Hepatitis B and C Screening Guidelines

Initial Testing and Interpretation

The Centers for Disease Control and Prevention recommends ordering Hepatitis B surface antigen (HBsAg) as the primary screening test for current HBV infection 1
The Centers for Disease Control and Prevention recommends ordering total (not IgM) anti-HBc (Hepatitis B core antibody) to detect both recent and past infections 1
The American Association for the Study of Liver Diseases suggests considering testing for anti-HBs (Hepatitis B surface antibody) to determine immunity status 2
A positive HBsAg result indicates current acute or chronic HBV infection, and follow-up testing with HBeAg, anti-HBe, and HBV DNA quantification is recommended to determine replication status 3
The Centers for Disease Control and Prevention recommends testing for IgM anti-HBc to distinguish between acute and chronic infection (IgM anti-HBc is usually only detected in acute hepatitis B) 1

The Centers for Disease Control and Prevention recommends ordering anti-HCV antibody test as the primary screening test for HCV infection 4, 5
If anti-HCV is positive, reflexively testing for HCV RNA using nucleic acid testing (NAT) is recommended to confirm current infection 4, 5
A positive anti-HCV result with a positive HCV RNA result indicates current HCV infection 5

For suspected recent exposure to HBV or HCV (within past 6 months), nucleic acid testing (HBV DNA or HCV RNA) is recommended as antibodies may not have developed 5
For immunocompromised patients, consider direct viral testing (HBV DNA or HCV RNA) as antibody production may be impaired 5
Liver function tests (such as liver enzyme tests and bilirubin levels) should be ordered to assess liver disease severity 1, 3

Relying solely on HBsAg for HBV screening may miss occult HBV infections, especially in patients with weakened immune systems 2
Testing only for anti-HCV without confirmatory HCV RNA testing cannot distinguish between current infection and resolved past infection 5
Isolated anti-HBc positivity requires careful interpretation and may need HBV DNA testing to rule out occult infection 3
False positive anti-HCV results can occur, especially in low-prevalence populations, necessitating confirmatory testing 5