Nucleic Acid Testing For Hcv
Since the HCV RNA is detectable within a few days of infection the nucleic acid-based tests are efficient in an early diagnostic of acute hepatitis C and should be considered as mandatory. The HCV RNA measurement is furthermore important in determination of the HCV genotype, selection of treatment strategy, therapy duration and evaluation of the treatment success. For a number of antiviral combination therapies, the HCV RNA follow-up studies are essential to define the outcome of the treatment and further therapeutic strategies, if necessary. Traditionally, the tests should be repeated 24 wk after treatment completion to assess whether a sustained virologic response has been achieved. However, as the probability of a virologic relapse is similar after 12 and 24 wk, the new time point for assessment of final virological treatment outcome is 12 wk after the end-of-treatment. Both qualitative and quantitative PCR-based detection assays are available. Qualitative PCR tests are sensitive and are used for initial diagnostic of hepatitis C, for screening of blood and organ donations and for confirming SVR after treatment completion .2). Quantitative reverse transcriptase real-time PCR-based assays can detect and quantify the HCV RNA over a very wide range, from approximately 10 IU/mL to 10 million IU/mL. The measurements are essential in the treatment monitoring when the virus load is gradually reducing.
How Can I Cover Medication Costs
New therapies called direct-acting antivirals are effective and can achieve cures of over 90%. Because these new therapies are very new, they remain very expensive. As such, drug coverage from both government and private companies may require that your liver disease has progressed to a certain stage before they are willing to cover the cost of these drugs.
Talk with your healthcare provider about financial support that may be available.
Below are useful resources when looking for financial assistance:Private health insurance or drug plansIf you have private health insurance or a drug plan at work, you may be able to have the medication paid through your plan. Please consult your private health insurance or drug plan provider to see if your drug is covered.
Publicly funded plansEach provincial and territorial government offers a drug benefit plan for eligible groups. Some are income-based universal programs. Most have specific programs for population groups that may require more enhanced coverage for high drug costs. These groups include seniors, recipients of social assistance, and individuals with diseases or conditions that are associated with high drug costs. For more details, please contact your provincial or territorial health care ministry, or click on the appropriate link below.
Yukon
Available Patient Assistance Programs for Hepatitis C treatment Holkira Pak Maviret
MerckCare Hepatitis C Program 1 872-5773 Zepatier
What Causes Hepatitis C
The hepatitis C virus causes hepatitis C. The hepatitis C virus spreads through contact with an infected persons blood. Contact can occur by
- sharing drug needles or other drug materials with an infected person
- getting an accidental stick with a needle that was used on an infected person
- being tattooed or pierced with tools or inks that were not kept sterilefree from all viruses and other microorganismsand were used on an infected person before they were used on you
- having contact with the blood or open sores of an infected person
- using an infected persons razor, toothbrush, or nail clippers
- being born to a mother with hepatitis C
- having unprotected sex with an infected person
You cant get hepatitis C from
- being coughed or sneezed on by an infected person
- drinking water or eating food
- hugging an infected person
- shaking hands or holding hands with an infected person
- sharing spoons, forks, and other eating utensils
- sitting next to an infected person
A baby cant get hepatitis C from breast milk.18
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Hepatitis C Antibody Test
Certain foreign substances that enter your body trigger your immune system to make antibodies. Antibodies are specifically programmed to only target the foreign substance they were made to fight.
If youve ever had a hepatitis C infection, your body will make hepatitis C antibodies as part of its immune response.
Your body only makes these antibodies if you have hepatitis C or had it in the past. So the hepatitis C antibody test can confirm whether you have the virus by testing for these specific antibodies.
It may take 2 to 3 months after exposure for the test to detect antibodies. If needed, your healthcare professional may order an HCV RNA test, which can detect the virus after just 1 or 2 weeks.
If the antibody test is positive, an HCV RNA test can show whether the infection is current.
While people of any gender experience the same hepatitis C symptoms, 2014 research suggested some effects of the virus may differ, depending on the sex you were assigned at birth.
Researchers noted that:
- women have a higher chance of clearing the virus without treatment
- liver disease may progress more rapidly in men
- men have a higher chance of developing cirrhosis
What Is Hepatitis C Infection How Many People Are Infected
Hepatitis C virus infection is an infection of the liver caused by the hepatitis C virus . It is difficult for the human immune system to eliminate hepatitis C from the body, and infection with hepatitis C usually becomes chronic. Over decades, chronic infection with hepatitis C damages the liver and can cause liver failure. In the U.S., the CDC has estimated that approximately 41,200 new cases of hepatitis C occurred in 2016. When the virus first enters the body there usually are no symptoms, so this number is an estimate. About 75%-85% of newly infected people become chronically infected. In the U.S., more than 2 million people are estimated to be chronically infected with hepatitis C. Infection is most commonly detected among people who are 40 to 60 years of age, reflecting the high rates of infection in the 1970s and 1980s. There are 8,000 to 10,000 deaths each year in the U.S. related to hepatitis C infection. HCV infection is the leading cause of liver transplantation in the U.S. and is a risk factor for liver cancer. In 2016, 18,153 death certificates listed HCV as a contributing cause of death this is believed to be an underestimate.
