Materiały źródłowe

• #1 Testing & Diagnostics

  https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hepatitis/testing-and-diagnostics

  WHO estimates that in 2022, 254 million people were living with chronic hepatitis B virus infection, and 50 million people with chronic hepatitis C virus infection. […] Testing is an essential entry point in accessing hepatitis B and C prevention, care and treatment services, making it a critical component of national responses. […] By the end of 2022, only 13% of the estimated 254 million people living with hepatitis B had been diagnosed, and less than 3% had received antiviral treatment. Of the estimated 50 million people living with hepatitis C, 36% had been diagnosed between 2015 and 2022, and 20% had received curative treatment. […] Demand creation and awareness raising, cost-effective testing strategies and active case-finding and testing allow early identification of people with chronic hepatitis B and C.

• #2 Hepatitis A – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hepatitis-a/diagnosis-treatment/drc-20367055

  Blood tests are used to look for signs of the hepatitis A virus in your body. A sample of blood is taken, usually from a vein in your arm. It’s sent to a laboratory for testing. […] If you have symptoms of hepatitis A, make an appointment with your health care provider. […] Your health care provider is likely to ask you a number of questions, including: Have you recently traveled or been exposed to someone with hepatitis A?

• #3 Hepatitis: What Is It? Types, Symptoms, Causes, and More

  https://www.healthline.com/health/hepatitis

  Hepatitis is an inflammation of the liver. […] It is crucial to understand what is causing hepatitis in order to treat it correctly. Doctors will progress through a series of tests to accurately diagnose your condition. […] To diagnose all forms of hepatitis, your doctor will first take your history to determine any risk factors you may have. […] Liver function tests use blood samples to determine how efficiently your liver works. […] If your liver function tests are abnormal, your doctor will likely order other blood tests to detect the source of the problem. […] When diagnosing hepatitis, doctors will also assess your liver for potential damage. A liver biopsy is a procedure that involves taking a sample of tissue from your liver. […] An abdominal ultrasound uses ultrasound waves to create an image of the organs within your abdomen. This test allows your doctor to take a close look at your liver and nearby organs.

• #4 Diagnosing and Managing Hepatitis | NYU Langone Health

  https://nyulangone.org/conditions/hepatitis/diagnosis

  At NYU Langone, hepatologists, or liver specialists, and infectious disease specialists use blood tests to diagnose and manage viral hepatitis, which can cause inflammation of the liver. […] If the results of a blood test confirm a diagnosis of viral hepatitis, your doctor may recommend imaging tests or a liver biopsy to determine the extent of liver disease. […] A physical exam helps identify signs and symptoms of viral hepatitis. […] Blood tests are used to look for signs that a viral infection is present and to evaluate liver function. […] The results of a blood test can confirm the type of viral hepatitis, the severity of the infection, whether an infection is active or dormant, and whether someone is currently contagious. […] If the results of blood tests confirm a diagnosis of hepatitis, your doctor may recommend one or more imaging tests of the liver to assess liver damage and to screen for liver cancer.

• #5

  https://www.mountelizabeth.com.sg/conditions-diseases/hepatitis/diagnosis-treatment

  Your doctor will ask about your symptoms and perform a physical examination to look for signs and symptoms of viral hepatitis. This may including feeling your abdomen to check if your liver is swollen, or examining your skin and eyes to see if there is jaundice. […] You will have to undergo a blood test to diagnose the type of viral hepatitis. […] A liver scan is usually required to check the structure of your liver. If significant liver damage is suspected, you may also be recommended a liver biopsy to assess the extent of disease and its impact on your liver function.

• #6 Clinical manifestations, diagnosis, and treatment of acute hepatitis C virus infection in adults – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-treatment-of-acute-hepatitis-c-virus-infection-in-adults

  Clinical manifestations, diagnosis, and treatment of acute hepatitis C virus infection in adults […] By convention, acute hepatitis C virus (HCV) infection refers to the first six months of HCV infection following presumed HCV exposure. While HCV infection is estimated to account for 15 percent of symptomatic cases of acute hepatitis in the United States, the majority of patients with acute HCV go undetected. This is due in large part to the fact that patients with acute HCV are typically asymptomatic. […] Guidelines for the diagnosis and management of HCV infection were released jointly by the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA), are continuously updated, and can be accessed at www.hcvguidelines.org. The discussion in this topic is generally consistent with those guidelines. […] Most patients who are acutely infected with HCV are asymptomatic. Symptomatic patients may experience jaundice, nausea, dark urine, and right upper quadrant pain. Patients with acute HCV infection typically have moderate to high serum aminotransferase elevations.

• #7 Clinical Testing and Diagnosis for Hepatitis B | Hepatitis B | CDC

  https://www.cdc.gov/hepatitis-b/hcp/diagnosis-testing/index.html

  CDC published updated recommendations among adults for hepatitis B screening and testing in 2023 that are complementary to the 2022 Advisory Committee on Immunization Practices (ACIP) vaccine recommendations for hepatitis B. […] The recommendations consider a simpler and less stigmatizing implementation strategy than previous risk-based hepatitis B virus (HBV) screening recommendations among adults. […] More than half of people with hepatitis B are unaware of their infection status, and approximately 50%–70% of people with acute hepatitis B are asymptomatic. Without testing, people with hepatitis B virus (HBV) infection can unknowingly transmit the virus to others. […] Chronic HBV infection can lead to substantial morbidity and mortality but is detectable before the development of severe liver disease using reliable and inexpensive screening tests. Routine monitoring and treatment for chronic HBV infection can reduce morbidity and mortality, supporting the importance of early detection of HBV infection.

• #8 Overview of Acute Viral Hepatitis – Hepatic and Biliary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/hepatitis/overview-of-acute-viral-hepatitis

  Acute viral hepatitis is diffuse liver inflammation caused by specific hepatotropic viruses that have diverse modes of transmission and epidemiologies. […] Diagnosis is by liver tests and serologic tests to identify the virus. […] Acute hepatitis must first be differentiated from other disorders that cause similar symptoms. […] In the prodromal phase, hepatitis mimics various nonspecific viral illnesses and is difficult to diagnose. […] Anicteric patients suspected of having hepatitis based on risk factors are tested initially with liver tests, including aminotransferases, bilirubin, and alkaline phosphatase. […] Acute hepatitis can usually be differentiated from other causes of jaundice by its marked elevations of AST and ALT: Often 400 IU/L (6.68 microkat/L). […] If laboratory results suggest acute hepatitis, particularly if ALT and AST are 1000 IU/L (16.7 microkat/L), PT/INR is measured to assess liver function.

• #9 Hepatitis B virus: Screening and diagnosis in adults – UpToDate

  https://www.uptodate.com/contents/hepatitis-b-virus-screening-and-diagnosis-in-adults

  Hepatitis B virus: Screening and diagnosis in adults […] The identification of hepatitis B virus (HBV) infection was revolutionized by the discovery of Australia antigen, now called hepatitis B surface antigen (HBsAg). […] The diagnosis of HBV infection can also be made by the detection of HBsAg or hepatitis B core antigen (HBcAg) in liver tissues by immunohistochemical staining and of HBV DNA by Southern hybridization, in-situ hybridization, or PCR. […] This topic will focus on the approach to testing and screening for HBV infection in adults and will review the changes in hepatitis B antigens, antibodies, and DNA levels that occur during acute and chronic infection and how these tests can be used clinically. […] Screening persons for HBV is supported by the American Association for the Study of Liver Diseases, the American College of Physicians, the United States Centers for Disease Control and Prevention, the World Health Organization, and the United States Preventative Task Force.

• #10 Hepatitis B Workup: Approach Considerations, Diagnostic Tests, Radiologic Studies

  https://emedicine.medscape.com/article/177632-workup

  Please note that the guidelines for the current diagnostic workup and management of hepatitis B virus (HBV) infection continue to evolve. Clinicians are advised to refer frequently to the most recent recommendations of the American Association for the Study of Liver Diseases (AASLD). […] Laboratory evaluation of hepatitis B disease generally consists of liver enzyme tests, including levels of alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gamma-glutamyl transpeptidase (GGT), as well as liver function tests (LFTs) that include total and direct serum bilirubin, albumin, and the measurement of the international normalized ratio (INR). […] Serologic tests for hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti-HBc) immunoglobulin M (IgM) are required for the diagnosis of acute hepatitis B virus (HBV).

