Hepatitis B and hepatitis C are viral infections of the liver. Both can sit quietly for years, slowly causing scarring, and both are found with a simple blood test. Over the past few years the CDC has moved from testing only people with known risk factors to recommending that every adult be tested at least once.

If you have never been tested, or are not sure, this is an easy item to add to your next blood draw.

Why test people who feel fine

The CDC notes that many people with hepatitis C look and feel healthy, and that most people who are infected develop a lifelong infection. Left untreated, it can lead to cirrhosis, liver failure and liver cancer, and it is a leading cause of liver transplants in the United States.

Hepatitis B is similar. According to the CDC, about 1 in 2 people with hepatitis B do not know they are infected, and many have no symptoms for decades. Chronic infection can also cause cirrhosis and liver cancer.

Both viruses spread through blood, and hepatitis B also through other body fluids. Many people who test positive cannot point to a clear exposure, which is part of why testing everyone once makes sense.

Hepatitis C: test once, and the cure

The CDC’s hepatitis C testing recommendations, first issued in 2020, say:

  • All adults 18 and older should be tested at least once in their lifetime.
  • Pregnant women should be tested during each pregnancy.
  • People with ongoing risk, including people on maintenance hemodialysis and people who inject drugs, should be tested regularly.
  • Anyone who asks for a test should get one.

For most adults, that means a single test. Dialysis is one of the exceptions on both lists: people on maintenance dialysis are tested for hepatitis B and C on a regular schedule, which is one of the places where kidney care and liver screening meet.

Testing starts with an antibody test. If it is reactive, a second test looks for the virus itself (HCV RNA). A positive antibody with a negative RNA result usually means a past infection that has cleared or been treated.

The news after a positive result is better than it used to be. Current oral medicines cure more than 95 percent of people in 8 to 12 weeks. Hepatitis C has gone from a lifelong condition to one that, for most people, is treated once and finished.

Hepatitis B: test once, with three markers

In 2023 the CDC updated its hepatitis B testing advice:

  • All adults 18 and older should be screened at least once.
  • The recommended screen is a triple panel: hepatitis B surface antigen (HBsAg), surface antibody (anti-HBs) and total core antibody (anti-HBc).
  • People with ongoing risk, including people on dialysis, people with HIV and people who inject drugs, should be tested periodically.
  • Anyone who asks for a test should get one.

The three markers together answer three questions: are you infected now, have you been infected in the past, and are you protected by vaccination or past infection. That last answer is useful on its own.

Treatment for chronic hepatitis B is different from hepatitis C. The CDC notes that medicines exist for chronic hepatitis B but are not a cure, and that regular liver monitoring by a specialist matters.

What about the hepatitis B vaccine?

If your triple panel shows you are not immune, vaccination may be the next step. The CDC currently recommends the hepatitis B vaccine for adults aged 19 to 59, and for adults 60 and older who have risk factors for hepatitis B. Vaccine advice has been under review in recent years, so it is worth confirming the current guidance with your doctor.

When to call sooner

Screening is for people without symptoms. The CDC lists signs of liver infection such as yellow skin or eyes, dark urine, clay-colored stools, nausea and fatigue. If you notice yellowing of the skin or eyes, call your doctor promptly. Confusion, vomiting blood or black stools need emergency care.

For a fuller picture of routine blood work, see what you need from an annual physical.

At Legacy Medical, blood is drawn in the office, so hepatitis B and C screening can be added to the labs you are already having. If a result is positive, Dr. Shtern explains it and coordinates the right specialist. To meet her first, the first visit is a complimentary meet and greet.

This article is general information, not advice for your situation. Members can call the office with questions about their own care.