Viral Hepatitis Screening

Testing or screening for Hepatitis will depend on the clinical situation: i.e. whether the patient is asymptomatic, has a history of exposure, has high risk behaviors, or is clinically symptomatic (elevated transaminases, jaundice, nausea, vomiting, etc.). Generally, we'd recommend screening in any symptomatic patient, all HIV patients at the time of diagnosis, and IV drug users. Routine screening (hepatitis panel) should include screening for:

• Hepatitis A, with total antibody to HAV (anti-HAV Ab)* or IgM antibody to HAV (IgM anti-HAV).
• Hepatitis B, with Hepatitis B surface antigen (HBsAg) and IgM antibody to hepatitis B core antigen (IgM anti-HBc).
• Hepatitis C, with Antibody to HCV (anti-HCV).

Special Populations

• Routine screening of pregnant women for HBsAg is done to identify infants of infected women who require post-exposure prophylaxis.
• High risk populations for chronic HBV infection (e.g., STD and drug treatment patients, inmates of correctional facilities, immigrants from countries with a HBsAg prevalence >2%) might benefit from routine HBsAg testing, but the feasibility and cost effectiveness of such testing in various clinical settings has not been determined.
• Recommendations have been developed for routine anti-HCV testing for persons at high risk of HCV infection (i.e., persons who have ever injected illegal drugs, persons who received a blood transfusion or organ transplant before July 1992, persons ever on chronic hemodialysis, persons who received clotting factor concentrates made before 1987, persons with abnormal liver enzyme levels).

Confirmatory Testing

• The presence of other serologic markers of HBV infection (i.e. total anti-HBc or IgM anti-HBc) can be used to evaluate the likelihood that an HBsAg positive test result is a true positive but isolated HBsAg positive test results should be verified by a confirmatory assay (e.g. neutralization assay).
• Anti-HCV positive results by enzyme immunoassay (EIA) should be verified by a supplemental antibody assay (e.g., RIBA), which is available through McLendon labs. Detection of HCV RNA by RT-PCR verifies HCV infection, but the absence of detectable RNA in a single serum specimen does not exclude the possibility of HCV infection.

Yvonne Carter, MD