ABSTRACT
INDICATIONS ■ Evaluation of asymptomatic patients with increased serum
levels of transaminases ■ Evaluation of patients with symptoms suggestive of infectious
hepatitis-fevers, jaundice, malaise, right upper quadrant pain
tious source-parenteral exposure, needlestick, high-risk sexual contacts
■ Evaluation of immunity in patients vaccinated against viral hepatitis
INTERPRETATION ■ For interpretation of hepatitis serologic tests, see Table 1. ■ Hepatitis A-markers include anti-HAV total and IgM
fraction ■ Hepatitis B
Disease state Test results Comments
Acute hepatitis A (+) Anti-HAV IgM Past exposure to (+) Anti-HAV IgG Anti-HAV IgG confers
hepatitis A immunity Acute hepatitis B (+) HBsAg (+) HBeAg or (+) HBV-
(+) Anti-HBcAg DNA indicates high (IgM) infectivity
Chronic hepatitis B (+) HBsAg (high infectivity) (+) Anti-HBcAg
(IgG) (+) HBeAg
Chronic hepatitis B (+) HBsAg (low infectivity) (+) Anti-HBcAg
(IgG) (+) Anti-HBeAg
Recovery from (+) Anti-HBsAg Anti-HBsAg IgG acute hepatitis B (+) Anti-HBcAg confers immunity
(IgG) (±) Anti-HBeAg
Vaccinated against (+) Anti-HBsAg hepatitis B
Exposure to hepa-(+) Anti-HCV If (+) by ELISA and titis C (−) by RIBA, consider
false positive Anti-HCV is not protective against disease
Chronic hepatitis C (+) Anti-HCV (+) HCV-RNA
Active hepatitis D (+) Anti-HDV Hepatitis D occurs only as coinfection with acute hepatitis B or as superinfection on chronic hepatitis B
▲ Markers include HBsAg (surface antigen), anti-HBsAg ▲ HBcAg (core antigen), anti-HBcAg (total and IgM frac-
tion) ▲ HBeAg (“e” antigen, which indicates active viral repli-
cation), anti-HBeAg ▲ HBV-DNA (also correlates with active viral replication)
■ Hepatitis C ▲ Markers include anti-HCV by ELISA and RIBA ▲ HCV-RNA by polymerase chain reaction
ADDITIONAL TESTING ■ Evaluation of patients with high-risk exposure (high-risk
sexual contact, injection drug use, occupational needlesticks) should include evaluation for HIV.
