Getting Tested For Hepatitis C
A blood test, called an HCV antibody test, is used to find out if someone has ever been infected with the hepatitis C virus. The HCV antibody test, sometimes called the anti-HCV test, looks for antibodies to the hepatitis C virus in blood. Antibodies are chemicals released into the bloodstream when someone gets infected.
Test results can take anywhere from a few days to a few weeks to come back. Rapid anti-HCV tests are available in some health clinics and the results of these tests are available in 20 to 30 minutes.
What Does The Test Measure
Hepatitis C testing identifies antibodies to the hepatitis C virus, detects viral RNA, and/or determines the strain of hepatitis C. Hepatitis C testing may involve several different tests:
- Hepatitis C antibody test: Antibodies are a part of the bodys response to an infection. Testing for hepatitis C antibodies determines whether or not a patient has been exposed to the hepatitis C virus at some point in their life. If this test is positive, the next step is to test for hepatitis C RNA which can tell you if you have a current infection.
- Hepatitis C RNA test: RNA is a type of genetic material from the hepatitis C virus that can be detected in the blood. If test results are positive after a hepatitis C antibody test, doctors use a hepatitis C RNA test to look for and/or measure the amount of the virus in the blood. Qualitative HCV RNA tests can detect the presence of HCV RNA, while quantitative HCV RNA tests measure the amount of HCV RNA. Understanding the amount of HCV in the blood helps to monitor response to treatment.
- Genotype test: There are at least six types of hepatitis C, which are also called strains or genotypes. Treatment for hepatitis C depends on the strain, so genotype testing to guide treatment is performed in patients who are diagnosed with an HCV infection.
Who Should Get Tested
You should consider getting tested for hepatitis C if youre 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.
The following groups of people are at an increased risk of hepatitis C:
- ex-drug users and current drug users, particularly users of injected drugs
- people in the UK who received blood transfusions before September 1991
- 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 north Africa, the Middle East and central and east 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 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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Natural History Following Infection With Hcv
Hepatitis C can present as acute or chronic hepatitis. Most of the cases of acute hepatitis C are asymptomatic. Symptomatic acute hepatitis with jaundice is seen in 10-15% of patients only and can be severe, but fulminant liver failure is rare. Spontaneous clearance is observed in 25-50% of those with symptomatic infection and in 10-15% of those with asymptomatic infection. The natural history following exposure to HCV is summarized in .
Natural history following infection with hepatitis C virus
Chronic hepatitis C is marked by the persistence of HCV RNA in the blood for at least 6 months after the onset of acute infection. The risk of progression to chronic infection by HCV is influenced by various factors including:
Age at the time of infection
How And Where To Donate
The need for blood donation is critical and ongoing. From the time of donation, blood can be stored in a refrigerator for only 42 days. Moreover, blood centers typically run out of types O and B, placing patients with these blood types at risk during public health emergencies.
If you are least 16 years of age in most states, are in good health, and weigh at least 110 pounds, you are eligible to be considered as a blood donor. You can find where to donate blood near you by accessing the American Red Cross website.
From start to finish, the blood donation process takes around the hour, including 10 minutes to draw one pint of blood.
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Who Should Get Tested For Hepatitis C
The CDC recommends that you get tested at least once no matter what. Definitely get screened if any of these things apply to you:
- You were born between 1945 and 1965.
- You use or inject drugs.
- You have ever injected drugs — even if it was just once or a long time ago.
- Youâre on kidney dialysis.
- You have abnormal alanine aminotransferase levels .
- You had a blood transfusion, blood components, or an organ transplant before July 1992.
- Youâve ever gotten clotting factor concentrates made before 1987.
- You received blood from a donor who later tested positive for hepatitis C virus.
- Youâre a health care worker, first responder, or have another job that exposes you to HCV-infected needles.
- You were born to a mother with HCV.
