Acute Viral Hepatitis Testing

You don’t need to do anything special to prepare for this test. You can eat and drink normally beforehand.

The test uses a blood sample taken from a vein in your arm.

Results usually take about 7 working days, though some tests may take longer if sent to specialist laboratories.

What the test measures

Acute viral hepatitis testing looks for evidence of infection with three main hepatitis viruses: hepatitis A, B, and C. These viruses all cause liver inflammation but spread in different ways.

An acute hepatitis panel typically includes four tests:

Hepatitis A antibody, IgM:

• Detects antibodies your body makes when fighting a current hepatitis A infection
• These antibodies appear 3–4 weeks after infection and last about 2–6 months

Hepatitis B surface antigen (HBsAg):

• Detects proteins on the surface of the hepatitis B virus
• Appears even before symptoms develop, so useful for early detection
• Present in both acute and chronic hepatitis B infection

Hepatitis B core antibody, IgM:

• Detects antibodies against the core of the hepatitis B virus
• First antibody produced in response to hepatitis B infection
• Indicates acute infection or flare-up of chronic infection

Hepatitis C antibody:

• Detects antibodies produced in response to hepatitis C infection
• Cannot tell the difference between current and past infection, so further tests (HCV RNA) are needed

Results are interpreted by looking at the pattern of positive and negative tests. Here’s what different combinations mean:

Acute hepatitis A

If you have:

• Positive hepatitis A IgM antibody
• Negative hepatitis B surface antigen
• Negative hepatitis B core IgM antibody
• Negative hepatitis C antibody

This indicates you have acute hepatitis A infection. Hepatitis A usually causes a short-term illness and most people recover completely. There’s no chronic hepatitis A.

Acute hepatitis B

If you have:

• Negative hepatitis A IgM antibody
• Positive hepatitis B surface antigen
• Positive hepatitis B core IgM antibody
• Negative hepatitis C antibody

This indicates acute hepatitis B infection. Most adults recover within 6 months, but some (about 5–10%) develop chronic hepatitis B.

Chronic hepatitis B

If you have:

• Negative hepatitis A IgM antibody
• Positive hepatitis B surface antigen
• Negative hepatitis B core IgM antibody
• Negative hepatitis C antibody

This indicates chronic hepatitis B infection that has persisted for more than 6 months. This requires ongoing monitoring and possibly treatment.

Hepatitis B with low virus levels

If you have:

• Negative hepatitis A IgM antibody
• Negative hepatitis B surface antigen
• Positive hepatitis B core IgM antibody
• Negative hepatitis C antibody

This can indicate hepatitis B infection where the amount of virus in blood is too low to detect with the surface antigen test. Further tests are needed.

Hepatitis C (acute or chronic)

If you have:

• Negative hepatitis A IgM antibody
• Negative hepatitis B surface antigen
• Negative hepatitis B core IgM antibody
• Positive hepatitis C antibody

Important: The hepatitis C antibody test cannot tell the difference between current and past infection. If you test positive for hepatitis C antibody, you’ll need an HCV RNA test to determine whether the virus is still active in your blood. About 25% of people clear hepatitis C naturally, so a positive antibody test doesn’t always mean you have ongoing infection.

It’s possible to be infected with more than one hepatitis virus at the same time, in which case you may have positive results for multiple viruses.

All tests negative

If all tests are negative, your symptoms are probably not caused by hepatitis A, B, or C. Other possible causes include hepatitis D or E viruses, other viral infections (like EBV or CMV), autoimmune hepatitis, alcohol, or drug-induced liver damage.

Your doctor may request additional tests to find the cause of your liver inflammation.

If you have acute hepatitis A

Your doctor will:

• Advise you to rest and drink plenty of fluids
• Recommend avoiding alcohol
• Monitor your liver function with blood tests
• Advise on hygiene measures to prevent spreading infection

Most people recover completely within a few months. There’s no specific treatment for hepatitis A. You’re infectious from about 2 weeks after infection until 1 week after jaundice appears.

Close contacts may be offered hepatitis A vaccination to prevent infection.