Those who have cirrhosis from HCV also have a yearly risk of liver cancer of about 1%-5%.
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What Other Tests Diagnose Hepatitis C
Once the diagnosis of hepatitis C is established, other tests may be done to determine whether the patient has developed liver fibrosis or scarring . This can be done with a needle biopsy of the liver, and examining the biopsied liver tissue under the microscope. Liver biopsy is less commonly done today because noninvasive tests are more readily available, more easily accomplished and less costly.
Liver imaging can evaluate fibrosis using ultrasound and MRI scans. Additionally, calculations using a variety of blood tests also can predict the degree of inflammation and fibrosis present. Genotype testing will typically be done to determine what subtype of hepatitis C the patient has, as this will impact what drugs are used for treatment.
Testing for other infections including HIV, hepatitis A, and hepatitis B is typically done to determine if the patient might have other conditions that could impact patient’s treatment and prognosis.
With the newest forms of antiviral treatment, the most common types of chronic hepatitis C can be cured in most individuals.
How Does The Hepatitis C Virus Affect The Liver
Infection with the hepatitis C virus causes hepatitis. People with hepatitis C develop liver inflammation in two phases:
Acute hepatitis C infection phase
The first phase is called acute infection, and it can last up to 6 months. During this time, the liver isnt working properly but the damage is reversible. In 50% of cases, the immune system will clear the virus and hepatitis will resolve without any treatment. In this instance, the liver usually returns to functioning normally.
Chronic hepatitis C infection phase
If the infection does not go away, people develop chronic infection. After many years, chronic infection can lead to permanent liver damage. Of all the people with chronic hepatitis C, 5% to 25% will develop cirrhosis of the liver, a condition where scar tissue replaces healthy liver tissue. Liver cirrhosis is a problem because it can cause serious and often fatal conditions, such as liver failure and even liver cancer.
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Causes Of Noninfectious Hepatitis
Although hepatitis is most commonly the result of an infection, other factors can cause the condition.
Alcohol and other toxins
Excess alcohol consumption can cause liver damage and inflammation. This may also be referred to as alcoholic hepatitis.
The alcohol directly injures the cells of your liver. Over time, it can cause permanent damage and lead to thickening or scarring of liver tissue and liver failure.
Other toxic causes of hepatitis include misuse of medications and exposure to toxins.
Autoimmune system response
In some cases, the immune system mistakes the liver as harmful and attacks it. This causes ongoing inflammation that can range from mild to severe, often hindering liver function. Itâs three times more common in women than in men.
Should I Be Screened For Hepatitis C
Doctors usually recommend one-time screening of all adults ages 18 to 79 for hepatitis C. Screening is testing for a disease in people who have no symptoms. Doctors use blood tests to screen for hepatitis C. Many people who have hepatitis C dont have symptoms and dont know they have hepatitis C. Screening tests can help doctors diagnose and treat hepatitis C before it causes serious health problems.
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Can Hepatitis C Be Treated
Yes, since 2010 enormous progress has been made in the treatment of chronic hepatitis C. New therapies called direct-acting antivirals are pills that act on the virus itself to eradicate it from the body, unlike older medicines like interferon injections which work by stimulating an immune response. These new treatments are very effective and can achieve cure rates of over 90%. In most situations now, there is no need for interferon, which was responsible for many of the side effects previously associated with HCV treatment. The new treatment combinations require shorter treatment durations , have reduced side effects and appear to be effective at all stages of the disease.
Because these new therapies are very new, they remain very expensive. As such, drug coverage from both government and private companies may require that your liver disease has progressed to a certain stage before they are willing to cover the cost of these drugs.
Your primary care physician may refer you to a specialist to determine whether you are eligible for treatment. A specialist will help you decide which drug therapy is best for you based on the severity of your liver disease, your virus genotype and whether or not you have been treated in the past.
Is Screening For Hepatitis C Recommended During Pregnancy
There is a 4%-7% risk of transmitting HCV from mother to infant with each pregnancy. Currently, there is no CDC recommendation for routine hepatitis C screening during pregnancy, and there is no currently recommended medicine to prevent transmission from mother to infant . However, CDC is monitoring research findings and may make recommendations in the future as evidence arises.
While data is still limited, a recent study of over 1,000 cases in the United Kingdom found that 11% of infants had been infected at birth, and that these infants were likely to develop cirrhosis in their early 30s. The case for screening for HCV during pregnancy includes the potential to safely treat mothers during pregnancy with direct-acting antiviral agents to treat the mother before cirrhosis develops, prevent infant transmission, and prevent transmission to others. Children born to HCV-infected mothers may also be offered treatment at an early age to prevent cirrhosis, as well as transmission to others. Coordination of care between multiple specialists will be important to accomplish these goals.