Hep C Virus Rna Assays
An HCV RNA test shows whether people have an active hepatitis C infection or not. An HCV RNA test checks for the viral load to indicate the amount of the virus in the blood.
An HCV RNA test can also show how a person with a hepatitis C infection responds to treatment to see if medication is helping lower the viral load.
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Question 6 Why Didnt The Test Reflex To Hcv Genotype When My Patient Had A Detectable Viral Load
The LiPA usually requires a minimum viral load of 300 IU/mL to successfully obtain a genotype. Since the viral load assay used in this reflex test has a much lower limit of quantitation, it is possible for the patient to have a detectable viral load and not have a reportable genotype result. Therefore, this test code does not reflex to HCV genotype if the patients viral load is < 300 IU/mL.
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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.
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Hcv Core Antigen Detection
During the past decade, several assays for the detection of the core antigen of HCV by ELISA or CLIA have been developed. These assays were envisioned as alternatives to NAT to be used in resource-limited settings, where molecular laboratory services are either not available or not widely utilized owing to cost issues. Since these assays are either ELISA or CLIA based, they are user friendly, require less technical expertise and are less expensive compared to molecular techniques. Evaluations in transfusion settings have shown that the HCVcore Ag assay detects HCV infection as effective as NAT, about 40-50 days earlier than the current third generation anti-HCV screening assays. HCV core antigen levels closely follow HCV RNA dynamics, and allow clinical monitoring of a patient’s therapy, independently of HCV genotype. The major limitation of the HCV core Ag assay is its lower sensitivity limiting its utility. A new generation CLIA based quantitative test with sensitivity comparable to that of end point PCR but less than that of real time RT-PCR has been reported.
Question 2 For Whom Is Hcv Screening Recommended
The US Preventive Services Task Force and the CDC recommend 1-time screening for HCV infection for adults born 1945 through 1965.2,3 One-time screening is also recommended for adults with high risk due to:
- Injection drug use 3,4
- Receipt of clotting factor concentrates produced before 19873,4
- HIV infection the co-infection rate among this group is 20% to 30%5
Screening is also recommended for children born to HCV-positive mothers.3,4
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Can I Take The Test At Home
At-home hepatitis C tests are available that allow patients to collect a blood sample at home and mail it to a laboratory for testing. Test samples are collected through pricking a finger with a sharp object, called a lancet, thats included in the test kit.
At-home HCV testing is a form of hepatitis C antibody testing and does not test for hepatitis C RNA or the strains genotype. Testing for hepatitis C at home is not a substitute for testing performed by a health care professional, and positive test results may need to be confirmed by laboratory-based testing.
Hepatitis C Virus Antibody Test
Antibodies are proteins that travel through the blood as part of the immune systems response to neutralize foreign substances or antigens in the body, such as viruses or bacteria. The body produces antibodies to fight specific antigens.
An HCV antibody test detects antibodies in the blood that the immune system has created to respond to an HCV infection.
Healthcare professionals use HCV antibody tests to determine if people may have had any previous exposure to HCV or if they have a current hepatitis C infection.
However, the test cannot tell the difference between previous exposure or current infection.
If results are negative or nonreactive, a person has not acquired the hepatitis C infection. However, if results are positive or reactive, it means an individual has had exposure to HCV at some point.
However, positive test results do not always mean an active virus people who are clear or cured of the virus will still have antibodies in their blood.
If individuals test negative for HCV antibodies and have a low suspicion for any recent exposure to HCV, they will not need to take any further action.
Additionally, if people have a negative antibody test result but suspect they have had exposure to HCV, they can take a second test, called an HCV RNA test. This is important, as the body may not develop antibodies against HCV until 2 months after exposure to the virus.
If people test positive for HCV antibodies, they will also need to take an HCV RNA test.
