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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.