--- title: "Hepatitis B & C: Which Blood Tests Do You Need?" type: condition url: "https://www.test-well.com/conditions/hepatitis" date_published: 2026-11-03 reviewed_at: 2026-11-04 --- # Hepatitis B & C: Which Blood Tests Do You Need? *Both infections are silent for decades, both are now treatable, and the CDC recommends every adult be screened at least once. Here is which test answers which question — current infection, past infection, immunity, or liver damage.* > Never been screened? The Hepatitis Panel ($69.99) covers hepatitis A, B and C in one draw. Only hepatitis C is the question — the most common reason, and the one the CDC says every adult should check once — the Hepatitis C Test with Confirmation is $29.99. Checking whether your hepatitis B vaccine worked is the Hepatitis B Immunity Test ($27.99). Liver enzymes show damage, not infection, so they are an add-on, not a screen. ## Recommended tests | Recommended | Type | Price | Why | | --- | --- | --- | --- | | [Hepatitis Panel (A, B, C)](https://www.test-well.com/tests/hepatitis-panel) | Test | $69.99 | A, B and C screening in one draw — $69.99; the never-been-tested option | | [Hepatitis C Test with Confirmation](https://www.test-well.com/tests/hepatitis-c-test) | Test | $29.99 | Antibody with reflex to RNA confirmation — $29.99; the once-for-every-adult test | | [Hepatitis B Test with Confirmation](https://www.test-well.com/tests/hepatitis-b-test) | Test | $59.99 | Surface antigen with confirmation — $59.99; current infection | | [Hepatitis B Immunity Test](https://www.test-well.com/tests/hepatitis-b-immunity) | Test | $27.99 | Surface antibody — $27.99; did the vaccine take, and are you protected | | [Liver Function Panel](https://www.test-well.com/tests/hepatic-function-panel) | Test | $19.49 | ALT, AST, bilirubin, albumin — $19.49; liver injury, not infection | | [HIV 1/2 Antigen & Antibodies (4th Gen)](https://www.test-well.com/tests/hiv-test) | Test | $38.99 | Shares every risk factor; the CDC pairs HIV, HBV and HCV screening | | [CBC with Differential](https://www.test-well.com/tests/cbc-with-differential) | Test | $17.99 | Platelets fall as liver scarring advances — a cheap fibrosis clue | All prices are cash-pay plus one $6 lab processing fee per order; physician authorization is included. ## Why everyone is now told to screen once Hepatitis B and C are the two viral infections that quietly scar the liver over 20–30 years and lead to cirrhosis and liver cancer — and most people carrying them feel fine and do not know. In the United States an estimated 2.4 million people live with hepatitis C and about 40% are unaware; roughly 880,000 live with chronic hepatitis B and two-thirds are undiagnosed. Risk-based testing missed most of them, which is why the CDC moved to **universal screening: every adult once for hepatitis C (2020) and once for hepatitis B with the triple panel (2023)**, every pregnancy for both, and repeat testing for anyone with ongoing risk. The case for finding them changed too. **Hepatitis C is now cured** in more than 95% of people with 8–12 weeks of well-tolerated tablets. Hepatitis B is not cured but is controlled with one daily tablet when needed, and the people who do not need treatment yet still benefit from liver monitoring, cancer surveillance and vaccinating their household. There is also a vaccine for hepatitis B — the immunity test tells you whether yours worked. ## The hepatitis B tests: three questions, three markers Hepatitis B serology confuses people because one infection produces three different answers. **Surface antigen (HBsAg)** means the virus is present now — acute or chronic infection; a positive is confirmed, and the next steps are a viral load (HBV DNA), e-antigen status and liver tests. **Surface antibody (anti-HBs)** means you are protected, either from vaccination or from a past infection you cleared; a level of **10 mIU/mL or more** is considered immune. **Core antibody (anti-HBc)** means you were infected at some point — it is never produced by the vaccine — and it persists for life whether the infection cleared or became chronic. Read together: *antibody positive, antigen and core negative* = vaccinated and immune. *Core positive and surface antibody positive* = past infection, recovered, immune. *Antigen positive and core positive* = current infection. *Core positive