• #11 Hepatitis B Workup: Approach Considerations, Diagnostic Tests, Radiologic Studies

  https://emedicine.medscape.com/article/177632-workup

  Imaging/staging studies: Abdominal ultrasonography, Vibration-controlled transient elastography (eg, FibroScan) or a serum fibrosis marker panel […] Testing should be performed with a HBsAg test followed by a licensed, neutralizing confirmatory test for initially reactive screening results. […] The following screening recommendations are from the 2018 AASLD guidance update: Perform screening with both hepatitis B surface antigen (HBsAg) and antibody to HBsAg (anti-HBs). […] Laboratory studies will be discussed according to the stage of the disease. […] High levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), within a range of 1000-2000 IU/mL, is the hallmark of this stage of HBV disease, although values 100 times above the upper limit of normal (ULN) can be also be identified.

• #12 Overview of Acute Viral Hepatitis – Hepatic and Biliary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/hepatitis/overview-of-acute-viral-hepatitis

  Acute viral hepatitis is diffuse liver inflammation caused by specific hepatotropic viruses that have diverse modes of transmission and epidemiologies. […] Diagnosis is by liver tests and serologic tests to identify the virus. […] Acute hepatitis must first be differentiated from other disorders that cause similar symptoms. […] In the prodromal phase, hepatitis mimics various nonspecific viral illnesses and is difficult to diagnose. […] Anicteric patients suspected of having hepatitis based on risk factors are tested initially with liver tests, including aminotransferases, bilirubin, and alkaline phosphatase. […] Acute hepatitis can usually be differentiated from other causes of jaundice by its marked elevations of AST and ALT: Often 400 IU/L (6.68 microkat/L). […] If laboratory results suggest acute hepatitis, particularly if ALT and AST are 1000 IU/L (16.7 microkat/L), PT/INR is measured to assess liver function.

• #13 Overview of Acute Viral Hepatitis – Hepatic and Biliary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/hepatitis/overview-of-acute-viral-hepatitis

  Acute viral hepatitis is diffuse liver inflammation caused by specific hepatotropic viruses that have diverse modes of transmission and epidemiologies. […] Diagnosis is by liver tests and serologic tests to identify the virus. […] Acute hepatitis must first be differentiated from other disorders that cause similar symptoms. […] In the prodromal phase, hepatitis mimics various nonspecific viral illnesses and is difficult to diagnose. […] Anicteric patients suspected of having hepatitis based on risk factors are tested initially with liver tests, including aminotransferases, bilirubin, and alkaline phosphatase. […] Acute hepatitis can usually be differentiated from other causes of jaundice by its marked elevations of AST and ALT: Often 400 IU/L (6.68 microkat/L). […] If laboratory results suggest acute hepatitis, particularly if ALT and AST are 1000 IU/L (16.7 microkat/L), PT/INR is measured to assess liver function.

• #14 Hepatitis – Wikipedia

  https://en.wikipedia.org/wiki/Hepatitis

  Diagnosis of hepatitis is made on the basis of some or all of the following: a person’s signs and symptoms, medical history including sexual and substance use history, blood tests, imaging, and liver biopsy. […] For other causes of hepatitis, especially chronic causes, blood tests may not be useful. […] In this case, liver biopsy is the gold standard for establishing the diagnosis: histopathologic analysis is able to reveal the precise extent and pattern of inflammation and fibrosis. […] Blood testing includes liver enzymes, serology (i.e. for autoantibodies), nucleic acid testing (i.e. for hepatitis virus DNA/RNA), blood chemistry, and complete blood count. […] Characteristic patterns of liver enzyme abnormalities can point to certain causes or stages of hepatitis. […] Generally, AST and ALT are elevated in most cases of hepatitis regardless of whether the person shows any symptoms.

• #15 Hepatitis – Wikipedia

  https://en.wikipedia.org/wiki/Hepatitis

  The degree of elevation (i.e. levels in the hundreds vs. in the thousands), the predominance for AST vs. ALT elevation, and the ratio between AST and ALT are informative of the diagnosis. […] Ultrasound, CT, and MRI can all identify steatosis (fatty changes) of the liver tissue and nodularity of the liver surface suggestive of cirrhosis. […] Unlike steatosis and cirrhosis, no imaging test is able to detect liver inflammation (i.e. hepatitis) or fibrosis. […] Liver biopsy is the only definitive diagnostic test that is able to assess inflammation and fibrosis of the liver.

• #16 The laboratory diagnosis of hepatitis B virus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2095015/

  Hepatitis B virus (HBV) chronically infects approximately 250,000 Canadians and 350 million people worldwide. […] HBV diagnosis is accomplished by testing for a series of serological markers of HBV and by additional testing to exclude alternative etiological agents such as hepatitis A and C viruses. […] Serological tests are used to distinguish acute, self-limited infections from chronic HBV infections and to monitor vaccine-induced immunity. […] Nucleic acid testing for HBV-DNA is increasingly being used to quantify HBV viral load and measure the effectiveness of therapeutic agents. […] The present guideline addresses tests for the diagnosis and management of HBV. […] The diagnosis of HBV infection in any individual has important management implications, including appropriate counselling, monitoring and/or treating and vaccinating family or at-risk contacts.

• #17 Virological techniques for the diagnosis and monitoring of hepatitis B and C | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-virological-techniques-for-diagnosis-monitoring-S1665268119318046

  Virological techniques for the diagnosis and monitoring of hepatitis B and C […] Virological tools are needed to diagnose chronic HBV and HCV infections, they may be useful to establish their prognosis, but they have found their principal application in guiding treatment decisions and assessing the virological responses to therapy. […] The detection (and eventually the quantification) of viral antigens and of specific antibodies in body fluids is based on the use of sandwich enzyme immunoassays (EIAs). […] Viral genome detection and quantification can be achieved by using two categories of molecular biology-based techniques, including target amplification (such as polymerase chain reaction (PCR)) and signal amplification (such as hybrid capture or the branched DNA assay). […] Real-time PCR has become the technique of choice to detect and quantify viral genomes in clinical practice.

• #18 Clinical Screening and Diagnosis for Hepatitis A | Hepatitis A | CDC

  https://www.cdc.gov/hepatitis-a/hcp/diagnosis-testing/index.html

  The results of a blood tests will determine if a person is infected with the hepatitis A virus (HAV). […] Diagnosis and prompt administration of postexposure prophylaxis (PEP) to potentially exposed contacts can interrupt transmission. […] A blood test can confirm a suspected case of hepatitis A. The types of diagnostic tests used to confirm an HAV infection include serologic testing and, occasionally, PCR-based tests. […] You will not be able to differentiate hepatitis A virus from other types of viral hepatitis using clinical or epidemiological features alone. Clinicians should conduct test(s) to make an accurate diagnosis. […] The following are laboratory markers that, if present, indicate an acute HAV infection: Immunoglobulin M antibodies to HAV (IgM anti-HAV) in serum, or HAV RNA is serum or stool.

• #19 Laboratory Diagnosis and Monitoring of Viral Hepatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10461253/

  Many microbes, toxins, autoimmune, and neoplastic diseases may cause liver inflammation; however, five main viruses whose main pathogenesis is liver disease are referred to as hepatitis A, B, C, D, and E viruses. […] Excellent serologic and nucleic acid detection methods are available for determining the precise etiology, and in some cases, the duration of infection. Diagnostics are critical for identifying those needing treatment and for monitoring the treatment success. […] Understanding hepatitis transmission modes, natural history and viral kinetics, and the limitations of testing is required for choosing appropriate diagnostic tests for viral hepatitis. […] In some circumstances serology requires concurrent NAT methods. […] HAV viremia begins prior to illness and virus excretion into the stool via the biliary tree peaks around the time of maximal liver enzyme elevations.

• #20 Laboratory Diagnosis and Monitoring of Viral Hepatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10461253/

  Anti-HAV antibodies are detected at or shortly after elevation of ALT. […] Measurement of total anti-HAV antibodies identifies both IgG and IgM isotypes, and if present, there is lifelong protection against reinfection. […] IgM specific antibody testing is required, and if positive, testing is diagnostic of acute infection. […] HBV DNA is usually not tested until HBsAg is detected. […] Fewer than 15% of patients with HBV infection have clinical hepatitis, and less than half of these developed jaundice. […] Clinical illness correlates with the age and immunological maturity, and newborns and children rarely having significant clinical disease. […] The rate of viremia clearance is inversely related to the magnitude of clinical illness; thus chronic infection is increased in newborns and immune compromised individuals who rarely have overt hepatitis.

