Estimated Prevalence Numbers Of Hcv Exposure And Chronic Hcv Infection
Estimated prevalence numbers of HCV exposure and chronic HCV infection in the Tromsø population were calculated based on the observed prevalence in each age group and corrected for different attendance rates between the groups. An equal prevalence between attenders and non-attenders was presumed for the calculation of expected numbers of infected individuals.
Availability Of Data And Materials
Data from the seventh Tromsø Study is the property of UiT The Arctic University of Norway, Tromsø, Norway, and is available upon request at:
The dataset of the HCV infection cohort is available from the corresponding author on reasonable request.
What Are Cdcs Hepatitis C Screening Recommendations
All patients 18 years and older should be screened for hepatitis C at least once in their lifetime, except in settings where the prevalence of HCV infection is < 0.1%.
Patients with recognized exposures should be tested for hepatitis C regardless of age or setting prevalence, and regular periodic testing should continue as long as risk persists.
Testing For Hepatitis C
Two tests need to be done to discover if you have hepatitis C:
- Antibody test: Which establishes whether you have ever been exposed to the hepatitis C virus.
- PCR test: Which establishes whether the virus is still active and needs treating.
The two tests can often be done from one sample of blood which means you may only need to provide the sample once. Both tests can then be done on your sample at the laboratory. However, some services will perform one test and then call you back for a further blood sample to perform the second test.
A hepatitis C antibody test is the first test undertaken. This is to determine whether you have ever been exposed to the hepatitis C virus. It works by testing for the presence of antibodies to the virus generated by your immune system. If you receive a negative hepatitis C antibody test but have been experiencing symptoms or have been recently exposed to hepatitis C, then you are likely to be advised to have a second test.
It is important to remember that there is a ‘window period’. This is the short period of time when your immune system may not have had time to produce antibodies. It usually takes between six and twelve weeks for these antibodies to develop. However, in a few people it can take up to six months. So if you have the test within this window period and the result is negative, it does not necessarily mean that you don’t have the virus.
When Should I Get Hepatitis C Testing
When used for early detection in patients without symptoms of hepatitis C, screening is recommended at least once for all adults aged 18 years or older, except in locations with very low prevalence of HCV. Screening is also recommended during pregnancy and for patients of any age with risk factors for HCV infection. In patients with risk factors, periodic screening is recommended for as long as risk factors persist.
Risk factors for HCV include:
- Current or past injectable drug use
- Having a blood transfusion or organ transplant before July 1992
- Receiving kidney dialysis
- Pain in the abdomen or joints
- Nausea, vomiting, or loss of appetite
- Jaundice or yellowish skin and eyes
Hepatitis C testing may also be performed when liver tests are abnormal or when diagnosing the cause of existing liver damage.
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Diagnosis And Hepatitis C Elimination
In one report, the National Academies of Sciences, Engineering, and Medicine explored the feasibility of hepatitis C elimination and concluded that hepatitis C could be eliminated as a public health problem in the United States, but that substantial obstacles exist . In another report, specific actions were recommended to achieve elimination considering information, interventions, service delivery, financing, and research . These reports were the culmination of decades of progress in the development of HCV infection diagnostic and therapeutic tools.
In 1990, serologic tests to detect immunoglobulin G anti-HCV by enzyme immunoassay were licensed and became commercially available in the United States, and U.S. blood banks voluntarily began testing donations for anti-HCV . In 1991, U.S. Public Health Service issued interagency guidelines addressing hepatitis C screening of blood, organs, and tissues . These guidelines recommended hepatitis C testing for all donations of whole blood and components for transfusion, as well as testing serum/plasma from donors of organs, tissues, or semen intended for human use .
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Hepatitis C: Diagnosis And Treatment
THAD WILKINS, MD JENNIFER K. MALCOLM, DO DIMPLE RAINA, MD and ROBERT R. SCHADE, MD, Medical College of Georgia, Augusta, Georgia.
Am Fam Physician. 2010 Jun 1 81:1351-1357.
An estimated 170 million persons, or 3 percent of the worlds population, are chronically infected with the hepatitis C virus .1 In the United States, the prevalence of hepatitis C antibody is 2 percent in adults 20 years and older, but the prevalence is higher in groups at increased risk .2,3 HCV, a single-stranded RNA virus, is transmitted through percutaneous exposure to infected blood.4 HCV is categorized into nine genetically distinct genotypes.5 In the United States, 72 percent of patients with HCV infection have genotype 1 16 to 19 percent have genotype 2 8 to 10 percent have genotype 3 and 1 to 2 percent have other genotypes.6 This article focuses on chronic HCV infection in adults and excludes special groups, such as children, pregnant women, transplant recipients, and persons coinfected with hepatitis B virus or human immunodeficiency virus .
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Persons who are not at increased risk should not be screened for HCV infection.
HCV = hepatitis C virus.
*Recommendation for treatment is C because the outcome is a surrogate marker rather than mortality.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Persons who are not at increased risk should not be screened for HCV infection.
HCV = hepatitis C virus.
