DIAGNOSTIC IMMUNOLOGY - HEPATITIS AND HIV TESTING
Immunologist
Claudia Rogers
307-777-6061
Hepatitis and HIV testing is available in the Immunology Laboratory as descibed below.
Hepatitis HIV Antibody Testing
HAV-Total, HAV-IgM
HBsAb, HBsAg, HBcIgM
Anti-HCV
Hepatitis
Specimen Requirements for Hepatitis Testing
1. Submit a full 7 ml of blood in red top or tiger top tubes or 2 ml of serum if you have the capability of centrifuging your specimens.
2. A serology lab requisition form should be submitted with each specimen.
3. A separate HIV requisition form will need to be included if screening for HIV.
4. Providers will be provided blood drawing supplies through the WPHL.
Reminder: Public health nursing policy states that PHNs do not open test tubes to pour serum.
General Criteria for Rejection:
1. Gross hemolysis, lipemia, contamination
2. Improper Sample
3. No Name or identifier on specimen
4. HIV Testing will NOT be performed on specimens with names.
5. Quantity not sufficient (QNS) - Please send sufficient volume if multiple tests are ordered.
6. Specimens not submitted by an approved health care provider or clinic
Packaging and Shipping of Diagnostic Specimens:
1. Ship body fluids and other human biological specimens as diagnostic specimens
2. Use mailers provided by WPHL or comparable approved shipping containers
3. Sender must follow postal or carrier shipping regulations associated with packaging & shipping
DESCRIPTION OF HEPATITIS MARKERS
Hepatitis A testing for total antibody (HAV-Total) and IgM antibody to Hepatitis A Virus (HAV-IgM) will be offered in the case of acute hepatic illness or exposure to a known Hepatitis A cases.
HAV-Total Antibody to hepatitis A virus. This marker detects total antibody and should be used to screen patients to determine if they are immune due to a previous hepatitis A infection or have received the vaccination.
HAV-IgM Hepatitis A IgM antibody. This marker is present during most acute hepatitis A infections and should be requested to determine if the patient is actively infected and potentially infectious.
Hepatitis B testing will be offered if there is an overt blood-borne exposure, if there is sexual contact to a known infectious hepatitis B partner, or in the case of acute hepatic illness. Routine determination of immune status is no longer available. Three viral markers are available to determine the status of a patient: HBsAb - Hepatitis B surface antibody; HBsAg - Hepatitis B surface antigen; and HBc-IgM - Hepatitis B core IgM antibody.
HBsAb Hepatitis B surface antibody. This marker should be requested if you are checking to see if the patient has antibody to hepatitis B. A patient would have antibody if they have been previously infected with hepatitis B and have recovered from acute infection or have received the vaccination series.
HBsAg Hepatitis B surface antigen. This marker should be requested to detect surface antigen and determine whether the patient has an acute or chronic hepatitis B infection and to determine if the blood is potentially infectious. This should be ordered in conjunction with HBc-lgM.
HBc-lgM Hepatitis B Core IgM. This marker should be requested to detect core IgM antibody and determine whether the patient has an acute hepatitis B infection and to determine if the blood is potentially infectious. This should be ordered in conjunction with HBsAg
Hepatitis C is available for testing of high-risk individuals. Antibody tests for Hepatitis C cannot distinguish between a past or present infection.
HCV Antibody to hepatitis C virus. This marker should be requested when screening for hepatitis C antibody. This screening test (EIA) will not differentiate between acute, chronic, or resolved infections. Patient may or may not be infectious if screening test is positive.
HEPATITIS MARKERS SHOULD BE REQUESTED UNDER FOUR CIRCUMSTANCES
Acute illness - patient is exhibiting signs and symptoms of hepatitis infection.
Test Requests: HBsAb, HBsAg, HBclgM, HCV, HAV-Total, HAV-IgM
Eligibility: No restrictions if submitted through public health, State Institutions, or correctional facilities.
Post blood-borne exposure - patient has recently had a blood borne exposure.
Test Requests: Source HbsAg, HBclgM, HCV
Exposed: HBsAb; HCV
Eligibility: State employees, public health discretion
High risk screening - patient meets the Department of Health criteria for high risk individual.
Test Requests: HBsAb, HBsAg, HBcIgM, HCV
Eligibility: No restrictions if submitted through publicly funded programs and meet the definition of high risk criteria.
Post Hepatitis B vaccination screening - patient has recently completed their three shot Hepatitis B vaccination series. Post immunization screening should be done 4-8 weeks following the third dose.
Test Requests: HBsAb
Eligibility: State employees-PHN’s are tested following series per policy
HEPATITIS TESTING INTERPRETATIONS
Hepatitis B
HBsAb(positive) results indicate that the patient has antibody to hepatitis B virus. This is usually a result of a resolved infection with hepatitis B or a result of immunization against hepatitis B.
HBsAb(negative) results indicate that the patient has no antibody to hepatitis B virus and they are considered susceptible to infection with the Hepatitis B virus. If the patient is known to have been vaccinated against hepatitis B, their antibody levels may be present but non-detectable.
HBsAg(positive) results indicate that the patient has an acute or chronic infection with hepatitis B virus and is considered infectious.
HBsAg(negative) results indicate that no detectable hepatitis B viral antigen can be detected and status of the patient should be made on the result of the HBclgM.