Children of HCV-infected mothers may be screened for hepatitis C as early as 1-2 months of age using hepatitis C viral load or PCR testing . Antibodies to hepatitis C passed from the mother to child will be present for up to 18 months, so children should be tested for HCV antibody no earlier than this.
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What Is Viral Hepatitis
Hepatitis means inflammation of the liver. The liver is a vital organ that processes nutrients, filters the blood, and fights infections. When the liver is inflamed or damaged, its function can be affected. Heavy alcohol use, toxins, some medications, and certain medical conditions can cause hepatitis. However, hepatitis is often caused by a virus. In the United States, the most common types of viral hepatitis are hepatitis A, hepatitis B, and hepatitis C.
How Does Hepatitis C Spread
The hepatitis C virus spreads when any blood that is contaminated with the virus enters the bloodstream of an uninfected individual. This most commonly occurs when people share contaminated needles or syringes used for injecting drugs. However, hepatitis C can also spread via:
- Tattoo or piercing needles that have not been properly clean and sterilized
- Blood transfusions and organ transplants performed before 1992
- Medical procedures where healthcare professionals have not performed proper sterilization steps
A mother with hepatitis C can also potentially pass the infection to her baby during birth. This occurs in about 6% of the infants born to a mother with hepatitis C.
Essentially, you can get hepatitis C from sharing any personal item that came into contact with infected blood. If that infected blood then enters your own bloodstream, the infection can spread. This means that people can potentially get infected from sharing glucose monitors, nail clippers, razors, or even toothbrushesâthough these are rare routes of transmission.
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Complications Of Hepatitis C
If the infection is left untreated for many years, some people with hepatitis C will develop scarring of the liver .
Over time, this can cause the liver to stop working properly.
In severe cases, life-threatening problems, such as liver failure, where the liver loses most or all of its functions, or liver cancer, can eventually develop.
Treating hepatitis C as early as possible can help reduce the risk of these problems happening.
History And Physical Exam
To diagnose all forms of hepatitis, your doctor will first take your history to determine any risk factors you may have.
During a physical examination, your doctor may press down gently on your abdomen to see if thereâs pain or tenderness. Your doctor may also check for any swelling of the liver and any yellow discoloration in your eyes or skin.
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What Is The Health Outlook For Someone With Hepatitis C
Thanks to DAAT therapy, the outlook for someone with hepatitis C is excellent. DAAT therapy cures 95% of people with hepatitis C. Even those who already have liver disease can have improved liver function after treatment. For those with advanced liver disease, DAAT treatment can lower the risk of getting liver cancer.
DAAT treatment is also available for children 3 years and older who have hepatitis C. For children younger than 3, a liver specialist will help determine when treatment should start.
What Is The Treatment For People With Acute Hepatitis C Infection
When people first get hepatitis C, the infection is said to be acute. Most people with acute hepatitis C do not have symptoms so they are not recognized as being infected. However, some have low-grade fever, fatigue or other symptoms that lead to an early diagnosis. Others who become infected and have a known exposure to an infected source, such as a needlestick injury, are monitored closely.
Treatment decisions should be made on a case-by-case basis. Response to treatment is higher in acute hepatitis infection than chronic infection. However, many experts prefer to hold off treatment for 8-12 weeks to see whether the patient naturally eliminates the virus without treatment. Approaches to treatment are evolving. Patients with acute hepatitis C infection should discuss treatment options with a health care professional who is experienced in treating the disease. There is no established treatment regimen at this time.
How effective is hepatitis C treatment? Is hepatitis C curable?
If the hepatitis C RNA remains undetectable at the end of the treatment and follow-up period, this is called a sustained virologic response and is considered a cure. Over 90% of people treated with DAAs are cured. These people have significantly reduced liver inflammation, and liver scarring may even be reversed.
About 5% of people who are treated for HCV infection are not cured by some of the older regimens. These people may still have options for cure with the newer regimens.
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Hcv Genotypes/subtypes Dependent Transmission
The HCV genome demonstrated a prominent genetic diversity. Seven genotypes and 67 subtypes have been described. The genotypes are characterized by a distinct geographic distribution and clinical manifestations. For example, the genotype 1 is prevalent in Americas, Japan and Europe. Indeed, the HCV genotype prevalence also differs according to the transmission route and the age of infected individuals. For instance, the HCV gt 3a and 1a are highly represented among intravenous drug users and the HCV gt 1b is frequent among patients who received blood transfusions. In Japan, the HCV gt 1b is the most prevalent while, the infected population is generally older than in the United States, and an iatrogenic transmission is a predominant risk factor for the HCV acquisition.
Needle Use Or Accidental Stick
You can get hepatitis C from:
- Sharing needles and other equipment used to inject drugs.
- Having your ears or another body part pierced, getting a tattoo, or having acupuncture with needles that have not been sterilized properly. The risk of getting hepatitis C in these ways is very low.
- Working in a health care environment where you are exposed to fresh blood or where you may be pricked with a used needle. Following standard precautions for health care workers makes this risk very low.
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