• #21 Diagnosis of Hepatitis A Infection | Marler Clark

  https://marlerclark.com/foodborne-illnesses/hepatitis-a/hepatitis-diagnosis

  Hepatitis A infection is typically diagnosed through blood tests. […] Fortunately, blood tests are widely available to accurately diagnose hepatitis A, including tests for antibodies, or the affected persons immune response to hepatitis A proteins. […] For a positive hepatitis A diagnosis, HAV RNA is present in blood and feces soon after infection (while an individual is asymptomatic), until 1 to 2 weeks after the onset of symptoms. […] IgM positive / IgG negative: This result indicates acute hepatitis A. […] IgM positive / IgG positive: This result indicates that acute hepatitis A occurred within the last six months. […] IgM negative / IgG positive: Persons with this result are immune to hepatitis A.

• #22 Core Concepts – HBV Screening, Testing, and Diagnosis – Screening and Diagnosis – Hepatitis B Online

  https://www.hepatitisb.uw.edu/go/screening-diagnosis/diagnosis-hbv/core-concept/all

  The CDC recommends universal HBV screening for all adults (18 years of age and older) using a 3-test panel, which includes: Hepatitis B surface antigen (HBsAg), Antibody to hepatitis B surface antigen (anti-HBs), Total antibody to hepatitis B core antigen (anti-HBc). […] The benefits of using a 3-test panel are that it can identify individuals with current HBV infection, those with prior HBV infection, those with immunity due to prior vaccination, and those who are susceptible to HBV and would benefit from vaccination. […] Chronic HBV is an indolent and often silent disease that over time can lead to serious health consequences, including cirrhosis, decompensated liver disease, hepatocellular carcinoma (HCC), and death. […] Universal screening for HBV has the advantage of averting substantial morbidity and mortality and it has been shown to be cost-effective.

• #23 Clinical Testing and Diagnosis for Hepatitis B | Hepatitis B | CDC

  https://www.cdc.gov/hepatitis-b/hcp/diagnosis-testing/index.html

  CDC recommends screening all adults aged 18 and older for hepatitis B at least once in their lifetime using a triple panel test. […] CDC recommends testing all infants born to HBsAg-positive people for HBsAg and antibody to hepatitis B surface antigen (anti-HBs) seromarkers. […] CDC recommends HBV screening for HBsAg for all pregnant women during each pregnancy, preferably in the first trimester, regardless of vaccination status or history of testing. […] CDC recommends testing susceptible people periodically, regardless of age, with ongoing risk for exposures while risk for exposures persists. […] CDC now recommends use of the triple panel test, which includes testing for: HBsAg, Anti-HBs, Total antibody to hepatitis B core antigen (total anti-HBc). […] Different serologic markers or combinations of markers are used to identify different phases of HBV infection. They determine whether a patient has acute or chronic HBV infection, is immune to HBV as a result of prior infection or vaccination, or is susceptible to infection.

• #24 Hepatitis B: Risk Factors, Symptoms & Diagnosis

  https://www.healthline.com/health/hepatitis-b

  Doctors can usually diagnose hepatitis B with blood tests. Screening for hepatitis B may be recommended for people who: […] To screen for hepatitis B, your doctor will perform a series of blood tests. […] A hepatitis B surface antigen test shows if you have an active infection. A positive result means you have hepatitis B and can transmit the virus to others. A negative result means you dont currently have hepatitis B. […] This test doesnt distinguish between chronic and acute infection. This test is used together with other hepatitis B tests to determine the state of a hepatitis B infection. […] The hepatitis B core antigen test shows whether youre currently living with HBV. Positive results usually mean you have acute or chronic hepatitis B. It may also mean youre recovering from acute hepatitis B.

• #25 Hepatitis B Foundation: Understanding Your Hepatitis B Test Results

  https://www.hepb.org/prevention-and-diagnosis/diagnosis/understanding-your-test-results/

  Understanding your hepatitis B blood tests can be confusing. It is important to talk to your health care provider, so you understand your test results and your hepatitis B status. The Hepatitis B Panel of blood tests includes 3 tests and all three results must be known to confirm your status. […] According to the CDC, a hepatitis B blood test result (or serologic marker) varies depending on whether the infection is a new (acute) infection or a chronic infection. […] HBsAg (hepatitis B surface antigen) is the first serologic marker to appear in a new acute infection, which can be detected as early as 1 week and as late as 9 weeks (range: 6-60 days), with an average of one month after exposure to the hepatitis B virus (HBV). […] Acutely infected persons who spontaneously recover from an infection will generally test negative for HBsAg and negative for HBV DNA about 15 weeks after the appearance of symptoms.

• #26 Hepatitis B Foundation: Understanding Your Hepatitis B Test Results

  https://www.hepb.org/prevention-and-diagnosis/diagnosis/understanding-your-test-results/

  Anti-HBs or HBsAb (hepatitis B surface antibody) becomes detectable on a blood test after the disappearance of HBsAg in persons who are able to get rid of the virus (recover from an acute infection). The presence of anti-HBs following a new acute infection generally indicates recovery and a person is then protected (or immune) from re-infection with hepatitis B. […] HBeAg (hepatitis B e-antigen) is generally detectable in patients with a new acute infection but can also be present in a chronic infection. The presence of HBeAg is associated with higher HBV DNA levels, thus, increased infectiousness. […] IgM anti-HBc a positive blood test result indicates a person has a new acute hepatitis B infection. IgM anti-HBc is generally detectable at the time symptoms appear and declines to sub-detectable levels within 6 – 9 months.

• #27 The laboratory diagnosis of hepatitis B virus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2095015/

  Chronic HBV infection is defined by the continued presence of HBsAg in the blood for longer than six months. […] Test selection should be based on the person’s risk factors, vaccination history and findings from previous tests. […] If negative, chronic HBV infection is typically ruled out. […] If positive, the patient is considered HBV-infected. Chronic infection is diagnosed when the HBsAg remains detectable for greater than six months. […] If negative, past infection with HBV is typically ruled out. […] If positive, the patient has been infected with HBV. […] If negative, the patient has no apparent immunity to HBV. […] If positive, the patient is considered immune to HBV. […] Once an individual has been diagnosed with chronic HBV infection, follow-up testing must be performed for alanine aminotransferase (ALT), a marker of liver cell inflammation.

• #28 Virological techniques for the diagnosis and monitoring of hepatitis B and C | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-virological-techniques-for-diagnosis-monitoring-S1665268119318046

  The persistence of HBsAg for more than 6 months defines chronic HBV carriage. […] In a chronic HBV carrier, chronic hepatitis B is defined by an elevated serum HBV DNA level with persistent or intermittent elevation of aminotransferase levels and signs of chronic hepatitis B on liver biopsy. […] Serological and molecular HBV markers are used in clinical practice to diagnose chronic HBV infection, assess the prognosis of the disease, guide therapy and monitor treatment responses. […] In patients with clinical and/or biological signs of chronic liver disease, chronic hepatitis C is diagnosed by the simultaneous presence of anti-HCV antibodies and HCV RNA. […] Serological and molecular markers are used in clinical practice to diagnose chronic hepatitis C, guide treatment decisions and monitor the antiviral efficacy of treatment.

• #29 Laboratory Tests and Hepatitis C – Viral Hepatitis and Liver Disease

  https://www.hepatitis.va.gov/hcv/screening-diagnosis/laboratory-tests.asp

  Laboratory tests for hepatitis C are divided into four general categories: […] Screening for hepatitis C virus (HCV) is done with a serologic test for the HCV antibody (Ab). […] Diagnosis of chronic hepatitis C requires the presence of HCV RNA, commonly called hepatitis C viral load. […] Once it is determined that HCV RNA is present, the specific genotype and subtype of the virus can be determined with a genotype test. […] The presence of HCV RNA is required to confirm chronic HCV infection. Therefore, a positive HCV Ab screening result must be followed by a test for the HCV RNA. […] There are 4 major reasons that HCV RNA tests are used: To confirm a positive HCV Ab result and make the diagnosis of current HCV infection, to measure a patient’s baseline viral load prior to starting HCV therapy, to monitor a patient’s response to therapy, and to determine whether a patient has achieved a sustained virologic response (SVR).