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Table 2 Indications For Hav Hbv And Hcv Testing19
Suspect acute hepatitis
- Most chronic viral hepatitis infections are asymptomatic.
- ALT may or may not be elevated. No need to routinely test for AST.
- If HBsAg is positive for > 6 months, this confirms chronic HBV infection.
- The presence of anti-HCV can indicate current or past HCV infection. An HCV RNA is needed to confirm active HCV infection. Around 75% of initial HCV infections progress to chronic infection, usually within 6 months.
- If already diagnosed with viral hepatitis, see Appendix 7 Recommended Test for Individuals Already Diagnosed with Viral Hepatitis. Consult with a specialist as needed for HCV infection. Consultation with, or referral to a specialist is strongly recommended for chronic HBV infection.
Illicit drug use current or ever
Persons who are, or were incarcerated
Gay, bisexual and men who have sex with men
Cdc Recommendations For Hepatitis C Screening Among Adults In The United States
- Universal hepatitis C screening:
- Hepatitis C screening at least once in a lifetime for all adults aged 18 years and older, except in settings where the prevalence of HCV infection is less than 0.1%*
- Hepatitis C screening for all pregnant women during each pregnancy, except in settings where the prevalence of HCV infection is less than 0.1%*
- Any person who requests hepatitis C testing should receive it, regardless of disclosure of risk, because many persons may be reluctant to disclose stigmatizing risks
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Question 2 Why Are Hcv Rna Results Being Reported In Iu/ml
Results are reported in international units per milliliter to facilitate comparisons between results generated by different test methods. This is important because the various methods used by different laboratories are not standardized against each other. Use of IU/mL reporting units helps to make the comparison of viral load results across different methods more reliable.
Testing Procedures And Costs
The test for HCV antibodies, as well as follow-up blood tests, can be done in most labs that perform routine blood work.
A regular blood sample will be taken and analyzed. No special steps, such as fasting, are needed on your part.
Many insurance companies cover hepatitis C testing, but check with your insurer first to be sure.
Many communities offer free or low-cost testing, too. Check with your doctors office or local hospital to find out whats available near you.
Testing for hepatitis C is simple and no more painful than any other blood test.
But if youre at risk for the disease or think you may have been exposed to the virus, getting tested and starting treatment if necessary can help prevent serious health problems for years to come.
CDC recommends that all adults ages 18 years and older should be screened for hepatitis C except in settings where the prevalence of HCV infection is less than 0.1%.
Also, all pregnant women should be screened during each pregnancy, except in setting where the prevalence of HCV infection is less than 0.1%.
Hepatitis C is often associated with sharing needles . But there are other methods of transmission.
For example, healthcare workers who are regularly exposed to other peoples blood are at higher risk for contracting the virus.
Getting a tattoo from an unlicensed tattoo artist or facility where needles may not be properly sterilized also increases the risk of transmission.
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Hepatitis C And Health
How can health-care personnel avoid exposure to HCV?
Avoiding occupational exposure to blood is the primary way to prevent transmission of bloodborne illnesses among health-care personnel. To promote blood safety in the workplace, health-care personnel should consult infectious-disease control guidance from the National Institute for Occupational Safety and Health and from CDC. Depending on the medical procedure involved, Standard Precautions may include the appropriate use of personal protective equipment .
What is the risk of acquiring hepatitis C after being accidentally exposed to HCV-contaminated blood or body fluids in the workplace?
Although sharps injuries have decreased in recent decades due to improved prevention measures, they continue to occur, placing health-care personnel at risk for several bloodborne pathogens like hepatitis C. A recent analysis of several studies revealed an overall 0.2% risk for infection among those exposed to HCV-antibody-positive blood through needlestick or sharps injuries . Updated guidelines for management and treatment of hepatitis Cexternal icon are available to provide guidance for health-care personnel who become infected via exposure to contaminated blood at the workplace.
Other than needlesticks, do other exposures place health-care personnel at risk for hepatitis C?
Should HCV-infected health-care personnel be restricted in their work?
What Does A Negative Hcv Antibody Test Result Mean
A negative antibody test result usually means that the person has not been infected with hepatitis C .
The body needs at least two months to make antibodies. People with weakened immune systems are not always able to produce antibodies. This might happen in people with autoimmune disorders , HIV-positive people with a CD4 cell count below < 200 cells/mm3, and people taking immunosuppressants.
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Hcv Rna Detection In Pbmncs And In Ultracentrifuged Serum And Plasma Samples
Nonrefrigerated blood samples were received at FEHV within 24 hours after extraction. Upon arrival, serum samples were obtained from coagulated blood, made into aliquots, and stored at 30°C. PBMNCs and plasma were isolated from anticoagulated blood by density gradient centrifugation . Plasma was aliquoted and stored at 30°C, while cells were washed three times in phosphate-buffered saline and thereafter stored in solution also at 30°C.
