Screening for hepatitis B and C and assessment of liver fibrosis risk

Viral Hepatitis B and C Screening + Liver Fibrosis Risk Assessment is a comprehensive laboratory profile designed to detect hepatitis B and C virus infections, assess immunity to hepatitis B virus, and non-invasively evaluate the risk of liver fibrosis. The profile includes the main serological markers used for hepatitis screening and the FIB-4 index, which estimates the risk of liver fibrosis without the need for invasive procedures. This screening is especially recommended for individuals who have never been diagnosed with hepatitis B or C and wish to determine their infection status and evaluate their liver health.

Profile Components

HBsAg (Hepatitis B surface antigen)
The main marker of a current hepatitis B virus infection. It is detected in acute or chronic infection and is used for primary screening.

Anti-HBc total (total IgM and IgG antibodies to the hepatitis B core antigen)
Indicates a current or previous hepatitis B virus infection. These antibodies do not appear after vaccination and help distinguish a previous infection from vaccine-induced immunity.

Anti-HBs, quantitative (antibodies to the hepatitis B surface antigen)
Determines immunity to hepatitis B virus following vaccination or a previous infection. Quantitative measurement allows assessment of the level of protective antibodies.

Anti-HCV (total IgG/IgM antibodies to hepatitis C virus)
A screening test for detecting exposure to hepatitis C virus. A positive result indicates the need for additional investigations to confirm an active infection.

FIB-4 (non-invasive assessment of liver fibrosis risk)
A calculated index based on the patient's age and laboratory parameters. It allows assessment of the probability of liver fibrosis without the need for biopsy and helps determine whether further investigations are required.

Indications

• screening for hepatitis B and C in individuals with no previous diagnosis;
• assessment of immunity to hepatitis B virus;
• individuals with risk factors for viral hepatitis (blood transfusions, surgical procedures, invasive medical procedures, tattoos, piercings, or contact with infected individuals);
• abnormal liver function test results;
• monitoring of patients with chronic liver diseases;
• non-invasive assessment of the risk of liver fibrosis.

Procedure

The test requires a venous blood sample. The same blood sample is used to determine the main serological markers of hepatitis B and C (HBsAg, anti-HBc total, anti-HBs, and anti-HCV). In addition, the FIB-4 index is automatically calculated based on the patient's age and laboratory parameters to estimate the risk of liver fibrosis. The combined interpretation of these results provides information about current or past hepatitis B infection, immunity to hepatitis B, screening for hepatitis C infection, and the risk of liver fibrosis.

Method

Serological markers are determined using the chemiluminescent immunoassay (CLIA) method. The FIB-4 index is calculated automatically using an internationally validated algorithm.

Limitations

The test results should be interpreted together with the patient's clinical findings and, when necessary, additional laboratory or imaging investigations. A positive screening result may require confirmatory testing. The FIB-4 index estimates the risk of liver fibrosis but does not establish a definitive diagnosis and does not replace medical evaluation.

Sources:

https://pmc.ncbi.nlm.nih.gov/articles/PMC12595518/
https://cdn.who.int/media/docs/default-source/searo/hiv-hepatitis/training-modules/09-non-invasive-liver-fibrosis.pdf?sfvrsn=b5dedcc2_2
https://testingportal.ashm.org.au/clinical-assessment-of-patients-with-hepatitis-b-virus-infection/