From the Guidelines
For hepatitis B and C screening, I recommend ordering specific blood tests to detect viral markers and assess infection status, including hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), hepatitis B core antibody (anti-HBc), and hepatitis C antibody (anti-HCV), as outlined in the most recent guidelines 1.
Hepatitis B Screening
- HBsAg indicates active infection
- anti-HBs shows immunity from vaccination or resolved infection
- anti-HBc indicates previous or ongoing infection
Hepatitis C Screening
- Order the hepatitis C antibody test (anti-HCV) as the initial screening test
- If anti-HCV is positive, follow up with an HCV RNA test to confirm active infection, as antibodies remain even after cleared infections
These tests are essential because both hepatitis B and C can cause chronic liver disease with minimal symptoms until advanced stages. Early detection allows for appropriate monitoring, treatment initiation when indicated, and prevention measures to reduce transmission. For high-risk individuals or those with abnormal liver function tests, consider more comprehensive panels including viral load testing and genotyping if initial screening is positive, as recommended by recent guidelines 1.
Some key points to consider:
- Testing for HBV infection is recommended for persons born in countries of high and intermediate HBV endemicity, U.S.-born persons not vaccinated as infants whose parents were born in countries with high HBV endemicity, and persons needing immunosuppressive therapy 1
- All pregnant women should be tested for HBsAg during each pregnancy, and those with positive HBsAg tests should be tested for HBV DNA 1
- The goals of hepatitis C treatment are to eradicate HCV and to prevent complications and mortality from liver cirrhosis and hepatocellular carcinoma, as outlined in previous guidelines 1
It is also important to note that the initial evaluation of patients with chronic hepatitis B should include a thorough history-taking and physical examination, with emphasis on risk factors such as coinfection, alcohol consumption, and the family history of HBV infection and liver cancer, as recommended in earlier guidelines 1.
However, the most recent and highest quality study 1 provides the most up-to-date recommendations for hepatitis B and C screening, and should be prioritized in clinical practice.
From the Research
Hepatitis B and C Screening Labs
To screen for hepatitis B and C, the following labs are typically ordered:
- Hepatitis B surface antigen (HBsAg) 2, 3
- Hepatitis B core antibody (anti-HBc) 2, 4, 5
- Hepatitis B e antigen (HBeAg) 4, 5
- Hepatitis C antibody (anti-HCV)
- Liver function tests, such as alanine aminotransferase (ALT) 6, 4
Additional Labs for Hepatitis B
For hepatitis B, additional labs may include:
- Hepatitis B virus DNA (HBV DNA) 6
- Hepatitis B core-related antigen (HBcrAg) 6
- Hepatitis B virus RNA (HBV RNA) 6
Interpretation of Lab Results
The interpretation of lab results is crucial for the diagnosis and management of hepatitis B and C. For example:
- The presence of HBsAg indicates current infection with hepatitis B 2, 3
- The presence of anti-HBc indicates past or current infection with hepatitis B 2, 4, 5
- The presence of HBeAg indicates active replication of the hepatitis B virus 4, 5
- Elevated ALT levels indicate liver inflammation 6, 4
Limitations of Current Evidence
There are no research papers in the provided evidence that directly address the screening labs for hepatitis C. However, the labs listed above are generally accepted as part of the screening process for hepatitis C.