• #30 Hepatitis C Diagnosis and Tests for HCV: Antibody, PCR, and More

  https://www.webmd.com/hepatitis/diagnostic-tests-hepatitis-c-virus

  You can be infected with the hepatitis C virus (HCV) and have no symptoms. Your doctor could find it when they check your blood and see that your level of certain liver enzymes is high. If that happens, they’ll follow up with other tests to confirm you have the disease. […] Doctors will start by checking your blood for: […] This blood test is the first — and sometimes only — one you may get. Also called the ELISA screen, it checks for antibodies that your body releases to fight the virus. These are proteins your body makes when it finds the hep C virus in your blood. They usually show up about 12 weeks after infection. Your test will be either negative or positive for antibodies. […] If your antibody test is positive, you’ll need to have a different kind of test: […] This test measures the number of viral RNA (genetic material from the hepatitis virus) particles in your blood, also called the viral load. The RNA test is almost 100% accurate and can detect an infection within a couple of weeks after exposure. […] Once the doctor knows you have hep C, they’ll do tests to find out more about your condition. This will help determine your treatment.

• #31 Hepatitis C: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1200/p626.html

  Screening recommendations and treatment guidelines for hepatitis C virus (HCV) infection have been updated. Universal screening with an anti-HCV antibody test with follow-up reflex HCV RNA polymerase chain reaction testing for positive results to confirm active disease is recommended at least once for all adults 18 years and older and during each pregnancy. […] Anti-HCV antibody testing (third-generation enzyme-linked immunosorbent assay with 99% sensitivity and specificity) is the screening test of choice with follow-up reflex HCV RNA polymerase chain reaction testing for positive results to confirm the active disease. […] The Centers for Disease Control and Prevention recommends universal HCV screening at least once for all adults 18 years and older and during each pregnancy. […] The U.S. Preventive Services Task Force recommends screening all asymptomatic adults (including people who are pregnant) 18 to 79 years of age and people younger or older who are at high risk of infection.

• #32

  https://www.nhs.uk/conditions/hepatitis-c/diagnosis/

  If you think you may have been exposed to hepatitis C, taking a test will put your mind at rest or, if the test is positive, allow you to start treatment early. […] GP surgeries, sexual health clinics, genito-urinary medicine (GUM) clinics or drug treatment services all offer testing for hepatitis C. […] You should consider getting tested for hepatitis C if you’re worried you could have been infected or you fall into one of the groups at an increased risk of being infected. […] Hepatitis C can be diagnosed using 2 blood tests: the antibody test and the PCR test. The results usually come back within 2 weeks. […] The antibody blood test determines whether you have ever been exposed to the hepatitis C virus by testing for the presence of antibodies to the virus. […] A positive test indicates that you have been infected at some stage. It doesn’t necessarily mean you are currently infected, as you may have since cleared the virus from your body.

• #33

  https://www.nhs.uk/conditions/hepatitis-c/diagnosis/

  The only way to tell if you are currently infected is to have a second blood test, called a PCR test. […] The PCR blood test checks if the virus is still present by detecting whether it is reproducing inside your body. […] If you have an active hepatitis C infection, you will be referred to a specialist for further tests to check if your liver has been damaged.

• #34 Hepatitis testing | Quest Diagnostics

  https://www.questdiagnostics.com/healthcare-professionals/about-our-tests/infectious-diseases/hepatitis

  Updated CDC guidance recommends that all adults aged 18 years and older in the US be screened at least once in their lifetime, using a triple panel test. […] CDC guidance recommends universal HCV screening for all US adults at least once in their lifetime, using an HCV antibody test with reflex to NAAT testing for HCV RNA. […] Screening is imperative for preventing serious illness as well as infection spread.

• #35 Hepatitis C: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1200/p626.html

  Screening recommendations and treatment guidelines for hepatitis C virus (HCV) infection have been updated. Universal screening with an anti-HCV antibody test with follow-up reflex HCV RNA polymerase chain reaction testing for positive results to confirm active disease is recommended at least once for all adults 18 years and older and during each pregnancy. […] Anti-HCV antibody testing (third-generation enzyme-linked immunosorbent assay with 99% sensitivity and specificity) is the screening test of choice with follow-up reflex HCV RNA polymerase chain reaction testing for positive results to confirm the active disease. […] The Centers for Disease Control and Prevention recommends universal HCV screening at least once for all adults 18 years and older and during each pregnancy. […] The U.S. Preventive Services Task Force recommends screening all asymptomatic adults (including people who are pregnant) 18 to 79 years of age and people younger or older who are at high risk of infection.

• #36 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Hepatitis-D-Diagnosis-and-Treatment.aspx

  Hepatitis D can be diagnosed on the basis of medical history, physical examination, and blood tests. […] Hepatitis D should be taken into consideration in HBsAg positive individuals or those who have suffered from HBV infection recently. The diagnosis of hepatitis D infection is confirmed after serologic tests positive for the virus. […] The detection of HDV antibodies (IgG or IgM anti-HDV) in HBsAg-positive patients is typically the first step in the diagnosis of HDV; though these antibodies can be falsely negative. […] HDV RNA viral load testing is also becoming an effective method to monitor ongoing HDV infection. […] In order to forecast the chances of development of hepatic problems in individuals with chronic HDV, a Baseline Event-Anticipation (BEA) score is used which takes into account patient demographics and other laboratory parameters such as bilirubin content and international normalized ratio (INR).

• #37 Viral hepatitis: Types, symptoms, and prevention

  https://www.medicalnewstoday.com/articles/145869

  Viral hepatitis is the inflammation and damage of liver cells due to infection. […] There are five main viruses that cause viral hepatitis, termed A, B, C, D and E. […] Healthcare professionals typically make a hepatitis A diagnosis by performing blood tests. These tests can detect antibodies that are specific to hepatitis A. […] Healthcare professionals will take several steps to diagnose hepatitis B. These include speaking with a person about sexual activity and needle use. The diagnostic process will also involve testing blood samples such as antibodies and antigens. […] As with hepatitis A and B, the primary diagnostic tool for hepatitis C is laboratory testing for hepatitis C antibodies. […] Doctors will make a hepatitis D diagnosis if they can find specific hepatitis D antibodies within a persons bodily fluids. This process involves laboratory testing. […] Healthcare professionals assess several different factors to make a hepatitis E diagnosis. These include their patients symptoms and travel history, as hepatitis E infections are endemic in some parts of the world.

• #38 Hepatitis diagnostics – USZ

  https://www.usz.ch/en/department/immunology/service/hepatitis/

  The detection of HCV RNA using PCR is available for this purpose. A positive PCR result proves an active infection, but a negative test does not completely rule out such an infection (in the case of chronic infection, positive HCV RNA results are occasionally only transient). […] Prior to antiviral therapy, the HCV RNA, the so-called viral load, and the HCV genotype are determined. […] To detect a hepatitis E infection, tests are used to detect IgG and IgM antibodies against the hepatitis E virus. If both IgG and IgM antibodies are present, it is an acute infection, provided that polyclonal stimulation by another infection, e.g. an EBV infection, is excluded. If IgG antibodies alone are detected, the patient has previously had a hepatitis E infection. If only IgM antibodies are positive, then there is probably an unspecific reaction in the context of another infection.

• #39 Hepatitis diagnostics – USZ

  https://www.usz.ch/en/department/immunology/service/hepatitis/

  In addition to this serology, we now also carry out quantitative hepatitis E-PCR. If IgM-AK is detected in the serology, it can be quickly determined whether the infection is actually active. Thanks to the quantitative determination, it is also possible to determine whether the infection is acute or chronic.

• #40 Virological techniques for the diagnosis and monitoring of hepatitis B and C | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-virological-techniques-for-diagnosis-monitoring-S1665268119318046

  Virological techniques for the diagnosis and monitoring of hepatitis B and C […] Virological tools are needed to diagnose chronic HBV and HCV infections, they may be useful to establish their prognosis, but they have found their principal application in guiding treatment decisions and assessing the virological responses to therapy. […] The detection (and eventually the quantification) of viral antigens and of specific antibodies in body fluids is based on the use of sandwich enzyme immunoassays (EIAs). […] Viral genome detection and quantification can be achieved by using two categories of molecular biology-based techniques, including target amplification (such as polymerase chain reaction (PCR)) and signal amplification (such as hybrid capture or the branched DNA assay). […] Real-time PCR has become the technique of choice to detect and quantify viral genomes in clinical practice.

• #41 Laboratory Diagnosis and Monitoring of Viral Hepatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10461253/

  In acute, self-limited infection, HBV DNA and HBsAg levels generally fall below detection limits in the first 34 months post-infection. […] The first antibodies to appear are directed against the core protein (anti-HBc). […] Total anti-HBc does not indicate the timing of infection, and anti-HBc IgM measurement is needed to determine if the infection is recent. […] In acute self-limited infection, antibodies to HBsAg are detected after HBsAg clearance and appearance of anti-HBc IgG. […] Current HBV vaccines are comprised of recombinant (non-infectious) HBsAg particles that elicit anti-HBs. […] The presence or absence of total anti-HBc will differentiate prior infection from vaccination in the HBsAb positive person, as vaccination does not elicit anti-HBc. […] Although the patterns in figures 3 and 4 are highly consistent, one serological pattern occurs that is difficult to reconcile with clinical decision making.

