Rna Or Viral Load Test
If you test positively for hepatitis C antibodies, you will need to get a 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.
- If your RNA test result is positive, you may have chronic hepatitis C. Talk to your doctor right away about a treatment plan.
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.
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.
Discusses Conditions That May Cause Diagnostic Confusion Including Improper Specimen Collection And Handling Inappropriate Test Selection And Interfering Substances
A single negative hepatitis C virus RNA test result together with a reactive HCV antibody screen result with a signal-to-cutoff ratio of 8.0 or greater does not rule out the possibility of chronic HCV infection. Repeat testing for HCV RNA in 1 to 2 months is recommended in patient at risk for chronic hepatitis C.
Infants born to HCV-infected mothers may have false-reactive HCV antibody test results due to transplacental passage of maternal HCV IgG antibodies. HCV antibody testing is not recommended until at least 18 months of age in these infants.
Performance characteristics have not been established for the following types of serum specimen:
-Individuals under 10 years of age
-Presence of particulate matter
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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’.
Grade Approach Grading Of Recommendations Assessment Development And Evaluation To Assessing Overall Quality Of Evidence
GRADE for RDT versus EIA
HCV Ab RDTs showed comparable sensitivity and specificity compared to that of EIAs. Among the five studies that evaluated RDTs versus EIA, 15,943 of samples were evaluated, and moderate risk of bias was observed , but there was a consistent high level of specificity. Since the unit of the analysis varied among studies , indirectness was observed. In addition, the overall strength of the pooled evaluation was moderate, with pooled sensitivity and specificity of 99% and 100% , respectively. Under the pre-test probability of 5%, the post-test probability after a positive test result is 97%, and the post-test probability after a negative test result is 100%.
Table 4 Pooled test accuracy for different testing strategies *
GRADE for oral RDT versus blood reference
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Hepatitis C Virus Antibody Confirmation Serum
Confirming the presence of hepatitis C virus -specific IgG antibodies in serum specimens that are reactive by HCV antibody screening tests
Distinguishing between true- and false-reactive HCV antibody screening test results
This test is not intended for use as an HCV antibody screening test for blood or human cells/tissue donors
This assay is not usefulfor detection of early or acute hepatitis C as immunocompromised patients may not develop detectable HCV antibodies in blood until 6 months after infection
This assay is not useful for differentiating between past and chronic hepatitis C
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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Hcv Core Antigen Testing
The hepatitis C core antigen is a viral protein. Since the core antigen is part of hepatitis C virus, it can usually be found in the bloodstream two weeks after infection.
Since HCV core antigen testing is simpler and less expensive than viral-load testing, some experts suggest using it in resource-limited settings. Core antigen testing can be usedoften with HCV antibody testingto detect acute HCV or to confirm chronic HCV infection. HCV core antigen testing can also be used to measure treatment outcome. Although it does not detect low levels of HCV , usually the hepatitis C viral load is much higher in people who relapse after HCV treatment.
What To Do If The Hcv Antibody Test Is Reactive
If the antibody test is reactive or positive, you need an additional test to see if you currently have hepatitis C. This test is called a nucleic acid test for HCV RNA. Another name used for this test is a PCR test.
If the NAT for HCV RNA is:
- Negative you were infected with hepatitis C virus, but the virus is no longer in your body because you were cured or cleared the virus naturally.
- Positive you now have the virus in your blood.
If you have a reactive antibody test and a positive NAT for HCV RNA, you will need to talk to a doctor about treatment. Treatments are available that can cure most people with hepatitis C in 8 to 12 weeks.
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Educating Clients About Viral Hepatitis
Clients may believe they know about viral , but their understanding of the disease may not be accurate. It is easy to confuse the three main types of viral , B, and C. Clients may have formed impressions based on limited or incorrect information. Counselors should briefly describe hepatitis A, B, and C, including their prevalence, , and relationship to drug use, as well as to other infections, such as HIV and sexually transmitted diseases. Specific strategies for speaking with clients include:
- Speak clearly and keep the message simple, focused, and brief.
- Use language, examples, and concepts that the client understands.
- Use appropriate visual aids.
- Frame numerical statements in terms that are easy to visualize. Say 5 out of 100 people rather than 5 percent of the population say more than half instead of the majority.
- Repeat the information at different times in different ways. The average client retains only approximately one-third of what he or she is told. Summarize essential points.
