Diagnosis

Marker Abbreviations Purpose or uses Technology
Hepatitis B surface antigen (qualitative) HBsAG
  • Donor testing – screening of blood and tissue donations
  • Diagnostic testing
  • Immunoassay
  • Immunoassay Particle agglutination Rapid, short incubation assay including PoC
Hepatitis B surface antigen neutralisation  / Confirmation of the presence of HBsAG Immunoassay
Hepatitis B surface antigen (quantitative) HBsAG Monitoring of therapy Immunoassay
Hepatitis B surface antibody anti-HBs or HBsAb Determining protective immunity* Immunoassay
Hepatitis B core total antibody anti-HBc or HBcT or HBcAb As part of strategy to determine exposure to hepatitis B virus Immunoassay
IgM to hepatitis B core antigen IgM anti-HBc or HBcIgM As part of strategy to diagnose acute hepatitis B infection Immunoassay
Hepatitis B e antigen HBeAg Determining infectivity of a person with HBV infection and phase of the infection for clinical management Immunoassay
Hepatitis B e antibody Anti-HBe or HBeAb Determining seroconversion from hepatitis B e antigen and phase of the infection for clinical management Immunoassay

 

*anti-HBs levels fall over time and may become undetectable in people vaccinated years ago or in those who have cleared the virus. These individuals are still regarded as having acquired immunity. Where relevant, anti-HBc may provide evidence of past exposure when anti-HBs has become undetectable.

 


Interpretation of Results of Tests for Hepatitis B Virus Infection and Further Actions

HBsAg

Anti-HBs

Anti-HBc

Serology interpretation

Follow up

Susceptible to infection

Vaccinate

+

+

Immune due to past resolved infection

No further action required. Record result in file.

+

Immune due to vaccination

Record result. No need for further action.

+

+

Likely chronic infection

Manage as per guidelines for chronic hepatitis B

 

Serologic markers of HBv infection

Serologic marker

Description

HBsAg

• Protein on the surface of HBV

• Can be detected at high levels in serum during acute HBV infection or in CHB

• Presence indicates the patient is infected

Anti-HBs

• Antibody to HBsAg

• Presence may indicate recovery and immunity from HBV infection

• Also develops in patients successfully vaccinated against HBV

Total anti-HBc

• Antibody to core antigen of HBV (core antigen is not detectable in blood)

• Appears at the onset of symptoms in acute HBV infection and remains throughout life

• Presence indicates previous or ongoing HBV

IgM anti-HBc

• Immunoglobulin M class antibody to the core antigen of HBV

• Presence indicates recent acute infection with HBV (≤6 months)

HBeAg

• Protein produced by the virus when it is actively replicating

• Can be detected in serum during acute HBV infection and CHB

• Some strains of HBV do not make e antigen

• Presence indicates active replication

Anti-HBe

• Antibody to HBeAg

• Presence indicates inactive infection except strains of HBV that do not make e antigen

HBV DNA

• Genetic material of HBV

• Number of HBV DNA copies in the blood is used to detect active HBV infection and to

monitor response to antiviral therapy (10,000 copies/mL = 2000 IU/mL)

 


Interpretation of Results of Tests for Hepatitis C Virus Infection and Further Actions


Test outcome


Interpretation


Further actions

HCV antibody nonreactive

No HCV antibody detected

Sample can be reported as nonreactive for HCV antibody. No further action required.

If recent exposure in person tested is suspected, test for HCV RNA.*

HCV antibody reactive

Presumptive HCV infection

A repeatedly reactive result is consistent with current HCV infection, or past HCV infection that has resolved, or biologic false positivity for HCV antibody. Test for HCV RNA to identify current infection.

HCV antibody reactive,

HCV RNA detected

Current HCV infection

Provide person tested with appropriate counseling and link person tested to care

and treatment. †

HCV antibody reactive,

HCV RNA not detected

No current HCV infection

No further action required in most cases.

If distinction between true positivity and biologic false positivity for HCV antibody is desired,

and if sample is repeatedly reactive in the initial test, test with another HCV antibody assay.

In certain situations, §

follow up with HCV RNA testing and appropriate counseling.

* If HCV RNA testing is not feasible and person tested is not immunocompromised, do follow-up testing for HCV antibody to demonstrate seroconversion. If the person tested is immunocompromised, consider testing for HCV RNA.

† It is recommended before initiating antiviral therapy to retest for HCV RNA in a subsequent blood sample to confirm HCV RNA positivity.

§ If the person tested is suspected of having HCV exposure within the past 6 months, or has clinical evidence of HCV disease, or if there is concern regarding the handling or storage of the test specimen.

Recommended Testing Sequence for Identifying Current Hepatitis C Virus (HCV) Infection