• #42 Laboratory Tests and Hepatitis C – Viral Hepatitis and Liver Disease

  https://www.hepatitis.va.gov/hcv/screening-diagnosis/laboratory-tests.asp

  Genotype testing is performed by analyzing the sequences of various regions of the HCV genome. […] Resistance Associated Variants (RAVs) refer to mutations that occur in the target enzymes that confer resistance to DAAs. RAV testing is done in most patients who have failed a prior DAA-containing regimen before they initiate re-treatment with another DAA regimen.

• #43 Hepatitis diagnostics – USZ

  https://www.usz.ch/en/department/immunology/service/hepatitis/

  HBV genotyping and resistance testing for the most important mutants of the hepatitis B virus are also offered for the clarification of patients before or during antiviral therapy. […] The diagnosis of a hepatitis D infection first requires the detection of a hepatitis B infection. Hepatitis D infection is detected by determining anti-HDV antibodies and by PCR diagnostics. […] If the detection of the HBs antigen is questionable, an attempt is made to reverse the result by prior neutralization with an antibody against HBs. If this is successful, it is indeed HBs antigen, otherwise the result must be classified as a false positive. […] PCR is available for the direct detection of infectious virus particles (viral load). This determination is important for the assessment of infectivity, e.g. for the isolated detection of anti-HBc and for monitoring before and during antiviral therapy.

• #44 Diagnosis of hepatitis B

  https://atm.amegroups.org/article/view/11691/html

  HBsAg is the serological hallmark of HBV infection. […] Monitoring of quantitative HBsAg levels predicts treatment response to interferon and disease progression in HBeAg-negative CHB patients with normal serum alanine aminotransferase levels. […] The diagnosis of chronic infection is based on the persistence of HBsAg for more than 6 months. […] Occult HBV infection is defined by persistence of low level of intrahepatic HBV DNA without detectable HBsAg. […] The detection of HBV DNA in the liver is the gold standard of diagnosis for occult HBV infection, since cccDNA remains in the hepatocytes and HBV DNA is occasionally identified in the liver but not in the serum. […] Real-time PCR for serum HBV DNA detection have been shown with adequate sensitivity to identify occult HBV infection in many cases; thus, HBV DNA testing is widely used to diagnose occult HBV infection. […] Diagnosis of HBV infection is an important tool to determine acute, chronic and occult cases of infection in order to establish preventive remedies and to initiate antiviral treatment.

• #45 Hepatitis B – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hepatitis-b/diagnosis-treatment/drc-20366821

  Diagnosis involves the steps that your healthcare professional takes to find out if you have hepatitis B. Your healthcare professional gives you a physical exam and looks for symptoms of liver damage. These symptoms can include yellowing skin and stomach pain. Tests that can help diagnose hepatitis B or its complications are: […] Blood tests can detect the hepatitis B virus in your body. They also can tell your healthcare professional if the infection is acute or chronic. A simple blood test also can find out if you’re immune to the condition. […] A special ultrasound called transient elastography can show the amount of liver damage. […] Your healthcare professional might remove a small sample of your liver for testing to check for liver damage. This is called a liver biopsy. During this test, your healthcare professional inserts a thin needle through your skin and into your liver. The needle removes a tissue sample for the lab to check. […] Healthcare professionals sometimes test certain healthy people for hepatitis B. This is called screening. Screening is done because HBV can damage the liver before the infection causes symptoms.

• #46 Exploring Viral Hepatitis: Types, Diagnosis, and Treatment – Global Liver Institute

  https://globalliver.org/exploring-viral-hepatitis-types-diagnosis-and-treatment/

  Viral hepatitis, a group of infections affecting the liver, has long been a global health concern. […] Recently, the World Health Organization (WHO) released its 2024 Global Hepatitis Report, which sheds light on the current state of hepatitis worldwide. […] Diagnosis Initially, doctors use blood tests to find out what type of hepatitis virus is present. For types A, C, D, and E a blood test detects if the virus or antibodies are present. For type B however, as described in a recent episode of GLI LIVE a triple panel blood test is required to detect a surface antigen (which indicates active infection), a core antibody total test (which indicates past infection), and a surface antibody test (which can indicate immunity). If hepatitis is found, they may use imaging tests like ultrasound, transient elastography, MRI, or CT scans to look for liver damage or cancer.

• #47 Diagnosing and Managing Hepatitis | NYU Langone Health

  https://nyulangone.org/conditions/hepatitis/diagnosis

  Rarely, the results of imaging studies are not detailed enough to show the extent of liver damage, and a doctor may recommend a liver biopsy. A biopsy can determine the extent of scarring, or fibrosis, in a liver affected by viral hepatitis. Information provided by a biopsy can be used to guide treatment.

• #48 Hepatitis Diagnosis, Tests, and Treatment

  https://www.webmd.com/hepatitis/understanding-hepatitis-treatment

  Viral hepatitis, such as hepatitis A (HAV), hepatitis B (HBV) and hepatitis C (HCV), is diagnosed by your symptoms, a physical exam and blood tests. Sometimes imaging studies such as a sonogram or CAT scan and a liver biopsy are also used. […] If you have symptoms or signs of viral hepatitis, your health care provider can perform a blood test to check for the presence of an antibody. If you have hepatitis B or C, more blood samples may be necessary later — even if the symptoms have vanished — to check for complications and determine if you have progressed from acute (infected within the past six months) to chronic (having the virus for greater than six months) disease. […] Your healthcare provider may also require a liver biopsy, or tissue sample, in order to determine the extent of the damage. A biopsy is commonly performed by inserting a needle into the liver and drawing out a fragment of tissue, which is then sent to a lab to be analyzed.

• #49 Hepatitis B Workup: Approach Considerations, Diagnostic Tests, Radiologic Studies

  https://emedicine.medscape.com/article/177632-workup

  Several viral markers can be identified in the serum and the liver. Hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) (marker of infectivity) are the first markers that can be identified in the serum in acute disease. […] The hallmark of acute hepatitis B is liver cell death. […] The hallmark of chronic hepatitis B infection is lymphoid inflammation, mostly involving the portal tracts. […] Liver biopsy, percutaneous or laparoscopic, is the standard means of assessing the severity of disease in patients with features of chronic active liver disease (ie, abnormal aminotransferase levels and detectable levels of hepatitis B virus [HBV] DNA).

• #50 Hepatitis Diagnosis | Viral Serology | Hepatitis Panel

  https://www.apollohospitals.com/health-library/how-is-hepatitis-diagnosed/

  Hepatitis D virus (HDV) is diagnosed by blood tests that detect the Anti HDV antibodies and HDV antigen. […] The diagnosis of Acute Hepatitis E Virus (HEV) infection is done based on the detection of anti-HEV immunoglobulin M (IgM). […] In few cases, the doctor may examine a liver tissue sample, especially if the disease is suspected to be in an advanced stage. […] If a patient has chronic hepatitis B and C, a biopsy can establish the stage and severity of the disease. […] While diagnosing hepatitis, a set of tests may become necessary to assess the type of hepatitis a person may have, how much it may have progressed and finally, to decide on the best course of treatment for the condition.

• #51 Overview of Acute Viral Hepatitis – Hepatic and Biliary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/hepatitis/overview-of-acute-viral-hepatitis

  If acute hepatitis is suspected, efforts are next directed toward identifying its cause. […] In patients with findings suggesting acute viral hepatitis, the following studies are done to screen for hepatitis viruses A, B, and C: IgM antibody to HAV (IgM anti-HAV), Hepatitis B surface antigen (HBsAg), IgM antibody to hepatitis B core (IgM anti-HBc), Antibody to HCV (anti-HCV), Hepatitis C RNA (HCV-RNA) polymerase chain reaction. […] If any are positive, further serologic testing may be necessary to differentiate acute from past or chronic infection. […] No treatments attenuate acute viral hepatitis. […] Patients with acute HCV infection should be treated with antiviral therapy upon initial diagnosis without awaiting spontaneous resolution in order to prevent transmission to others. […] Good personal hygiene helps prevent transmission, particularly fecal-oral transmission as occurs with HAV and HEV. […] Do viral serologic testing (IgM anti-HAV, HBsAg, anti-HCV) if clinical findings are consistent with acute viral hepatitis and AST and ALT are elevated out of proportion to alkaline phosphatase.