HCV RNA detection was performed by laboratory personnel who were blinded to the serologic status of the donors. Each polymerase chain reaction run included a maximum number of 10 samples along with negative controls and reagent blanks in which total RNA was replaced with PCR-grade water. Negative controls and blanks were coprepared with the samples and accompanied them through the entire PCR process. As positive controls, HCV RNApositive sera and PBMNCs from patients with chronic HCV infection were used. The guidelines of Kwok and Higuchi were strictly observed for avoiding contaminations.
To further confirm the results, the remaining total RNA extracted from positive samples was sent to a second laboratory and used to perform an additional amplification of the 5 NC region of the HCV genome by nested RT-PCR. The PCR products obtained were also purified and sequenced as described below. The sequences of the primers used in these tests are given in Table .
- a Nucleotide designation according to Takamizawa et al.
What Causes Hepatitis C
Hepatitis C is more prevalent in young people and the hepatitis C virus usually spreads through blood to blood contact like in the case of intravenous drug use, poorly sterilized medical equipment, needlestick injuries and transfusions. Hepatitis C can also be passed down from an infected mother to its baby during child birth. Hepatitis C is also spread through sex with an infected person.
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Determining The Prevalence Threshold For The Recommendations
Although the intent of public health screening is usually to identify undiagnosed disease, many persons previously diagnosed with hepatitis C are not appropriately linked to care and are not cured of their HCV infection, thereby representing an ongoing source of transmission. Therefore, the prevalence threshold of 0.1% should be determined on the basis of estimates of chronic hepatitis C prevalence, regardless of whether hepatitis C has been diagnosed previously.
How To Get Tested
Hepatitis C testing is performed by a doctor. Testing requires a blood sample, which can be collected in a hospital, lab, or other medical setting. Blood is often drawn from a vein in the arm or, in children, taken by pricking the skin. After blood is collected, the sample is sent to a laboratory for analysis.
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Meaning Of Hcv Viral Load
The number of HCV RNA international units per milliliter of blood must be measured before treatment and during the course of treatment, to assess response. Before treatment, however, the HCV viral load is not related to the patients liver disease severity or HCV prognosis. This is important for patients and providers to understand.
Note: In hepatitis B, unlike hepatitis C, a higher HBV DNA viral load does correlate with increased disease severity and increased likelihood of outcomes such as hepatocellular carcinoma.
Question 4 What Do These Test Results Mean: < 15 Detected And < 15 Not Detected
A < 15 Detected viral load result means the assay detected HCV RNA in the patients specimen at a very low level , but could not measure the precise level. A < 15 Not Detected viral load result means the assay did not detect HCV RNA in the patients specimen.
This test is performed using a Taqman® assay. The lowest viral load this assay can accurately quantify is 15 IU/mL, but the qualitative limit of detection is in the 10 to 13 IU/mL range. Therefore, even when the viral load is below 15 IU/mL, we can still report qualitative detection of HCV RNA consistent with active infection in some cases.
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Time For Processing Hcv Ab Test Results
The turnaround time for 3rd-generation EIAs is at least 1 day. Many labs do not perform the tests on site and must send specimens to another lab for processing, which may further increase the turnaround time.
A point-of-care test is also available. The OraQuick® HCV Rapid Antibody Test is an FDA-approved test that can be performed with a fingerstick . It is also a CLIA-waived test and therefore can be used in clinic offices and outreach facilities. Results are reported as reactive or nonreactive within 20 minutes. Just as for the standard HCV Ab test done in the lab, a positive OraQuick® test must be confirmed by an HCV RNA test. The sensitivity and specificity of the test is similar to that of the laboratory-based assays.
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Infectious Testing At The Transfusion Centers
Anti-HCV reactivity was recorded in two donors , but none of them coud be confirmed on supplemental immunoblot testing. Therefore, all donors finally tested negative for anti-HCV. Markers of other infectious diseases were detected in six donors : HBV DNA in two , malaria in two , syphilis in one, and cytomegalovirus in one. None of the 2007 donors gave a HCV NAT yield.
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How Hepatitis C Is Diagnosed
To determine a hepatitis C diagnosis, your doctor will:
- Get your medical history .
- Perform a physical exam, especially checking for changes in skin color, swelling in your lower extremities, and tenderness in your abdomen.
- Order certain diagnostic blood tests.
The first diagnostic tool in the screening process is a blood test that screens for HCV antibodies proteins the body produces in response to the virus. An enzyme immunoassay is used to perform this test.
A negative result for the antibody test means that youve never had HCV in your blood, while a positive result means you were exposed to the virus at some point in your life. Up to a quarter of people spontaneously clear the virus from their blood within six months of contracting it.
Because EIA sometimes produces false-positive results, a test called recombinant immunoblot assay may be used to confirm that you have the HCV antibody. This test is not necessary for most patients, and it is more commonly performed by blood banks to check for the virus in donated blood.
A negative EIA result may just mean that your body has not yet produced the HCV antibody , and you may need to be tested again in a few months.
If you have a positive antibody test, your doctor will then use another blood sample to conduct a qualitative polymerase chain reaction test or a process called transcription-mediated amplification , which looks for the presence or absence of RNA of HCV in your blood.