Treatment: Chronic Hepatitis C
The latest drug to be approved by the FDA is glecaprevir and pibrentasvir . This medication offers a shorter treatment cycle of 8 weeks for adult patients with all types of HCV who donât have cirrhosis and who have not been previously treated. The length of treatment is longer for those who are in a different disease stage. The prescribed dosage for this medicine is 3 tablets daily.
There are several other combination drugs available, as well as some single drugs that may be used in combination. Your doctor will choose the right one for you depending on the type of hepatitis C you have, how well your liver is functioning and any other medical problems you may have. Also be sure to discuss your insurance coverage since these medications are expensive.
Understanding Your Test Results
Understanding your hepatitis B blood tests can be confusing. It is important to talk to your health care provider so you understand your test results and your hepatitis B status. Are you infected? Protected? Or at risk? The Hepatitis B Panel of blood tests includes 3 tests and all three results must be known in order to confirm your status.
Below is a chart with the most common explanation of the test results, but unusual test results can occur. Please note that this chart is not intended as medical advice, so be sure to talk to your health care provider for a full explanation and obtain a printed copy of your test results. In some cases, a person could be referred to a liver specialist for further evaluation.
More Detailed Information About Hepatitis B Blood Tests
An acute hepatitis B infection follows a relatively long incubation period – from 60 to 150 days with an average of 90 days. It can take up to six months, however, for a person to get rid of the hepatitis B virus. And it can take up to six months for a hepatitis B blood test to show whether as person has recovered from an acute infection or has become chronically infected .
The following graphic from the U.S. Centers for Disease Control and Prevention represents the typical course of an acute hepatitis B infection from first exposure to recovery.
According to the CDC, a hepatitis B blood test result varies depending on whether the infection is a new acute infection or a chronic infection.
What Is A Hepatitis C Screening
Testing for hepatitis C involves a blood test called an HCV antibody test . This test determines if youve ever had a hepatitis C infection by checking your blood for HCV-specific antibodies.
If you test positive for HCV antibodies, youll need to undergo follow-up testing. Having antibodies does not mean you currently have an active infection. It may simply mean that you have had a prior exposure that your immune system cleared.
To check whether you have an active infection, a doctor will order a nucleic acid test . A positive result means the virus is currently active in your bloodstream. If you get a negative result, the virus was once in your body, but its not anymore.
- have HIV
- have ever had a needle-stick injury or potentially been exposed to HCV-positive blood
- have had a tattoo or piercing done outside of a professional sterile environment
According to the , HCV may be passed through sexual activity, though this is not common. The agency notes that your risk may be increased if you:
- have a sexually transmitted infection
- have sex with multiple partners
- have anal sex
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Hepatitis C Is Curable
Link to care: interferon-free direct acting antiviral treatments have a sustained virologic response > 90%.
- treatment regimens range from 8 to 24 weeks and have few side effects
- consult a health professional experienced in the management of viral hepatitis
For more information, please visit Canada.ca and search ‘hepatitis C for health professionals’.
What Are The Symptoms Of Hepatitis B And C
In most patients, hepatitis B develops slowly over the course of several decades, and thus most patients have no symptoms. People who have advanced liver disease such as cirrhosis of the liver may experience complications and symptoms that reflect liver failure. Other symptoms include:
- A buildup of fluid within the abdominal cavity
- Confusion and tremors , which are complications due to the inability of the liver to filter out toxins that are normally cleaned out by a healthy liver
- Vomiting of blood, or blood within the stool . This is a complication in which enlarged veins within the esophagus or stomach bleed as a consequence of increased pressure around the diseased liver.
Most patients with chronic hepatitis C infection report no symptoms. But some patients may have very nonspecific symptoms related to fatigue and discomfort on the right side of the abdomen. Often, symptoms that lead to a diagnosis of hepatitis C are noticeable only at the end stage of liver disease, when the patient has developed liver cirrhosis and liver failure.
Because hepatitis B and C typically have no specific symptoms, many people who have the viruses dont even know it.
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Interpreting Hcv Rna Test Results
It is essential that the provider understands how to interpret HCV RNA test results, especially during the course of HCV treatment.
|Result of HCV RNA Test||Interpretation|
|A quantified viral load — any exact number||Ongoing HCV infection|
|“Detected”||The HCV RNA is detectable but the number of international units is so low that it cannot be quantified accurately. This indicates extremely low level of virus is present.|
|“< 12 IU/mL” or “< 15 IU/mL” or “< 25 IU/mL” All of these are “less than the LLOQ”||HCV RNA is undetectable. No virus is detected at all in the patient’s serum specimen.|
Hepatitis C: Who Is At Risk
People who have injected illegal drugs at any time, even one time, many years ago, could be walking around with chronic hepatitis C. Because there are often no symptoms, many former drug users may not realize they have the infection. People who received a blood transfusion before 1992 also have a higher risk. Before that year, donated blood was not screened for the hepatitis C virus.