• #52 NCD – Hepatitis Panel/Acute Hepatitis Panel (190.33)

  https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=166&ncdver=1

  This panel consists of the following tests: Hepatitis A antibody (HAAb), IgM Antibody; Hepatitis B core antibody (HBcAb), IgM Antibody; Hepatitis B surface antigen (HBsAg); and Hepatitis C antibody. […] Hepatitis is an inflammation of the liver resulting from viruses, drugs, toxins, and other etiologies. […] The diagnosis of acute HBV infection is best established by documentation of a positive IgM antibody against the core antigen (HBcAb-IgM) and by identification of a positive hepatitis B surface antigen (HBsAg). The diagnosis of chronic HBV infection is established primarily by identifying a positive hepatitis B surface antigen (HBsAg) and demonstrating positive IgG antibody directed against the core antigen (HBcAb-IgG). […] HCV is the most common cause of post-transfusion hepatitis; overall HCV is responsible for 15% to 20% of all cases of acute hepatitis, and is the most common cause of chronic liver disease.

• #53 Core Concepts – HBV Screening, Testing, and Diagnosis – Screening and Diagnosis – Hepatitis B Online

  https://www.hepatitisb.uw.edu/go/screening-diagnosis/diagnosis-hbv/core-concept/all

  The serologic hallmark of acute HBV infection is the detection of IgM anti-HBc, which is typically detectable at the onset of symptoms and persists for 6 to 9 months following infection. […] Chronic HBV can be diagnosed by detection of HBsAg, HBeAg, or HBV DNA on two separate samples 6 months apart, or by detection of HBsAg, HBeAg, or HBV DNA on a single sample with a concurrent negative IgM anti-HBc.

• #54 Overview of Chronic Hepatitis – Liver and Gallbladder Disorders – MSD Manual Consumer Version

  https://www.msdmanuals.com/home/liver-and-gallbladder-disorders/hepatitis/overview-of-chronic-hepatitis

  Chronic hepatitis can progress to cirrhosis and ultimately liver cancer and/or liver failure. […] A biopsy is sometimes done to confirm the diagnosis, but chronic hepatitis is usually diagnosed based on blood test results. […] Testing for chronic hepatitis usually begins with blood tests to measure the levels of liver enzymes and other substances produced by the liver (liver tests). These tests may help establish or exclude the diagnosis of hepatitis, identify the cause, and determine the severity of liver damage. […] A liver biopsy is sometimes done to confirm the diagnosis. The liver biopsy also enables a doctor to do the following: Determine how severe the inflammation is, Determine whether any scarring (fibrosis) or cirrhosis has developed, Possibly help identify the cause of hepatitis.

• #55 Overview of Chronic Hepatitis – Hepatic and Biliary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/hepatitis/overview-of-chronic-hepatitis

  Chronic hepatitis is hepatitis that lasts 6 months. […] Biopsy is sometimes necessary to confirm the diagnosis and to grade and stage the disease. […] Hepatitis B virus (HBV) and hepatitis C virus (HCV) are frequent causes of chronic hepatitis; 5 to 10% of cases of HBV infection, with or without hepatitis D virus (HDV) coinfection, and about 75% to 85% of cases of HCV infection become chronic. […] Criteria for the diagnosis of metabolic dysfunction-associated steatotic liver disease (MASLD) include the presence of steatosis in the liver in the setting of at least 1 of the following risk factors. […] Autoimmune hepatitis is normally diagnosed based on the presence of antinuclear (ANA), antismooth muscle (ASMA), or anti-liver/kidney microsomal type 1 (anti-LKM1) antibodies at titers of 1:80 (in adults) or 1:20 (in children) and usually elevations in serum immunoglobulins.

• #56 Overview of Chronic Hepatitis – Hepatic and Biliary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/hepatitis/overview-of-chronic-hepatitis

  Consider a liver biopsy to confirm the diagnosis and assess the severity of chronic hepatitis if noninvasive testing is nondiagnostic. […] If liver test results (eg, unexplained elevations in aminotransferase levels) are compatible with chronic hepatitis, do serologic tests for hepatitis B and C. […] There are specific antiviral treatments for chronic hepatitis B and antiviral treatments for chronic hepatitis C. […] Chronic hepatitis is suspected in patients with any of the following: suggestive symptoms and signs, incidentally noted elevations in aminotransferase levels, previously diagnosed acute hepatitis. […] If the cause of hepatitis is identified, noninvasive tests (eg, ultrasound elastography, serum markers) can be done to assess the degree of liver fibrosis. […] Treatment goals for chronic hepatitis include treating the cause and, if cirrhosis and portal hypertension have developed, managing complications.

• #57 Core Concepts – HBV Screening, Testing, and Diagnosis – Screening and Diagnosis – Hepatitis B Online

  https://www.hepatitisb.uw.edu/go/screening-diagnosis/diagnosis-hbv/core-concept/all

  The serologic hallmark of acute HBV infection is the detection of IgM anti-HBc, which is typically detectable at the onset of symptoms and persists for 6 to 9 months following infection. […] Chronic HBV can be diagnosed by detection of HBsAg, HBeAg, or HBV DNA on two separate samples 6 months apart, or by detection of HBsAg, HBeAg, or HBV DNA on a single sample with a concurrent negative IgM anti-HBc.

• #58 Clinical Testing and Diagnosis for Hepatitis B | Hepatitis B | CDC

  https://www.cdc.gov/hepatitis-b/hcp/diagnosis-testing/index.html

  CDC published updated recommendations among adults for hepatitis B screening and testing in 2023 that are complementary to the 2022 Advisory Committee on Immunization Practices (ACIP) vaccine recommendations for hepatitis B. […] The recommendations consider a simpler and less stigmatizing implementation strategy than previous risk-based hepatitis B virus (HBV) screening recommendations among adults. […] More than half of people with hepatitis B are unaware of their infection status, and approximately 50%–70% of people with acute hepatitis B are asymptomatic. Without testing, people with hepatitis B virus (HBV) infection can unknowingly transmit the virus to others. […] Chronic HBV infection can lead to substantial morbidity and mortality but is detectable before the development of severe liver disease using reliable and inexpensive screening tests. Routine monitoring and treatment for chronic HBV infection can reduce morbidity and mortality, supporting the importance of early detection of HBV infection.

• #59 Hepatitis Panel: MedlinePlus Medical TestLock

  https://medlineplus.gov/lab-tests/hepatitis-panel/

  You may need a hepatitis panel if you have symptoms of hepatitis. Hepatitis doesn’t always cause symptoms, but when it does, they may include: Jaundice, a condition that causes your skin and eyes to turn yellow, Fever, Fatigue, Loss of appetite, Dark-colored urine, Pale or clay-colored stool (poop), Abdominal (belly) pain, Nausea and vomiting, Joint pain, Diarrhea (hepatitis A only). […] If your test results are abnormal, you will likely need other tests to find out if you have an active infection and whether it is an acute or chronic infection. […] Medical experts recommend that certain people should be checked for hepatitis B and/or C using other blood tests that look for only one type of virus at a time. These recommendations suggest testing for: All adults 18 and older at least once in their lifetime. During each pregnancy. Routine prenatal testing usually includes a hepatitis B test. People who have an increased risk of getting hepatitis B or C.

• #60 Testing & Diagnostics

  https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hepatitis/testing-and-diagnostics

  WHO estimates that in 2022, 254 million people were living with chronic hepatitis B virus infection, and 50 million people with chronic hepatitis C virus infection. […] Testing is an essential entry point in accessing hepatitis B and C prevention, care and treatment services, making it a critical component of national responses. […] By the end of 2022, only 13% of the estimated 254 million people living with hepatitis B had been diagnosed, and less than 3% had received antiviral treatment. Of the estimated 50 million people living with hepatitis C, 36% had been diagnosed between 2015 and 2022, and 20% had received curative treatment. […] Demand creation and awareness raising, cost-effective testing strategies and active case-finding and testing allow early identification of people with chronic hepatitis B and C.

