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AHEPR
86137
Management Algorithm and Recommended Approach to the Diagnosis of Hepatitis C in Special
Instructions.
Useful For: The differential diagnosis of recent acute hepatitis
Interpretation: Hepatitis A Antibody against hepatitis A antigen is usually detectable by the onset of
symptoms (usually 15-45 days after exposure). The initial antibody consists almost entirely of IgM
subclass antibody. Antibody to hepatitis A virus (anti-HAV) IgM usually falls to undetectable levels 3 to
6 months after infection. Hepatitis B Hepatitis B surface antigen (HBsAg) is the first serologic marker
appearing in the serum 6 to 16 weeks following hepatitis B virus (HBV) infection. In acute cases, HBsAg
usually disappears 1 to 2 months after the onset of symptoms. Hepatitis B surface antibody (anti-HBs)
appears with the resolution of HBV infection after the disappearance of HBsAg. Anti-HBs also appears as
the immune response following a course of inoculation with the hepatitis B vaccine. Initially, hepatitis B
core antibody (anti-HBc) consists almost entirely of the IgM subclass. Anti-HBc, IgM can be detected
shortly after the onset of symptoms and is usually present for 6 months. Anti-HBc may be the only marker
of a recent HBV infection detectable following the disappearance of HBsAg, and prior to the appearance
of anti-HBs, ie, window period. See HBV Infection-Diagnostic Approach and Management Algorithm in
Special Instructions. Hepatitis C Hepatitis C virus antibody (anti-HCV) is usually not detectable during
the early months following infection and is almost always detectable by the late convalescent stage of
infection. Anti-HCV is not neutralizing and does not provide immunity. If HBsAg, anti-HAV (IgM), and
anti-HCV are negative and patient's condition warrants, consider testing for Epstein-Barr virus or
cytomegalovirus. See Advances in the Laboratory Diagnosis of Hepatitis C (2002) in Publications and
Recommended Approach to the Diagnosis of Hepatitis C in Special Instructions.
Reference Values:
HEPATITIS B SURFACE ANTIGEN
Negative
HEPATITIS A IgM ANTIBODY
Negative
HEPATITIS B CORE ANTIBODY, IgM
Negative
HEPATITIS C ANTIBODY SCREEN
Negative
Interpretation depends on clinical setting.
See Viral Hepatitis Serologic Profile in Special Instructions.
Clinical References: 1. Lemon SM: Type A viral hepatitis: epidemiology, diagnosis, and
prevention. Clin Chem 1997;43:1494-1499 2. Marcus EL, Tur-Kaspa R: Viral hepatitis in older adults. J
Am Geriatr Soc 1997;45:755-763 3. Mahoney FJ: Update on diagnosis, management, and prevention of
hepatitis B virus infection. Clin Microbiol Rev 1999;12:351-366
Acute Hepatitis Profile with Hepatitis C Virus Reflex
Clinical Information: Hepatitis A Hepatitis A virus (HAV) is an RNA virus (an enterovirus) that
accounts for 20% to 25% of the viral hepatitis in United States adults. HAV infection is spread by the
oral/fecal route and results in acute hepatitis with usually a benign, self-limited course. Spread of the
disease is usually associated with contaminated food or water caused by poor sanitary conditions.
Outbreaks frequently occur in overcrowded situations and in institutions or high density centers such as
prisons and health care centers. Epidemics may occur following floods or other disaster situations.
Chronic carriers of HAV have never been observed. Hepatitis B Hepatitis B virus (HBV) is a DNA virus
that is endemic throughout the world. The infection is spread primarily through percutaneous contact with
infected blood products, eg, blood transfusion, and sharing of needles by drug addicts. The virus is also
found in all types of human body fluid and is known to be spread through oral and genital contact. HBV
can be transmitted from mother to child during delivery through contact with blood and vaginal
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