HBcIgM(positive) results indicate that the patient has IgM antibody to hepatitis B and has recently been infected with the hepatitis B virus. The patient should be considered infectious at this time.
HBclgM(negative) results indicate that no detectable level of IgM antibody to hepatitis B virus exists and the status of the patient should be made in conjunction with the result of the HBsAg.
Hepatitis C
HCV(positive) result is consistent with infection with hepatitis C virus. It may be acute, chronic, or resolved infection. Positive results will be reported based on the CDC recommended algorithm in which high repeat reactive HCV (EIA) values, greater than 3.8 signal to cutoff ratio, may be considered screening test positive. The guidelines report that 95 percent of these cases are RIBA positive on confirmation. An interpretation of this recommendation will be included with the test results. The specimen will not be confirmed by RIBA. However, if the signal to cutoff is less than 3.8 on the screening EIA, the Wyoming Public Health Laboratory will reflex to RIBA testing and this report will be included with the final results.
HCV (negative) result provides no evidence for infection with hepatitis C virus.
Hepatitis A
HAV-Total(positive) results indicate that the patient has IgG or IgM antibody to the hepatitis A virus. This may indicate that the patient had a previous infection with hepatitis A virus or is currently infected. Status of the individual should be made in conjunction with the HAV-IgM.
HAV-Total(negative) results indicate that the patient has no detectable level of antibody to Hepatitis A virus. The patient is considered susceptible to Hepatitis A virus and should be considered a candidate for immunization if they meet the high risk criteria.
HAV-IgM(positive) results indicate that the patient has an acute infection with Hepatitis A virus and should be considered infectious.
HAV-IgM(negative) results indicate that the patient has no detectable level of IgM antibody to Hepatitis A virus. Be advised that the patient could be in the incubation period
HIV Antibody Testing
Enzyme Immunoassay (EIA)
Screening of samples for HIV antibody is done by EIA. Specimens that are initially reactive are repeated in duplicate. If either of the repeat tests are reactive, the specimen is considered repeat reactive and will be confirmed by Western Blot.
HIV Antibody EIA Specimen Requirements
A minimum of 1 ml serum should be submitted with an HIV form. All items on the form must be completed. DO NOT identify specimens in any way with the patient's name. Peel off the identifying number from the HIV form and affix it to the specimen tube. If additional tests are being requested with the HIV specimen, please use the identifying number on additional corresponding lab forms. Specimens considered in breach of confidentiality will not be processed.
HIV Antibody EIA Shipment
Specimens should be mailed in the HIV mailer provided by the Wyoming HIV/AIDS Prevention Program. (HIV containers should be ordered by calling (307) 777-5800). Specimens should be placed between the absorbent material inside the plastic bag provided. The specimen should then be placed inside the metal container. The lab form should be placed outside of the metal container and inside the cardboard container.
HIV Antibody Criteria for Rejection
1. Samples identified by patient name
2. Improper sample
3. Quantity not sufficient (QNS)
4. Specimens not submitted by health care provider
HIV EIA Reporting/Interpretation
Sample results will be reported as negative or positive. Negative samples have no detectable antibody to HIV. Positive samples are those that tested positive on initial EIA, repeat EIA, and Western Blot. One should remember that there is a window period with an HIV infection, and a negative result cannot guarantee that a patient is not infected with the HIV virus.
HIV Antibody EIA Normal value
Negative.
HIV Western Blot
This assay is a supplemental assay that is used to confirm HIV EIA results. HIV 1 virus is separated into its viral proteins on the strip by electrophoresis. Patients will develop antibody to the different glycoproteins at different rates and different stages of an infection. By determining the antibody to different viral bands that are present, a patient's status is determined. Our laboratory uses the Association of Public Health Laboratory Directors (APHL) criteria for determining reactivity. A specimen must exhibit any two of the three following bands to be considered reactive; p24, gp41, and gp120/160.
HIV Western Blot Specimen Requirements
If there is insufficient specimen left from the EIA, another sample with a minimum of 1 ml of serum or plasma is required. This specimen must be accompanied by an HIV form. DO NOT use patient's name on this form or any other form accompanying this specimen. This is considered a breach of confidentiality and an HIV test will not be performed on a specimen with a name identification.
HIV Western Blot Criteria for Rejection
1. Gross hemolysis or lipemic samples
2. Samples identified by patient name; breach of confidentiality
3. Improper sample
4. Quantity not sufficient (QNS)
5. Specimens not submitted by approved health care provider
HIV Western Blot Shipment
Specimens should be placed between absorbent material in the plastic bag. Place plastic bag in aluminum mailing container. Place HIV form around the outside of aluminum mailer and place this inside the cardboard mailing container and shipped as diagnostic specimens according to shipping regulations.
HIV Western Blot Reporting/Interpretation
Specimens will be reported as Negative, Positive, or Indeterminate. Specimens that are reported as negative show no detectable antibody to any of the viral protein bands on the Western Blot strip. Specimens exhibiting two or more of the three viral band patterns are considered to be HIV positive.
Specimens that are reported as Indeterminate show antibody to some of the viral protein bands, however, they do not show antibody to the bands required to call a specimen positive. A fresh sample should be resubmitted in six months. Specimens that continue to be Indeterminate in the absence of risk factors, symptoms and seroconversion, after six months should be considered as HIV negative specimens.
HIV Western Blot Normal value
Negative.
*All inquiries about HIV test results will be handled by the AIDS Prevention Program at (307) 777-5800.