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The Hep B Blood Tests
There are 3 hep B tests called HBsAg, anti-HBs, and anti-HBc. You should make sure your doctor does all three hep B tests. Our hep B testing chart can explain each test and help you to make sure your doctor does all the tests you need.
These three tests tell you if you have hep B, if you are protected against hep B , and if you have ever come into contact with hep B. Getting all three tests is important to helps you and our doctor understand your hep B status.
Who Should Get Tested
You should consider getting tested for hepatitis C if you’re worried you could have been infected or you fall into one of the groups at an increased risk of being infected.
Hepatitis C often has no symptoms, so you may still be infected if you feel healthy.
Some groups of people are at an increased risk of hepatitis C, including:
- ex-drug users and current drug users, particularly users of injected drugs
- people who received blood transfusions before September 1991 or blood products before 1986 in the UK
- UK recipients of organ or tissue transplants before 1992
- people who have lived or had medical treatment in an area where hepatitis C is common high-risk areas include Africa, the Middle East and central Asia
- babies and children whose mothers have hepatitis C
- anyone accidentally exposed to the virus, such as health workers
- people who have received a tattoo or piercing where equipment may not have been properly sterilised
- sexual partners, family members and close contacts of people with hepatitis C
If you continue to engage in high-risk activities, such as injecting drugs frequently, regular testing may be recommended. Your doctor will be able to advise you about this.
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American Association For The Study Of Liver Diseases Recommendations
The current AASLD recommendations for the initial evaluation of HBsAg-positive patients is summarized below.
Centers for Disease Control and Prevention. Hepatitis B information for health professionals: hepatitis B FAQs for health professionals. http://www.cdc.gov/hepatitis/HBV/index.htm. Available at . Updated May 31, 2015 Accessed: May 23, 2017.
Sorrell MF, Belongia EA, Costa J, et al. National Institutes of Health Consensus Development Conference Statement: management of hepatitis B. Ann Intern Med. 2009 Jan 20. 150:104-10. . .
McMahon BJ, Holck P, Bulkow L, Snowball M. Serologic and clinical outcomes of 1536 Alaska Natives chronically infected with hepatitis B virus. Ann Intern Med. 2001 Nov 6. 135:759-68. .
Chang MH, Chen CJ, Lai MS, et al. Universal hepatitis B vaccination in Taiwan and the incidence of hepatocellular carcinoma in children. Taiwan Childhood Hepatoma Study Group. N Engl J Med. 1997 Jun 26. 336:1855-9. .
Fattovich G, Giustina G, Schalm SW, et al. Occurrence of hepatocellular carcinoma and decompensation in western European patients with cirrhosis type B. The EUROHEP Study Group on Hepatitis B Virus and Cirrhosis. Hepatology. 1995 Jan. 21:77-82. .
Yang HI, Yeh SH, Chen PJ, et al. Associations between hepatitis B virus genotype and mutants and the risk of hepatocellular carcinoma. J Natl Cancer Inst. 2008 Aug 20. 100:1134-43. . .
Acute Hbv Infection With Recovery
Following acquisition of HBV, the first detectable serologic marker in blood is HBsAg. Detection of HBsAg typically occurs at 4 weeks following infection, with a range of 1 to 9 weeks following infection. Typically, when HBsAg is detectable during acute infection, HBV DNA can also be detected in blood. During early infection, persons may also test positive for HBeAg, which is a marker of infectivity and higher HBV DNA levels. Nearly all persons will test negative for HBsAg and HBV DNA by 15 weeks after the onset of symptoms. With acute HBV infection, IgM anti-HBc is typically detectable at the onset of symptoms and persists for 6 to 9 months following infection. Total anti-HBc, which consists of IgM anti-HBc and IgG anti-HBc, can similarly be detected at the onset of symptoms, but persists indefinitely as a marker of prior infection. During recovery, and after the disappearance of HBsAg, persons who have immunologic control of acute infection will develop antibodies to HBs , which may persist indefinitely or wane over time. It is important to note that following the disappearance of HBsAg and prior to the appearance of anti-HBs, there is a period of time when IgM anti-HBc and total anti-HBc may be the only detectable serologic markers. This period of time is known as the window period.
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Specific Hcv Rna Assays And Range Of Detectable Virus
HCV RNA tests use target amplification techniques. Several assays exist for HCV RNA testing. Methods include polymerase chain reaction , transcription mediated amplification , and branched chain DNA tests. Results are expressed as international units/mL . The different methods and different commercial assays each have a lower limit of quantification and lower limit of detection , therefore a patient’s results could be reported differently depending on the assay used. HCV RNA tests must have an LLOQ of 25 IU/mL or lower when used to assess treatment response with DAAs.
LLOQ = the lowest HCV RNA level that is within the linear and analytically acceptable range of the assay.