• #61 Clinical Testing and Diagnosis for Hepatitis B | Hepatitis B | CDC

  https://www.cdc.gov/hepatitis-b/hcp/diagnosis-testing/index.html

  CDC published updated recommendations among adults for hepatitis B screening and testing in 2023 that are complementary to the 2022 Advisory Committee on Immunization Practices (ACIP) vaccine recommendations for hepatitis B. […] The recommendations consider a simpler and less stigmatizing implementation strategy than previous risk-based hepatitis B virus (HBV) screening recommendations among adults. […] More than half of people with hepatitis B are unaware of their infection status, and approximately 50%–70% of people with acute hepatitis B are asymptomatic. Without testing, people with hepatitis B virus (HBV) infection can unknowingly transmit the virus to others. […] Chronic HBV infection can lead to substantial morbidity and mortality but is detectable before the development of severe liver disease using reliable and inexpensive screening tests. Routine monitoring and treatment for chronic HBV infection can reduce morbidity and mortality, supporting the importance of early detection of HBV infection.

• #62 The laboratory diagnosis of hepatitis B virus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2095015/

  Sustained and intermittent elevations in ALT beyond the upper limit of normal are indicative of hepatic inflammation and correlate with an increased risk of progressive liver disease. […] The presence of HBV-DNA in serum or plasma denotes active HBV infection and, depending on the viral load, correlates with the infectivity of the patient. […] The presence of this marker correlates with high infectivity and, in chronic carriers, with an enhanced risk of progression to cirrhosis. […] Testing for appropriate biochemical and virological markers at defined intervals can be used to follow the progression or resolution of chronic HBV infection. […] The sustained return of ALT levels to the normal range typically implies a favourable prognosis and reflects a decrease in the level of inflammation.

• #63 Understanding Lab Tests: Entire Lesson – Viral Hepatitis and Liver Disease

  https://www.hepatitis.va.gov/hcv/patient/diagnosis/labtests-single-page.asp

  Once you’ve been diagnosed with hepatitis C, your VA provider probably will order several to learn about your liver health and your overall health. These tests will help determine which drug therapy is most appropriate to treat your hepatitis C. […] Some tests are repeated while you are on treatment to see if the treatment is working and to monitor for side effects. 10-12 weeks after you complete the Hepatitis C treatment, a final test is ordered to see if the treatment was successful, and if you have been cured. This is a very important test and should not be missed. […] If you have scarring of the liver, or cirrhosis, you may be asked to complete tests on a regular basis. These tests will monitor your liver health and guide additional treatments to prevent worsening liver function. […] If you have hepatitis C, most likely, your provider will check blood tests of your liver. There are many different liver tests and it is helpful to know what each of them means. Here, we explain common liver blood tests and how to understand your results:

• #64 Understanding Lab Tests: Entire Lesson – Viral Hepatitis and Liver Disease

  https://www.hepatitis.va.gov/hcv/patient/diagnosis/labtests-single-page.asp

  If this test result is positive, it means your body was exposed to the hepatitis C virus and made antibodies. However, it does not tell you whether you are still infected with hepatitis C. […] If a qualitative RNA test is positive (detected), then it is confirmed that the patient has chronic hepatitis C. […] The viral load of hepatitis C refers to the amount of virus present in the bloodstream. The quantitative HCV RNA tests measure the amount of hepatitis C virus in the blood. […] A person’s hepatitis C genotype does not change over time. It needs to be tested only once. If you are treated for hepatitis C, your genotype will determine your treatment plan, such as which medications are prescribed and how long the treatment will be. […] It is especially important to understand these tests if you are taking hepatitis C treatments.

• #65 Hepatitis C: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1200/p626.html

  A positive HCV antibody test reflects active disease, a resolved infection, or a rare false-positive result. […] The presence of HCV RNA indicates acute infection and can be present as early as one to two weeks after exposure. […] Direct-acting antiviral therapy is more effective, better tolerated, and the treatment course is shorter than older interferon and ribavirin-based regimens. […] Undetectable HCV RNA 12 weeks after completion of treatment indicates a sustained virologic response and is indicative of a virologic cure as reflected by the high concordance at the five-year mark. […] A sustained virologic response is associated with lower all-cause mortality and improves hepatic and extrahepatic manifestations, cognitive function, physical health, work productivity, and quality of life.

• #66 Hepatitis C Virus: Diagnosis and Treatment

  https://liverfoundation.org/liver-diseases/viral-hepatitis/hepatitis-c/diagnosing-hepatitis-c/

  Diagnosing Hepatitis C […] Diagnosing Hepatitis C […] Talk to your doctor about getting tested for Hepatitis C if you: […] The CDC (Center for Disease Control) recently recommended that all people born between during this time have a 1-time screening test for Hepatitis C. […] If you do develop symptoms related to Hepatitis C, theyre generally mild and flu-like and may include: […] Hepatitis C is transmitted or spread when the blood from a Hepatitis C-infected person enters the bloodstream of someone who is not infected. […] There is no vaccine to prevent Hepatitis C, but there is research being done to develop one. […] However, treatment options are available and Hepatitis C may be cured (or cleared from the body). […] The Hepatitis C virus is considered cured if the virus is not detected in your blood when measured with a blood test 3 months after treatment is completed.

• #67 Current Challenges and Future Perspectives of Diagnosis of Hepatitis B Virus

  https://www.mdpi.com/2075-4418/13/3/368

  Current Challenges and Future Perspectives of Diagnosis of Hepatitis B Virus […] It is estimated that approximately 260 million people worldwide are infected with the hepatitis B virus (HBV), which is one of the leading causes of liver disease and liver cancer throughout the world. Compared with developed countries, low-income and middle-income countries have limited access to resources and advanced technologies that require highly specialized staff for HBV diagnosis. In spite of the heavy burden caused by hepatitis B virus, 90% of people are still undiagnosed. The World Health Organization (WHO) goal of eliminating hepatitis B by 2030 seems very difficult to achieve due to the existing diagnostic infrastructure in low-resource regions. The majority of diagnostic laboratories still use hepatitis B surface antigen (HBsAg)-based tests. WHO’s elimination plan is at risk of derailment due to phases like the window period, immune control, and occult HBV infection (OBI) not being detected by standard tests. Here, in this article, we are focusing on various diagnostic platforms for the better diagnosis of HBV. The aim of the elimination of HBV can only be achieved by detecting all phases of HBV infection, which can be executed by a combined approach of using new marker assays along with advanced pretesting and testing methods.

• #68 Current Challenges and Future Perspectives of Diagnosis of Hepatitis B Virus

  https://www.mdpi.com/2075-4418/13/3/368

  WHO’s plan to eliminate viral hepatitis by 2030 can be accomplished by increasing diagnosis, care, and treatment. The elimination of hepatitis refers to the reduction of 90% incidence and 65% of deaths from the 2015 baseline. Screening and diagnosis should be made available to the people unacquainted with their status of HBV infection or who have not so far entered into care and treatment. These unaware infected people recurrently carry on a spread of the virus. […] The diagnosis and follow-up of chronic infection rely on laboratory viral biomarkers. There are two key categories of HBV biomarker assays: one is serology, a term encompassing the detection and quantification of viral-specific antibodies and/or antigens, and the second is nucleic acid testing (NAT) for the detection and quantification of the HBV genome and its RNA transcripts.

• #69 Current Challenges and Future Perspectives of Diagnosis of Hepatitis B Virus

  https://www.mdpi.com/2075-4418/13/3/368

  Serology tests that identify or measure HB surface antigen (HBsAg) serum levels, HB surface antibodies (anti-HBs), and HB core antibodies (anti-HBcs) are used to detect patients who have been exposed to HBV, whereas NAT tests provide information on the level of virus replication, the manifestation of particular variants, and occurrence of virus reservoirs. Tests are being advanced to measure levels of intrahepatic HBV replication. These biomarkers are to be used to identify patients with HBV infection, follow disease progression, and determine response to therapy and efficacy of new agents in clinical trials. […] HBV can be diagnosed by various HBV markers such as hepatitis B surface antigens (HBsAgs), hepatitis B surface antibodies (anti-HBs), hepatitis B e-antigen (HBeAgs), hepatitis B e-antibodies (anti-HBes), and hepatitis core antigens (anti-HBcs).

• #70 Current Challenges and Future Perspectives of Diagnosis of Hepatitis B Virus

  https://www.mdpi.com/2075-4418/13/3/368

  The fast and more accessible diagnosis of the HBV is aided by POCTs, also known as rapid diagnostic tests (RDT). These tests require 1–2 drops of sample and are easy to use, and do not require specialized training, which makes them ideal for variety of community and outreach locations. The sensitivity of these tests kits are less in comparison to other tests. […] In low-resource settings or countries, collecting blood for HBV testing at a remote location usually requires additional logistic support for transport to the testing facility. HBV diagnosis usually relies on plasma or serum for most commonly available tests. Low-resource setting sub-centers usually lack centrifugation machines needed to separate plasma and serum from blood samples. Some sub-centers may have centrifugation machines, but it is difficult to arrange supplies such as consumables and power. Samples transported at room temperature do not usually affect serological test markers, but can degrade molecular markers. This issue can be overcome by using the DBS method of sample collection and using point-of-care tests. These measures may help in overcoming the lack of testing and loss of follow-up in low resource settings. Nucleic acid testing for screening HBV is being used extensively in the developed countries but it has limited use in low-income countries due to a higher cost and requirement of trained manpower.

