NYC Department of Health and Mental Hygiene, Bureau of Communicable Disease November 2013
Summary of Viral Hepatitis Lab Tests
Reportable Not reportable Hep A Hep A virus antibody IgM (report if positive or borderline) Hep A virus antibody total Hep B Hep B Surface Antigen (HBsAg) - Only the confirmatory HBsAg should be reported Hep B Core Antibody IgM (HBcIgM) (report if positive; do not report if borderline) Hep B e antigen (HBeAg) Hep B DNA (e.g., PCR or bDNA) Hep B genotype Hep B Surface Antibody (anti-HBs) Hep B Core Antibody total (anti-HBc) Hep B e Antibody (HBeAb) Hep C Hep C antibody with high-positive signal to cut off ratio (s/co) Hep C RNA (e.g., PCR or bDNA) Hep C genotype Hep C EIA positive without s/co Hep C EIA with low-positive s/co
Hep D Hep D IgM Hep D Ag Hep D IgG or total Hep E Hep E IgM Hep E IgG or total ALT Report ALT value if it is on the same accession number as a positive reportable hepatitis test. This is especially important with hepatitis A IgM and hepatitis B core IgM.
See below for details
NYC Department of Health and Mental Hygiene, Bureau of Communicable Disease November 2013
Hepatitis A Hepatitis A virus Antibody IgM (Reportable) Usually indicates acute infection Can also indicate recent vaccination High false-positive rate, especially in patients without clinical signs of hepatitis.
Hepatitis A virus Antibody total (Not reportable) Indicates acute or resolved infection After successful vaccination, can be negative or positive
Hepatitis B Hepatitis B Core Antibody IgM (HBcIgM) (Reportable) Usually indicates acute (new) infection with hepatitis B virus High false-positive rate, especially in: o patients without clinical signs of hepatitis o patients with chronic hepatitis B
Hepatitis B Core Antibody total (anti-HBc) (Not reportable) Indicates acute, chronic or resolved hepatitis B virus infection
Hepatitis B Surface Antigen (HBsAg) (Reportable only if confirmatory sAg is positive) Indicates acute or chronic infection Indicates that patient is infectious Can be identified in serum 30-60 days after exposure to hepatitis B virus and persists for variable periods If patient was vaccinated in the prior 6 weeks, a positive result may not be meaningful
Hepatitis B Surface Antibody (anti-HBs) (Not reportable) Produced following a natural infection or vaccination The vaccine includes surface protein only, not core protein. Therefore, vaccinated individuals are anti-HBs positive but anti-HBc negative If anti-HBs is negative, the patient is susceptible.
Hepatitis B e Antigen (HBeAg) (Reportable) Present in patients with high levels of virus
Hepatitis B e Antibody (HBeAb) (Not reportable) Used in association with the HBeAg test to monitor course of infection and treatment
Hepatitis B DNA viral detection test (HBV DNA) (Reportable) Detects the hepatitis B virus in the blood Indicates that patient is infectious Results can be Qualitative (positive or negative) or Quantitative (viral load, copies per ml or units per ml)
Hepatitis B genotype (Reportable) Indicates the strain of the virus - Not frequently ordered
NYC Department of Health and Mental Hygiene, Bureau of Communicable Disease November 2013
Hepatitis C
There is no lab test to distinguish acute from chronic hepatitis C infection.
Hepatitis C Antibody tests Will remain positive even if the infection is resolved.
Hepatitis C EIA (Enzyme ImmunoAssay) If positive, RNA test should be ordered to determine infection status Screening test, reportable if signal to cut off ratio is high (see below)
Hepatitis C EIA with signal to cut off ratio (s/co) (Reportable if s/co is high) If positive, RNA test should be ordered to determine infection status o If s/co is above the high threshold (e.g., => 3.8 or 8.0, depending on the assay) it is reportable o If s/co is low positive (e.g., between 1.0 and 3.7, depending on the assay), do not report. For s/co thresholds for the various commercial assays, see: http://www.cdc.gov/hepatitis/HCV/LabTesting.htm#section1
Tests for hepatitis C virus A positive nucleic acid test (NAT) indicates infection, but does not indicate whether the infection is acute (new) or chronic
RNA (e.g., Polymerase chain reaction (PCR) or bDNA) (Reportable) Detects the hepatitis C virus in the blood. There are two kinds: o Qualitative (result is detected or not detected) or o Quantitative (result is viral load, IU per ml); used to monitor response to treatment
Hepatitis C genotype (Reportable) Indicates the strain of the virus, e.g., 1a Different genotypes require different antiviral treatment regimens
NYC Department of Health and Mental Hygiene, Bureau of Communicable Disease November 2013
Hepatitis D
Hepatitis D can only cause infection when hepatitis B is also present.
Hepatitis D IgM (Reportable) Usually indicates an acute infection with hepatitis D
Hepatitis D Ag (Reportable) Indicates that the patient has hepatitis D
Hepatitis E
Hepatitis E IgM (Reportable) Usually indicates an acute infection High false-positive rate
Liver Function Tests (LFTs) AST=SGOT ALT=SGPT
For both tests, the normal range (reference range) varies & should therefore be reported with the test result. The normal range is typically around 20-50 for both tests.
Generally with viral hepatitis: ALT value is higher than AST. Generally with alcohol-induced liver damage: AST is higher than ALT, sometimes much higher.
ALT should be reported along with any positive reportable hepatitis serology tests. This is especially important with hepatitis A IgM and hepatitis B core IgM tests.