Figure 1.

Diagnosis of Acute Hepatitis

Symptomatic or HAV IgM Ab HAV infection unlikely

high-risk individual

HAV IgM Ab+ HAV infection

HBc IgM Ab HBV infection unlikely HDV Ab HDV infection unlikely

HAV IgM Ab HBsAg
HBc IgM Ab
HBsAg
HCV Ab HBc IgM Ab+ or Consider test HBc IgM Ab+ HBV with HDV
HBsAg+ HBV infection for HDV Ab HDV Ab+ coinfection

HBc IgM Ab HBV with HDV

HCV Ab HCV infection unlikely HDV Ab+ superinfection

HCV Ab+ Confirm active infection with

a sensitive HCV RNA test

HCV RNA+ HCV RNA

Active HCV Active HCV infection

infection unlikely; follow-up testing
as clinically indicated

Because HCV Ab may not be detectable for several months after infection, HCV Ab-negative patients with suspected recent exposure (<6 months) should
receive HCV RNA testing or follow-up testing for HCV antibody. HCV RNA testing may also be appropriate for immunocompromised individuals. For HCV Ab-
positive/HCV RNA-negative patients, testing with another HCV antibody assay can be considered to differentiate resolved HCV infection from biologic false
positivity for HCV Ab; patients with clinical evidence of HCV infection or suspected recent exposure should be retested for HCV RNA; retesting may also be
considered if sample mishandling is suspected. HAV indicates hepatitis A virus; HBc IgM Ab, hepatitis B core IgM antibody; HBsAg, hepatitis B surface antigen;
HCV, hepatitis C virus; and HDV, hepatitis D virus.
This figure was developed by Quest Diagnostics and is based in part on references 12, 14, 15, and 16. It is provided for informational purposes only and is not
intended as medical advice. A physicians test selection and interpretation, diagnosis, and patient management decisions should be based on his/her education,
clinical expertise, and assessment of the patient.

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