Acute Viral Hepatitis Panel

How is the test used?

An acute viral hepatitis panel is used to help detect and/or diagnose acute liver infection and inflammation that is due to one of the three most common hepatitis viruses: hepatitis A virus (HAV), hepatitis B virus (HBV), or hepatitis C virus (HCV).

There are several causes of hepatitis and the accompanying symptoms, so these tests are used to determine if symptoms are due to a current infection with a virus and to identify which virus in particular is causing the disease. These tests may also help determine if someone has been exposed to one of the viruses even before symptoms develop.

An acute viral hepatitis panel typically consists of the following tests:

• Hepatitis A antibody, IgM—these antibodies typically develop early in a hepatitis A infection, about 2 to 3 weeks after a person is first infected and persist for about 2 to 6 months. A positive hepatitis A IgM test is usually considered diagnostic for acute hepatitis A in a person with signs and symptoms.
• Hepatitis B testing  
  • Hepatitis B core antibody, IgM—this is the first antibody produced in response to a hepatitis B infection and, when detected, may indicate an acute infection. It may also be present in people with chronic hepatitis B when flares of disease activity occur.
  • Hepatitis B surface Ag—this is a protein present on the surface of the hepatitis B virus. It is the earliest indicator of an acute infection but may also be present in the blood of people with chronic hepatitis B.
• Hepatitis C antibody—this test detects antibodies produced in response to a hepatitis C infection. It cannot distinguish between an active or previous infection. If positive, it is typically followed up with other tests to determine if the infection is a current one. (See the article on Hepatitis C Testing for more on this.)

There are some other tests that may be offered as part of a hepatitis panel, depending on the laboratory performing the tests. These may include:

• Hepatitis A antibody, total and Hepatitis B core antibody, total—these tests detect both IgM and IgG antibodies and may be used as part of the panel to determine if someone has had a previous infection.
• Hepatitis B surface antibody—the test for this antibody may sometimes be included in a panel to help determine if an infection has resolved or if a person has developed the antibody after receiving the hepatitis B vaccine and achieved immunity for protection against HBV.

When is it ordered?

An acute viral hepatitis panel may be ordered when a person has had blood tests done as part of a health checkup that show abnormal results on liver tests or when someone has acute symptoms associated with liver damage, such as:

• Fever, fatigue
• Loss of appetite
• Nausea, vomiting, abdominal pain
• Dark urine and/or pale colored stool
• Joint pain
• Jaundice
• Itching (pruritus)

The acute viral hepatitis panel may sometimes be used to screen people when they are at an increased risk for hepatitis B or hepatitis C infection or when it is known that they have been exposed. Below are listed some examples of who may be screened using the panel:

• People who have elevated liver enzymes (ALT and AST) with no known cause
• People who inject illegal drugs
• People with sexually transmitted diseases
• Men who have sex with men
• People with certain medical conditions that require that their immune system be suppressed (for example, transplant recipients)
• People who are in close contact with someone infected with hepatitis B or hepatitis C
• Those infected with HIV
• People who received a blood transfusion or organ transplant before July 1992 or clotting factor produced before 1987
• People on long-term dialysis
• Children born to hepatitis B- or hepatitis C-positive women
• For hepatitis B, people who were born in areas of the world where the virus is common, which includes Asia, Africa, southern Europe and parts of South America
• People with evidence of chronic liver disease
• For hepatitis C, per a 2012 Centers for Disease Control and Prevention recommendation, to help identify chronic hepatitis C infections in persons born during 1945-1965 as they are considered at an increased risk

What does the test result mean?

The table below summarizes results that may be seen with a hepatitis panel that is performed to detect an infection:

If other hepatitis tests are performed to help determine prior exposure or previous infection, they may indicate the following:

• Hepatitis A antibody, total (IgM and IgG) — if negative, no current or previous HAV infection; if positive, indicates exposure to HAV or the HAV vaccine. An IgM test must be done if an acute infection is suspected.
• Hepatitis B core antibody, total (IgM and IgG) — a positive test can indicate exposure to the virus. An IgM test must be performed if an acute infection is suspected.
• Hepatitis B surface antibody — if positive, it indicates that a HBV infection has resolved; depending on results of other HBV tests, a negative result may indicate that an infection has not resolved. Hepatitis B surface antibody will also be positive with a negative hepatitis B core antibody after a person has received a hepatitis B vaccine. (For more on this, see Hepatitis B Testing.)