If you have acute hepatitis B

Your doctor will:

• Monitor your condition with regular blood tests
• Test for other hepatitis markers (hepatitis B e antigen, hepatitis B DNA)
• Advise avoiding alcohol
• Explain how to prevent spreading the virus
• Arrange vaccination for household contacts and sexual partners

Most adults clear acute hepatitis B within 6 months without treatment. However, 5–10% develop chronic infection. You’re contagious as long as hepatitis B surface antigen is positive.

If infection persists for more than 6 months, you’ll need specialist referral for chronic hepatitis B management.

If you have chronic hepatitis B

You’ll need:

• Referral to a liver specialist (hepatologist)
• Regular monitoring with blood tests (every 3–6 months)
• Liver ultrasound scans (every 6 months) to check for liver damage
• Tests to check how active the virus is (hepatitis B DNA levels)
• Antiviral treatment if the virus is very active or causing liver damage

Treatment can suppress the virus and reduce liver damage, but rarely cures chronic hepatitis B completely.

If you have hepatitis C

Your doctor will:

• Request an HCV RNA test to confirm active infection
• Refer you to a liver specialist
• Assess liver damage (blood tests, FibroScan, or liver biopsy)
• Discuss treatment options

You’re considered infectious while HCV RNA is detectable in your blood.

Good news about hepatitis C treatment: Modern direct-acting antiviral drugs can cure hepatitis C in over 95% of cases. Treatment is usually 8–12 weeks with minimal side effects. Unlike hepatitis B, hepatitis C can be completely eliminated from your body. If you’re diagnosed with hepatitis C, ask about referral for treatment.

Several factors can affect test results:

• Timing of testing: antibodies take time to develop, so testing too early may give false negatives
• Window period: there’s a gap between infection and detectable antibodies (3–4 weeks for hepatitis A, 4–10 weeks for hepatitis B, 8–12 weeks for hepatitis C)
• Immunosuppression: people with weakened immune systems may not produce normal antibody responses
• Previous vaccination: hepatitis A and B vaccines can cause positive antibody tests
• Cleared infection: some antibodies remain detectable after recovery

Acute viral hepatitis testing is usually done alongside other tests:

Liver function tests:

• ALT (alanine aminotransferase) – shows liver cell damage
• AST (aspartate aminotransferase) – another marker of liver damage
• ALP (alkaline phosphatase) – can indicate bile duct problems
• Bilirubin – causes jaundice when elevated
• Prothrombin time (PT/INR) – tests blood clotting (liver makes clotting factors)

Additional hepatitis tests:

• Hepatitis A total antibody – detects both current and past infection
• Hepatitis B surface antibody – shows immunity from vaccination or cleared infection
• Hepatitis B core antibody total – indicates past or chronic infection
• Hepatitis B e antigen (HBeAg) – indicates high infectiousness
• Hepatitis B DNA – measures virus levels
• Hepatitis C RNA – confirms active infection and measures virus levels

Other viral tests:

• Hepatitis E antibody – if other tests negative
• CMV (cytomegalovirus) antibody
• EBV (Epstein-Barr virus) antibody

Liver assessment:

• Liver ultrasound scan
• FibroScan (measures liver stiffness/​scarring)
• Liver biopsy (if needed)

Viral hepatitis is inflammation of the liver caused by viruses. The three most common are hepatitis A, B, and C, which spread in different ways and have different outcomes.

Hepatitis A:

• Spread through contaminated food and water or close contact with infected person
• Usually causes short-term illness lasting a few weeks to months
• Never becomes chronic
• Vaccine available for prevention

Hepatitis B:

• Spread through blood, sexual contact, or from mother to baby during birth
• Most adults clear the infection within 6 months
• About 5–10% develop chronic infection
• Vaccine available for prevention

Hepatitis C:

• Spread primarily through blood contact (sharing needles, contaminated medical equipment)
• About 75–85% develop chronic infection
• Can be cured with direct-acting antiviral drugs (over 95% cure rate)
• No vaccine available

Chronic hepatitis B and C can lead to cirrhosis (liver scarring) and liver cancer if left untreated. Regular monitoring and treatment when needed can prevent these complications.

Learn more about hepatitis on NHS.uk and the British Liver Trust