LLOD = the lowest level of HCV RNA that is detected 95% of the time.
Are Hepatitis B And C Preventable
Hepatitis B is a vaccine-preventable disease.
There is a three-shot vaccination series that is very effective in protecting people against the virus if theyre exposed. In the United States, all newborns are vaccinated for hepatitis B and all pregnant women are screened for hepatitis B during pregnancy. This way, mothers infected with hepatitis B can take protective steps to decrease the risk of transmission of the virus to the child.
There is no vaccine for hepatitis C.
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How Are Hepatitis B And C Diagnosed
Hepatitis B is diagnosed by a series of blood tests. The test may show an ongoing infection or antibodies that indicate that the patient is protected against hepatitis B. In patients who have a positive screening test that suggests the possibility of ongoing infection, further testing is done to determine the levels of the virus in the bloodstream.
Hepatitis C is diagnosed via a blood test called a Hepatitis C Antibody Test. A positive result means that hepatitis C antibodies are present in the blood. But a positive antibody test doesnt necessarily mean a person has hepatitis C. A further blood test is needed to confirm the diagnosis. This second blood test quantifies the amount of the virus or the viral load in the liver and the bloodstream.
Screening For Viral Hepatitis During The Domestic Medical Examination Of Newly Arrived Refugees
- Hepatitis B
- New arrivals from certain countries may have been tested for hepatitis B surface antigen and receive 1-2 doses of the hepatitis B vaccine overseas through the Vaccination Program for US-bound Refugees. Domestic clinicians should review the DS-3025 .
- All newly arriving refugees who were born in or have lived in countries with intermediate or high prevalence of chronic hepatitis B virus infection should be tested for HBV infection. Serologies for hepatitis B should include HBsAg, hepatitis B surface antibody , total hepatitis B core antibody , and IgM antibody to hepatitis B core antigen .
- Those who do not have HBV infection should be offered hepatitis B vaccination series according to the ACIP-recommended schedule.
- Clinicians should consider further evaluation and management for people whose serologic testing indicates prior HBV infection. In this case, hepatitis B vaccination is not indicated.
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New Who Testing Guidelines
As part of this broader global response to viral hepatitis, and to complement existing care and treatment guidance for HBV and HCV , WHO has now developed guidelines on hepatitis B and C testing for low and middle-income countries . In recognition of the need to substantially increase viral hepatitis testing to meet the 2030 elimination targets , but also of the substantial cost to health budgets of increased testing, the guidelines take an evidence-based but pragmatic, low-cost approach. Their primary target audience are policy makers responsible for development of national hepatitis testing and treatment programmes in LMICs. A particularly challenging aspect in the guidelines development was the limited direct quantity and quality of evidence available to guide the development of recommendations based on the use of the GRADE process. In addition, very few rapid diagnostic serological tests for hepatitis B surface antigen or hepatitis C antibody have undergone formal quality assurance approval process by WHO or another recognised stringent national regulatory programme.
Table 2 Adaptation of Table . Summary of recommendations on testing for chronic hepatitis B and C virus infection, from WHO Guidelines on hepatitis B and C testing ). Who to test for chronic HBV infection
Enzyme Immunoassays For Detection Of Hepatitis C Antibody
The HCV Ab test is used for initial screening for hepatitis C. The test is performed by enzyme immunoassays , which detect the presence of hepatitis C antibodies in serum. The result of the test is reported as positive or negative. Third-generation EIAs have a sensitivity/specificity of approximately 99%. However, the presence of HCV Ab does not indicate whether the infection is acute, chronic, or resolved. A positive antibody test result should be followed up with an HCV RNA test to confirm that viremia is present.
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Letsgetchecked Hepatitis B And C Test
- Price: $$
- Pros: tests for both hepatitis B and C, includes option to speak with a nurse if you test positive
- Cons: no option to test for hepatitis C only
If you want to buy a hepatitis C test from LetsGetChecked, you have to buy the hepatitis B and C testing bundle.
The hepatitis B surface antigen test checks for hepatitis B specific antigens and antibodies in the blood to determine if you have an active infection. A positive test means you can transmit the virus, but it cannot tell you if you have a chronic or acute infection.
Additionally, a negative test will only tell you that youre not currently contagious. You can test negative and still have hepatitis B. LetsGetChecked does not include this info on the product page. It may still be important to visit a doctor to determine if you have the virus and what stage its in.
Testing for hepatitis C involves an HCV antibody test. Youll need additional testing if you test positive for HCV antibodies.
Tests from LetsGetChecked should be safe and accurate when used as directed. Still, you should talk with your doctor about your results.
Both the hepatitis B and C tests involve taking a finger-prick sample. You can take the sample in the morning and send it back the same day.
Results should arrive within 2 to 5 business days. If either test returns a positive result, a nurse will get in touch to go over what this means. However, we recommend also going over your results with your doctor.