• #71 Current Challenges and Future Perspectives of Diagnosis of Hepatitis B Virus

  https://www.mdpi.com/2075-4418/13/3/368

  In spite of the fact that there are several unresolved and controversial issues in the diagnosis of hepatitis B, there is a necessity for mass testing, especially in areas where hepatitis B is more prevalent and where resources are limited. There is, however, an urgent need for the development of sensitive, standardized, and validated test procedures for the detection of HBsAg, HBV DNA (in blood and in liver), and other viral markers. These tests should identify HBV S variants as well as HBsAg present within immune complexes with anti-HBs. A standard report on occult blood infections should be adopted, so that this type of infection can be reported in the future. As part of the WHO’s goal to eliminate viral hepatitis from the public health agenda by 2030, the improvement of awareness of the disease, case identification, surveillance strategies, and treatment optimization are crucial steps towards achieving this goal.

• #72 Laboratory Diagnosis and Monitoring of Viral Hepatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10461253/

  In acute, self-limited infection, HBV DNA and HBsAg levels generally fall below detection limits in the first 34 months post-infection. […] The first antibodies to appear are directed against the core protein (anti-HBc). […] Total anti-HBc does not indicate the timing of infection, and anti-HBc IgM measurement is needed to determine if the infection is recent. […] In acute self-limited infection, antibodies to HBsAg are detected after HBsAg clearance and appearance of anti-HBc IgG. […] Current HBV vaccines are comprised of recombinant (non-infectious) HBsAg particles that elicit anti-HBs. […] The presence or absence of total anti-HBc will differentiate prior infection from vaccination in the HBsAb positive person, as vaccination does not elicit anti-HBc. […] Although the patterns in figures 3 and 4 are highly consistent, one serological pattern occurs that is difficult to reconcile with clinical decision making.

• #73 Hepatitis diagnostics – USZ

  https://www.usz.ch/en/department/immunology/service/hepatitis/

  Anti-HBc antibodies are markers for contact with the hepatitis B virus. While the HBs antigen signals the current presence of the virus, the detection of anti-HBs antibodies means that the infection has been overcome. After vaccination, only anti-HB antibodies are detectable, as only the surface antigen is immunized. […] The HBe antigen (secreted by-product of the HBc antigen, which dampens the immune reaction against the HBc antigen) is an indication of active virus replication with high viremia. […] As the immunological screening tests are highly sensitive, false reactive results may occur. If the HBs antigen is detected, HBs antigen confirmation is carried out. An HBs antigen-neutralizing antibody is added and then measured again. […] There are cases in which only HBc antibodies can be detected, but no HBs antigen or anti-HBs antibodies. The so-called anti-HBc only findings can have the following possible explanations: The anti-HBs antibodies have fallen below the detection limit, as the infection occurred a very long time ago, or it is an HBs antigen-negative infection (HBs antigen mutants), testing in the window phase (no more HBs antigen and still no anti-HBs antibodies) of a fading infection is also theoretically possible. Direct detection by PCR is useful for clarifying infectivity. PCR is also used for therapy monitoring.

• #74 Hepatitis diagnostics – USZ

  https://www.usz.ch/en/department/immunology/service/hepatitis/

  HBV genotyping and resistance testing for the most important mutants of the hepatitis B virus are also offered for the clarification of patients before or during antiviral therapy. […] The diagnosis of a hepatitis D infection first requires the detection of a hepatitis B infection. Hepatitis D infection is detected by determining anti-HDV antibodies and by PCR diagnostics. […] If the detection of the HBs antigen is questionable, an attempt is made to reverse the result by prior neutralization with an antibody against HBs. If this is successful, it is indeed HBs antigen, otherwise the result must be classified as a false positive. […] PCR is available for the direct detection of infectious virus particles (viral load). This determination is important for the assessment of infectivity, e.g. for the isolated detection of anti-HBc and for monitoring before and during antiviral therapy.

• #75 Viral Hepatitis Testing – Mayo Clinic LaboratoriesDetection, confirmation, and quantificationGenotyping

  https://news.mayocliniclabs.com/gastroenterology/liver-disease/viral-hepatitis/

  Several laboratory tests may be performed in cases of known or suspected viral hepatitis to help diagnose and monitor patients. Our algorithmic approach to viral test ordering focuses on proper test utilization, taking the guesswork out of test ordering, saving time and money. Developed collaboratively by physicians and laboratorians, our hepatitis-focused algorithms assist with diagnosis, treatment, and monitoring. […] The U.S. Preventative Services Task Force recommends one-time screening for HCV infection for adults born between 1945 and 1965 and for those determined to be at high risk for infection. Our reflexive suite of comprehensive testing for the detection and confirmation of both acute and chronic HCV infection enables clarity on disease presence and progression. […] Confirms diagnosis of chronic hepatitis C.

• #76 Testing & Diagnostics

  https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hepatitis/testing-and-diagnostics

  WHO estimates that in 2022, 254 million people were living with chronic hepatitis B virus infection, and 50 million people with chronic hepatitis C virus infection. […] Testing is an essential entry point in accessing hepatitis B and C prevention, care and treatment services, making it a critical component of national responses. […] By the end of 2022, only 13% of the estimated 254 million people living with hepatitis B had been diagnosed, and less than 3% had received antiviral treatment. Of the estimated 50 million people living with hepatitis C, 36% had been diagnosed between 2015 and 2022, and 20% had received curative treatment. […] Demand creation and awareness raising, cost-effective testing strategies and active case-finding and testing allow early identification of people with chronic hepatitis B and C.

• #77

  https://www.who.int/news-room/fact-sheets/detail/hepatitis-c

  HCV infection is diagnosed in 2 steps: Testing for anti-HCV antibodies with a serological test identifies people who have been infected with the virus. […] If the test is positive for anti-HCV antibodies, a nucleic acid test for HCV ribonucleic acid (RNA) is needed to confirm chronic infection and the need for treatment. This test is important because about 30% of people infected with HCV spontaneously clear the infection by a strong immune response without the need for treatment. […] Innovative new test such as HCV core antigen are in the diagnostic pipeline and will enable a one-step diagnosis of active hepatitis C infection in the future. […] Early diagnosis can prevent health problems that may result from infection and prevent transmission of the virus. WHO recommends testing people who may be at increased risk of infection. […] WHO recommends that all adults have access to and be offered HCV testing with linkage to prevention, care and treatment services.

• #78 Testing & Diagnostics

  https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hepatitis/testing-and-diagnostics

  WHO estimates that in 2022, 254 million people were living with chronic hepatitis B virus infection, and 50 million people with chronic hepatitis C virus infection. […] Testing is an essential entry point in accessing hepatitis B and C prevention, care and treatment services, making it a critical component of national responses. […] By the end of 2022, only 13% of the estimated 254 million people living with hepatitis B had been diagnosed, and less than 3% had received antiviral treatment. Of the estimated 50 million people living with hepatitis C, 36% had been diagnosed between 2015 and 2022, and 20% had received curative treatment. […] Demand creation and awareness raising, cost-effective testing strategies and active case-finding and testing allow early identification of people with chronic hepatitis B and C.

• #79 Exploring Viral Hepatitis: Types, Diagnosis, and Treatment – Global Liver Institute

  https://globalliver.org/exploring-viral-hepatitis-types-diagnosis-and-treatment/

  The 2024 Global Hepatitis Report by the World Health Organization paints a concerning picture of the hepatitis landscape worldwide. Despite progress in prevention efforts, hepatitis-related deaths are on the rise, with approximately 1.3 million deaths annually, equivalent to tuberculosis. The world still bears a substantial burden, since millions of people live with chronic hepatitis B and C globally. Access to diagnosis and treatment remains limited, as of the end of 2022, only 13% of people with chronic hepatitis B were diagnosed, and about 3% received antiviral therapy. From 2015 to 2022, only 36% of those with hepatitis C were diagnosed, and 20% received treatment. […] Efforts must be made to improve access to testing and treatment, reduce pricing disparities, and strengthen healthcare systems to ensure equitable care for all.

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