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Question 10 I Am Treating My Hcv
If HCV RNA is detectable at week 4 of treatment, per AASLD guidelines, it is suggested to repeat quantitative HCV RNA viral load testing after 2 additional weeks of treatment. If quantitative HCV RNA testing at week 6 of treatment shows an increase of greater than 10-fold , discontinuation of HCV treatment is recommended. The cause of a positive HCV RNA test result at week 4, with decreasing levels at week 6 or week 8, is unknown. There is no recommendation to stop therapy or extend therapy for these patients.9
Getting Tested Is The Only Way To Know If You Have Hepatitis C
A blood test called a hepatitis C antibody test can tell if you have been infected with the hepatitis C viruseither recently or in the past. If you have a positive antibody test, another blood test is needed to tell if you are still infected or if you were infected in the past and cleared the virus on your own.
- Are 18 years of age and older
- Are pregnant
- Currently inject drugs
- Have ever injected drugs, even if it was just once or many years ago
- Have HIV
- Have abnormal liver tests or liver disease
- Are on hemodialysis
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Question 3 Why Does Quest Diagnostics Also Report Results As Log Iu/ml
This makes it easier to understand whether a change in viral load is clinically meaningful.
Replicate PCR test results using the same specimen can vary analytically by as much as 0.5 log IU/mL thus, only changes greater than 0.5 log IU/mL from one measurement to the next are considered to represent true changes in viral load.3 Reporting the viral load results in log IU/mL units helps the healthcare provider accurately interpret changes in viral load and better assess a patients response to antiviral treatment.
Low Vs High Viral Load
A low viral load means a person has low levels of HCV in their blood, while a high viral load indicates higher levels of the virus present.
According to the Department of Veterans Affairs, healthcare professionals usually define a low viral load as less than 800,000 international units per liter . In contrast, a high viral load is more than 800,000 IU/L.
This measure can be in the millions a result of more than 100,000,000 international units per milliliter indicates an active HCV infection.
In contrast, a result of less than 15 IU/mL shows that HCV is present, but the level is not measurable. This may mean HCV is undetectable, or levels of HCV are too low to show on the test. People may require a follow-up test 12 months later to track any changes in these levels.
If a result is inconclusive, the test was not successful in measuring viral load, and people need to take another test.
If a result comes back as undetected, it means the test found no HCV is present.
The viral load can change depending on the treatment. If people have an increasing viral load, it may mean the treatment is not targeting the virus effectively. If they have a decreasing viral load, it may mean that the treatment is working.
Treatment for hepatitis C is highly effective for low and high viral loads. If individuals have an undetected viral load 12 weeks after completing treatment for hepatitis C, they no longer have the infection.
People will need regular testing if they:
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Question 8 What Do The Following Hcv Rna Results Mean: < 15 Iu/ml Detected Or < 15 Iu/ml Not Detected
The result < 15 IU/mL, Detected means that HCV RNA is detected, although at a level that is too low to be quantified. This result could indicate current active HCV infection if consistent with other clinical and laboratory data. NOTE: If this test is being performed for HCV diagnosis, then this < 15 IU/mL Detected result should be confirmed using a second sample from the patient.
In contrast, the result < 15 IU/mL, Not Detected means that HCV RNA is not detected and there is no evidence of current active infection.
Quest Diagnostics measures HCV RNA viral load with the Roche cobas® HCV methodology. This is a quantitative real-time PCR assay with a lower limit of quantification of 15 IU/mL the limit of detection is slightly lower, at 10 IU/mL to 13 IU/mL. If the viral load is just at or above this LOD, but less than 15 IU/mL, the assay can determine that HCV RNA is present but cannot provide a reliable quantitative result. In such cases, the qualitative result of < 15 IU/mL, Detected is provided.
How Is The Hbcab Test Done
This is a blood test. A clinician will fill a tube with blood taken from a vein in your arm through which a needle is inserted. If you are giving blood, a sample will be taken from the blood youre donating. The blood is sent to a lab, where it is tested. Sometimes HBcAb will be added on to lab orders when results from other tests indicate there may be a hepatitis B infection.
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