Hepatitis B and C Diagnosis and Management

Diagnosis and Interpretation

• A positive test for hepatitis B surface antigen (HBsAg) indicates acute or chronic infection, and the presence of HBeAg indicates active viral replication, as recommended by the Centers for Disease Control and Prevention 1
• A positive test for anti-HBs indicates recovery and immunity, while anti-HBc (total) indicates previous exposure to the virus, and IgM anti-HBc distinguishes between acute and chronic hepatitis B 1
• The following serologic marker patterns are used for interpretation:

• Comprehensive serologic testing for hepatitis A, B, and C should be performed in patients with a claimed history of hepatitis but unknown details, including anti-HCV antibody with reflex HCV RNA testing, HBsAg, anti-HBc, anti-HBs, and anti-HAV antibodies, as recommended by the American Association for the Study of Liver Diseases 2, 3
• HCV RNA testing should be performed reflexively if anti-HCV is positive to confirm active infection, with a high sensitivity (>90%) 3, 4

Screening and Risk Assessment

• All adults aged 18-79 years should be screened for Hepatitis C virus (HCV) infection at least once in their lifetime, with more frequent screening for those with ongoing risk factors, such as injection drug use, as recommended by the American Academy of Family Physicians and the US Preventive Services Task Force 5, 3
• High-risk individuals, including those with a history of illicit drug use, should receive periodic screening, as recommended by the American Academy of Family Physicians and the US Preventive Services Task Force 5, 6, 7
• Screening is voluntary and should be undertaken only with patient knowledge and consent, as recommended by the American Academy of Family Physicians 5

Treatment and Management

• All patients with chronic HCV infection should be considered for treatment, with priority given to those with advanced fibrosis, cirrhosis, or significant extrahepatic manifestations, as recommended by the American Academy of Family Physicians 3
• Direct-acting antiviral (DAA) therapy is the standard of care, with treatment selection based on HCV genotype, presence/absence of cirrhosis, prior treatment history, and comorbidities, as recommended by the American Association for the Study of Liver Diseases 5, 8, 9
• Typical treatment duration is 8-12 weeks, as noted by 5
• The goal of treatment is to achieve sustained virological response (SVR), defined as undetectable HCV RNA 12 weeks after completion of therapy, as recommended by the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases 8, 9

Monitoring and Follow-up

• Continuous surveillance for development of cirrhosis and hepatocellular carcinoma is necessary, with ultrasound surveillance every 6 months for patients with cirrhosis, as recommended by the American Academy of Family Physicians and the CDC 3, 10, 11
• The following laboratory tests are recommended for assessment of liver disease severity:

• Early detection and treatment of HCV infection significantly reduces progression to cirrhosis, development of hepatocellular carcinoma, and overall mortality, as noted by 3
• Patients with advanced liver disease require careful monitoring during treatment, and certain medications may be contraindicated or require dose adjustments, as recommended by the EASL 8
• For patients with cirrhosis, continued surveillance for hepatocellular carcinoma is required even after achieving SVR, as advised by the EASL 8