It is possible to be infected with more than one hepatitis virus, and an acute infection with one hepatitis virus can be superimposed on a chronic infection with a different hepatitis virus. In such cases, there may be a positive result for more than one type of virus and care must be taken when interpreting the results.

If all the viral tests are negative, then the antibody or antigen level is too low to detect or the hepatitis is due to some other cause. For more on this and other tests that may be done to determine the cause, see the article on Hepatitis.

Are these tests always run as a panel?

No. Sometimes, if the particular hepatitis virus a person was exposed to is known, tests specific for that virus may be performed. Also, some of these tests are used for other purposes, such as monitoring the progression of disease or determining if treatment is working, and they may be run singly or in different combinations in those cases. For more about other tests used in viral hepatitis infections, see the individual articles on Hepatitis A Testing, Hepatitis B Testing, and Hepatitis C Testing.

What other laboratory tests might my healthcare practitioner perform?

In addition to tests for hepatitis viruses, your healthcare practitioner may choose to run tests to see how your liver has been affected. These may include a liver panel or individual liver enzyme tests such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP). Your healthcare practitioner may also run a test for bilirubin and a prothrombin time (PT), which can help determine if there is liver damage.

If I have viral hepatitis, am I contagious?

You may be contagious; it depends on which hepatitis virus you were infected with and the stage of your infection. Often, people with viral hepatitis can spread the infection even though they don't have symptoms. With hepatitis A, you may be contagious from the time you are infected and continue to be contagious, but less so, for several weeks after symptoms, such as jaundice, develop. A person with hepatitis B is contagious as long as the virus is present in their blood. Anyone who tests positive for the presence of hepatitis C virus (HCV RNA test) should be considered contagious. The HCV RNA test may be performed as follow up to a positive result for anti-HCV.

Is there a way to prevent viral hepatitis?

Yes. There is a vaccine available for hepatitis A. It is recommended for all children at age one year and for people who are at an increased risk of exposure to the virus. Hepatitis A can also be prevented with good hygiene. This includes washing hands well after using the bathroom, after changing diapers, and before eating or starting any food preparation.

Effective hepatitis B vaccines have been available in the U.S. since 1981, and beginning in 1991, healthcare practitioners in the U.S. began vaccinating all newborns. Children and adolescents who were not vaccinated at birth are routinely given the series of shots. The Centers for Disease Control and Prevention also recommends that adults in high risk groups get vaccinated. Unless there is something in your medical history to the contrary, it is prudent to get the series of vaccinations.

Currently, there is no vaccine available for hepatitis C, although efforts are ongoing to develop one. Spread of hepatitis C can be prevented by avoiding exposure to blood and body fluids and the sharing of needles or other equipment to inject drugs.

The results of my hepatitis panel came back negative. What other conditions can cause similar symptoms?

Hepatitis can be caused by several different factors and conditions such as alcohol, drugs like acetaminophen, or inherited disorders. (For more on these, see the article on Hepatitis.) There are a few other viral infections that may cause similar symptoms, such as cytomegalovirus (CMV) and Epstein-Barr virus (EBV). An autoimmune disease is another possibility your healthcare provider may need to consider if your hepatitis panel is negative. Typically, additional tests will be performed to help determine the cause of your condition.

Is there anything else I should know?

The tests that are typically included in an acute viral hepatitis panel may not always be able to tell whether someone has had a previous hepatitis infection or has developed antibodies in response to a vaccine. Usually other types of tests are performed to provide this type of information. See the individual articles on Hepatitis A Testing, Hepatitis B Testing or Hepatitis C Testing for more on this.

The presence of hepatitis A IgM antibodies in the blood are considered diagnostic for acute infection with hepatitis A when the test information is combined with a person's signs and symptoms. When the hepatitis screening test is performed for people who do not have symptoms of acute hepatitis, the presence of hepatitis A IgM antibodies may represent a false-positive result. Therefore, the Centers for Disease Control and Prevention has recommended against using the test for screening in people without acute hepatitis symptoms to decrease the possibility of false-positive results.