Screening Labs
To order for hepatitis screening, the following labs are recommended:
- HBsAg (Hepatitis B surface antigen) testing
- Anti-HBc (Hepatitis B core antibody) testing
- Anti-HBs (Hepatitis B surface antibody) testing
- HBV DNA (Hepatitis B virus DNA) testing for patients who are anti-HBc positive
Rationale for Lab Orders
The rationale for ordering these labs is based on the following evidence:
- HBsAg testing alone is insufficient for detecting all chronic HBV infections 2
- Anti-HBc and anti-HBs testing can indicate resolved infection and immunity, and are not routinely performed 2
- Occult HBV infection (OBI) can occur in patients who are HBsAg negative and anti-HBc positive, and HBV DNA testing can detect this condition 2
- Triple panel testing for hepatitis B, including HBsAg, anti-HBc, and anti-HBs, can provide a comprehensive picture of the disease burden and reduce the risk of missing people with occult hepatitis B 3
Additional Considerations
Additional considerations for hepatitis screening include:
- The importance of testing for anti-HBc, as it can indicate a chronic occult bloodstream infection 3
- The use of commercial analyzers for serological screening of hepatitis A, B, C, and HIV, and the comparison of their analytical performance 4
- The potential for anti-HBc to serve as a predictor of spontaneous HBsAg seroclearance in chronic hepatitis B patients 5