Summary Of The Literature
For the all-adult review, the initial literature search yielded 4,867 studies. Twenty-nine duplicates were identified. Of 4,838 unique studies, 4,170 were deemed irrelevant by title/abstract screening, resulting in 668 full texts for review. Among these, 368 studies had data available to extract.
For the pregnancy review, the initial literature search yielded 1,500 studies. Two duplicates were identified. Of 1,498 unique studies, 1,412 were deemed irrelevant by title/abstract screening, resulting in 86 full texts for review.
The supplementary review yielded an additional 1,038 and 195 studies among all adults and pregnant women, respectively. Of these, 912 and 168 , respectively, were deemed irrelevant by title/abstract screening, resulting in 126 and 27 , respectively, full texts for review. One study was added to the pregnant women review outside of the formal literature search .
Considering all 104 applicable studies, the median anti-HCV positivity prevalence among all adults was 6.6% . Median anti-HCV positivity prevalence was 1.7% for the general population , 7.5% for ED patients , 3.3% for birth cohort members , 9.3% for others/multiple risk factors , 54.2% for persons who use drugs , 5.2% for persons with HIV or sexual risk , and 4.7% for immigrants . Considering 26 applicable studies among pregnant women, median anti-HCV positivity prevalence was 1.2% .
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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Pregnancy And Hepatitis C
Should pregnant women be tested for HCV antibodies?
Yes. All pregnant women should be screened for anti-HCV during each pregnancy, except in settings where the prevalence of HCV infection is < 0.1% . Pregnant women with known risk factors should be tested during each pregnancy, regardless of setting prevalence. Any pregnant women testing positive for anti-HCV should receive a PCR test for HCV RNA to determine current infection status.
Can a mother with hepatitis C infect her infant during birth?
The overall risk of an infected mother transmitting HCV to her infant is approximately 4%8% per pregnancy . Transmission occurs during pregnancy or childbirth, and no prophylaxis is available to protect the newborn from infection. The risk is significantly higher if the mother has a high HCV viral load, or is coinfected with HIV with which the rate of transmission ranges from 8%15% . Most infants infected with HCV at birth have no symptoms.
Should a woman with hepatitis C be advised against breastfeeding?
When should children born to HCV-infected mothers be tested to see if they were infected at birth?
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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.
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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Virus Description And Transmission
HCV is a small, single-stranded, enveloped RNA virus in the flavivirus family with a high degree of genetic heterogeneity. Seven distinct HCV genotypes have been identified. Genotype 1 is the most prevalent genotype in the United States and worldwide, accounting for approximately 75% and 46% of cases, respectively . Geographic differences in global genotype distribution are important because some treatment options are genotype specific . High rates of mutation in the HCV RNA genome are believed to play a role in the pathogens ability to evade the immune system . Prior infection with HCV does not protect against subsequent infection with the same or different genotypes.
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
* See Appendix 2 for further information on Hepatitis Laboratory Tests and Appendix 3 for Hepatitis B Serology Results and Interpretation.
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Explanation Of Test Results:
If this test result is positive, it means your body was exposed to the hepatitis C virus and made antibodies . However, it does not tell you whether you are still infected with hepatitis C. If the antibody test result is positive, you should be tested for hepatitis C RNA , which determines whether you are chronically infected. The lab will perform this RNA test automatically if your hepatitis C antibody test is positive.
If the antibody test result is negative, it means you have not been infected with the hepatitis C virus, and further testing for hepatitis C usually is not needed.
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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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Hepatitis C Viral Load / Hcv Rna Quantitative Testing
The viral load of hepatitis C refers to the amount of virus present in the bloodstream. The quantitative HCV RNA tests measure the amount of hepatitis C virus in the blood. The result will be an exact number, such as â1,215,422 IU/L.â Many people refer to the quantitative measurement as the hepatitis C âviral load.â
Viral load tests are used to confirm active hepatitis C infection and are used during treatment to help determine response. If you have lower levels of virus in your blood when you start treatment, you may have a better chance of getting rid of the virus.
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What Is The Treatment For Hcv
There are several drugs that can be used to treat HCV infection. Most commonly, a combination of drugs is used, and new drugs are under development. Before 2000, chronic HCV was curable in only 10% of cases. Now, treatments for HCV can cure over 90% of people with hepatitis C before late complications occur, but even those with advanced liver disease often respond to treatment. This increases the opportunity to intervene early and prevent HCV-associated deaths.
- According to the CDC, recent treatment guidelines recommend monitoring people with acute HCV but only considering treatment if the infection persists longer than 6 months.
- Chronic HCV is usually treated with a combination of drugs.
What Does This Hep C Virus Ab 0 1 Mean
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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?
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.
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Other Things To Know:
- After a successful course of treatment for hepatitis C, the hepatitis C antibody remains detectable, but the hepatitis C RNA will be undetectable.
- If you plan to donate blood, you will be tested for the hepatitis C antibody and will be turned away even if you do not have an active infection.
- Any patient with a positive test result for the hepatitis C antibody should have additional tests to determine whether or not the virus is still active.
How Can I Tell If I Am Contagious And Can Spread The Infection To Others
If you have detectable HCV RNA in your blood, you have the potential to spread the disease to other people. Hepatitis C is spread by exposure to contaminated blood. The most common mechanism of exposure is the sharing of needles or other âworksâ used in consuming drugs such as cocaine or heroin. Other routes of transmission include use of contaminated equipment for body piercing and tattooing, occupational exposure of healthcare workers to used needles or other sharp objects, and, less commonly, through sexual activity that results in tissue tears or from mother to baby during childbirth.
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Rna Or Viral Load Test
If you test positively for hepatitis C antibodies, you will need to get an RNA or viral load test. The RNA test is a blood test that checks to see if hepatitis C is active in your body.
- If your RNA test result is negative, you do not have hepatitis C.
Supported by an independent educational grant from Merck & Co., Inc.
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Tests For Hiv Hepatitis A And B
These are tests to determine if you have been exposed to other viruses that can cause or worsen liver disease. Vaccines for hepatitis A and B are recommended for all unvaccinated patients with hepatitis C. A positive test result for hepatitis A and B may indicate you were previously exposed or vaccinated and the results should be interpreted by your provider.
A positive test result for HIV indicates exposure to the HIV virus and requires referral to an infectious disease specialist. HIV is treatable and should be treated before HCV treatment can be provided. Hepatitis C treatments are as effective in patients with HIV as they are in patients without HIV.
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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.
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.
Antibody 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.
PCR test
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.
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