alone* is the ambiguous one — a resolved infection with waning antibody, a very low-level chronic infection, or a false positive — and needs a clinician and often a DNA test, particularly before chemotherapy or immunosuppression, when a dormant virus can reactivate. *All three negative* = never infected, not immune: get vaccinated. The **Hepatitis B Test with Confirmation** answers "do I have it now"; the **Hepatitis B Immunity Test** answers "am I protected"; the triple panel the CDC recommends asks all three at once, which is why the full Hepatitis Panel is the right first test for anyone who has never been checked. ## The hepatitis C tests: antibody, then RNA Screening starts with the **hepatitis C antibody**. A negative means no infection (unless exposure was within the last 8–12 weeks, before antibodies form, or you are severely immunosuppressed). A positive means you were infected at some point — but about a quarter of people clear the virus on their own, and the antibody stays positive for life either way. So a positive antibody is **reflexed automatically to an HCV RNA (PCR) test** on the same sample: RNA detected means current infection and is what gets treated; RNA not detected means a past, resolved infection and no further action beyond knowing the antibody will always read positive. If RNA is detected, the next steps are a genotype (less important with modern pan-genotypic drugs), liver enzymes and a fibrosis assessment (platelet count, FIB-4 calculation, often an elastography scan), hepatitis B and HIV testing, and a referral or primary-care treatment course — many primary care clinicians now prescribe the cure directly. ## Who should test — and who should test again - **Everyone 18 and over, once**, for both hepatitis C (antibody with reflex RNA) and hepatitis B (triple panel), unless already known positive or documented immune. - **Every pregnancy**, for both — treatment and newborn vaccination prevent transmission. - **Periodically while risk continues:** any injection drug use (even once, years ago, for the one-time test; ongoing use for repeat testing), sharing equipment, non-sterile tattoos or piercings, a sexual partner or household member with hepatitis B or C, men who have sex with men, multiple partners, a history of sexually transmitted infections, HIV, dialysis, healthcare or public-safety work with blood exposure, and incarceration. - **Past exposures that warrant the one-time test now:** a blood transfusion or organ transplant before July 1992, clotting factor concentrates before 1987, long-term hemodialysis, a needlestick, birth to a mother with hepatitis B or C, or birth in a country where hepatitis B is common (much of Asia, Africa, the Pacific Islands and parts of Eastern Europe and South America). - **Unexplained abnormal liver enzymes**, fatigue, right-upper-abdominal discomfort, dark urine or jaundice — test rather than wait. - **Before chemotherapy, biologics or other immunosuppression** — the hepatitis B core antibody specifically, because a dormant infection can reactivate. ## What liver enzymes do and do not tell you A **liver function panel** — ALT, AST, alkaline phosphatase, bilirubin, albumin — measures injury and function, not infection. ALT is normal in many people with chronic hepatitis B and in a good share of those with hepatitis C, so a normal liver panel never rules either out; and a raised ALT has dozens of other causes, fatty liver first among them. Where the panel earns its place is *after* a positive result: it stages how much damage has occurred, decides how urgently treatment is needed, and tracks the response. A CBC adds the platelet count, which falls as scarring advances and feeds the FIB-4 fibrosis score with age, AST and ALT. Order the liver panel with the screen if you have symptoms, drink heavily, have fatty liver or diabetes, or simply want the whole picture in one visit; order the screen alone if the only question is whether you carry the virus. ## How to get tested and what happens next Order online and walk into any Quest or Labcorp location with your requisition — no appointment, no doctor's visit, no fasting (fast only if a metabolic or lipid panel is on the same order). Results post to your secure account, most within two to four business days; reflex confirmations add a day or two. Results are private and are not shared