Acute Viral Hepatitis Panel
A blood sample drawn from a vein in your arm
Hepatitis is an inflammation and enlargement of the liver. One of the most common causes of acute hepatitis is infection with a hepatitis virus, usually hepatitis A, hepatitis B or hepatitis C. An acute viral hepatitis panel is a group of blood tests often performed together to help diagnose viral hepatitis. Some of the tests detect antibodies produced by the immune system in response to the infection and one detects proteins (antigens) that indicate the presence of the virus.
A hepatitis panel typically includes:
- Hepatitis A antibody, IgM
- Hepatitis B core antibody, IgM
- Hepatitis B surface Ag
- Hepatitis C antibody
If acute symptoms are suspected to be caused by one of the hepatitis viruses or if someone is at an increased risk of being infected or has been exposed, then a hepatitis panel can help determine if the person has been infected and which virus is present.
Hepatitis A virus (HAV) is highly contagious and is usually contracted by ingesting food or water contaminated with the virus or by coming in contact with an infected person. While hepatitis A infections are usually mild, the virus can on rare occasions cause a severe, acute disease. Hepatitis A does not cause a chronic infection, as do hepatitis B and C. A vaccine is available to prevent hepatitis A.
Hepatitis B virus (HBV) is the most common cause of acute viral hepatitis. It is spread through contact with blood or other body fluids from an infected person. Exposure can occur, for example, through sharing of needles for intravenous drug use or through unprotected sex. People who live in or travel to areas of the world where hepatitis B is prevalent are at a greater risk. Rarely, mothers can pass the infection to their babies, usually during birth. The virus, however, is not spread through food or water, casual contact such as holding hands, or coughing or sneezing. A vaccine can be given to protect against hepatitis B.
Hepatitis C virus (HCV) is also spread by exposure to contaminated blood, primarily though the sharing of needles by intravenous drug users, but also by sharing personal items contaminated by blood such as razors, through sex with an infected person, via health care occupational exposure, and from mother to baby during childbirth. Before tests for HCV became available in the 1990s, HCV was often transmitted by blood transfusions. Currently, there is no vaccine to prevent infection with HCV.
Some of the hepatitis panel tests detect IgM antibodies. These are the first antibodies produced during the initial stages of infection. As the disease progresses or resolves, IgM antibody levels decrease. The panel also typically includes a test for hepatitis B surface antigen (HbsAg). This test detects proteins on the surface of the virus. HBsAg is the earliest indicator of an acute hepatitis B infection and is usually present even before symptoms appear, so this test is useful for screening those who are at high risk of infection or who may have been exposed. The test for hepatitis C antibody cannot distinguish between an active or previous infection and further testing is necessary to determine whether the infection is current.
How is the sample collected for testing?
A blood sample is obtained by inserting a needle into a vein in the arm.
Is any test preparation needed to ensure the quality of the sample?
No test preparation is needed.
How is it 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 2 to 3 weeks after first being infected and persist for about 2 to 6 months. Hepatitis A IgM antibodies develop early in the course of infection, so a positive hepatitis A IgM test is usually considered diagnostic for acute hepatitis A in a person with signs and symptoms.
- Hepatitis B core antibody, IgM—this is an antibody produced against the hepatitis B core antigen. It 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 those chronically infected.
- Hepatitis C antibody—this test detects antibodies produced in response to an HCV 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 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:
- HAV antibody, total and HBV 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.
- HBV 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
- 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 acute infection:
Anti-hepatitis A, IgM Hepatitis B surface antigen Anti-hepatitis B core, IgM Anti-hepatitis C Interpretation Positive Negative Negative Negative Acute hepatitis A Negative Positive Positive Negative Acute hepatitis B Negative Positive Negative Negative Chronic hepatitis B infection Negative Negative Positive Negative Acute hepatitis B; quantity of hepatitis B surface antigen is too low to detect Negative Negative Negative Positive Acute or chronic hepatitis C; additional tests are required to make the determination
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 or to HBV vaccine. 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. It 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: What does the test result mean?)
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.
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 have recommended against using the test for screening in people without acute hepatitis symptoms to decrease the possibility of false-positive results.
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 doctor perform?
In addition to tests for hepatitis viruses, your doctor may choose to run tests to see how your liver has been affected. These may include liver enzyme tests such as AST, ALT, and ALP. Your healthcare provider 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. Hepatitis A can 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. There is also a vaccine available. It is recommended for all children at age one year and for people who are at an increased risk of exposure to the virus.
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.
On This Site
Elsewhere On The Web
Centers for Disease Control and Prevention: Viral Hepatitis Risk Assessment
National Digestive Diseases Information Clearinghouse: Viral Hepatitis
American Liver Foundation: Hepatitis A, Hepatitis B, Hepatitis C
Centers for Disease Control and Prevention: Viral Hepatitis
World Health Organization: What is hepatitis?
WomensHealth.gov: Viral hepatitis fact sheet
Hepatitis Foundation International: Living with Hepatitis