with insurers or employers. A positive hepatitis C RNA or hepatitis B surface antigen is the beginning of a treatable condition, not an emergency: take the result to your clinician for staging and treatment, make sure household and sexual contacts are tested and, for hepatitis B, vaccinated, and ask about hepatitis A and B vaccination for yourself if you are not immune. A negative screen with no ongoing risk needs no repeat; with continuing risk, repeat yearly. ## Frequently asked questions ### Which hepatitis test do I need if I've never been tested? The CDC's recommendation for every adult is a one-time hepatitis C antibody with reflex RNA and a one-time hepatitis B triple panel (surface antigen, surface antibody, core antibody). The Hepatitis Panel (A, B, C) covers that screen in one draw; if hepatitis C is your only question, the Hepatitis C Test with Confirmation is the single test to order. ### What does a positive hepatitis C antibody mean? That you were infected at some point. About a quarter of people clear the virus on their own, and the antibody stays positive for life either way, so the sample is automatically reflexed to an RNA test: RNA detected means current infection, which is curable with 8–12 weeks of tablets; RNA not detected means a past, resolved infection. ### How do I know if my hepatitis B vaccine worked? A hepatitis B surface antibody (anti-HBs) level of 10 mIU/mL or higher means you are immune. Levels fall over the years after vaccination but protection usually persists; a low or negative result in someone who was vaccinated is often answered with a booster dose and a repeat test. Healthcare workers, dialysis patients and immunocompromised people are the groups where documented immunity matters most. ### Can liver enzymes rule out hepatitis? No. ALT and AST are normal in many people with chronic hepatitis B and in a good share of those with hepatitis C, and a raised ALT has many other causes, fatty liver most of all. Liver enzymes stage the damage once an infection is found; the antibody and antigen tests are what detect it. ### How soon after exposure can hepatitis be detected? Hepatitis C antibodies take 8–12 weeks to appear; an RNA test detects the virus within one to two weeks of exposure and is used when the exposure was recent. Hepatitis B surface antigen appears within one to nine weeks (usually about four). After a specific exposure such as a needlestick, test at baseline and again at 4–6 weeks and 6 months, and seek care promptly — post-exposure hepatitis B vaccine and immune globulin work best within 24 hours. ### Do I need to fast for a hepatitis test? No. None of the hepatitis antibody, antigen or RNA tests require fasting. If a comprehensive metabolic panel or lipid panel is on the same order, fast 8–12 hours for those; otherwise eat and drink normally. ## Sources - [CDC — Screening and testing for hepatitis B virus infection: CDC recommendations, United States, 2023 (MMWR Recomm Rep 2023;72(RR-1))](https://www.cdc.gov/mmwr/volumes/72/rr/rr7201a1.htm) - [CDC — Recommendations for hepatitis C screening among adults, United States, 2020 (MMWR Recomm Rep 2020;69(RR-2))](https://www.cdc.gov/mmwr/volumes/69/rr/rr6902a1.htm) - [USPSTF — Hepatitis C virus infection in adolescents and adults: screening (2020, grade B)](https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/hepatitis-c-screening) - [AASLD/IDSA — HCV guidance: recommendations for testing, managing, and treating hepatitis C](https://www.hcvguidelines.org/) - [Terrault NA, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67(4):1560–99](https://pubmed.ncbi.nlm.nih.gov/29405329/) - [CDC — Interpretation of hepatitis B serologic test results](https://www.cdc.gov/hepatitis-b/hcp/diagnosis-testing/index.html) --- Medically reviewed by Youmna DiStefano, MD (Medical Reviewer, TestWell); last reviewed 2026-11-04. Review policy: https://www.test-well.com/reviewers/youmna-distefano-md Canonical page: https://www.test-well.com/conditions/hepatitis Machine-readable catalog: https://www.test-well.com/api/catalog.json · MCP server: https://www.test-well.com/mcp · Overview for agents: https://www.test-well.com/llms.txt Prices are cash-pay, in USD, and include physician authorization; every order adds one flat $6 lab processing fee. Educational content is not a diagnosis — discuss results with a clinician.