- Pay attention to a clients response to the information. For example, if a client stiffens his or her posture, consider saying, I notice that this topic seems to make you uncomfortable. It does for a lot of people. Please tell me what youre feeling right now. Id really like to help you with this.
- Use the opportunity to describe the potential detrimental effects of alcohol and other substance use on the liver of a person who is infected with HCV.
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.
Available Patient Assistance Programs for Hepatitis C treatment Holkira Pak Maviret
MerckCare Hepatitis C Program 1 872-5773 Zepatier
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How Could A Person Have Been Exposed To Hepatitis C
HCV is spread primarily by direct contact with human blood. For example, you may have gotten infected with HCV if:
You ever injected street drugs, that may have had someone else’s blood that contained HCV on them. With the opioid crisis we are facing, we are now seeing increased rates of new hepatitis C infection.
You received blood, blood products, or solid organs from a donor whose blood contained HCV.
You were ever on long-term kidney dialysis as you may have unknowingly shared supplies/equipment that had someone else’s blood on them.
You were ever a healthcare worker and had frequent contact with blood on the job, especially accidental needlesticks.
Your mother had hepatitis C at the time she gave birth to you. During the birth her blood may have gotten into your body.
You ever had sex with a person infected with HCV.
You lived with someone who was infected with HCV and shared items such as razors or toothbrushes that might have had his/her blood on them.
What Are Antibodies
Antibodies are Y-shaped proteins made by a persons immune system. They are part of the immune systems response to viruses, bacteria, and other harmful substances .
Antibodies attach themselves to antigens or infected cells and tag them so that other immune cells can find and disable them. Antibodies stay in a persons body long after the antigen that triggered them disappears . If the same antigen enters a persons body again, even years later, the immune system will remember itand send antibodies to destroy it.
When HCV enters a persons bloodstream, it triggers an immune response. The immune system makes HCV-fighting antibodies. Sometimes, the immune system gets rid of hepatitis C virus by itself . About a quarter of people with hepatitis C will spontaneously clear the virus. This is more likely in young people , people who do not have HIV, and people with the IL28B CC genotype .
Even when a person has cleared HCV or been cured by treatment, HCV antibodies remain in a persons blood for years.
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How It Is Done
The health professional taking a sample of your blood will:
- Wrap an elastic band around your upper arm to stop the flow of blood. This makes the veins below the band larger so it is easier to put a needle into the vein.
- Clean the needle site with alcohol.
- Put the needle into the vein. More than one needle stick may be needed.
- Attach a tube to the needle to fill it with blood.
- Remove the band from your arm when enough blood is collected.
- Put a gauze pad or cotton ball over the needle site as the needle is removed.
- Put pressure on the site, and then put on a bandage.
What To Think About
- There is no vaccine to prevent infections with the hepatitis C virus.
- All donated blood and organs are tested for hepatitis C before being used.
- Other tests that show how well the liver is working are usually done if your doctor thinks you may have hepatitis C. These may include blood tests for bilirubin, alkaline phosphatase, alanine aminotransferase, and aspartate aminotransferase.
- Aspartate Aminotransferase
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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.
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.
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Can You Have A False Positive Anti
Yes. A false positive test means the test looks as if it is positive, but it is really negative. This happens more often in persons who have a low risk for the disease for which they are being tested. For example, false positive anti-HCV tests happen more often in persons such as blood donors who are at low risk for hepatitis C. Therefore, it is important to confirm a positive anti-HCV test with a supplemental test as most false positive anti- HCV tests are reported as negative on supplemental testing. There are certain situations where individuals with autoimmune disorders, such as Lupus, may have a false positive HCV antibody test. Confirming this with a HCV-RNA will usually be negative-indicating no active hepatitis C.
Should Patients With Hepatitis C Change Their Sexual Practices If They Have Only One Long
No. There is a very low chance of spreading HCV to that partner through sexual activity. If you want to lower the small chance of spreading HCV to your sex partner, you may decide to use barrier precautions such as latex condoms. The efficacy of latex condoms in preventing infection with HCV is unknown, but their proper use may reduce transmission. Your partner should also be tested.
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What Is A False Positive
A false-positive result means that a test indicated that you have a disease or condition when you actually dont.
One drawback is that the anti-HCV test cant differentiate between an active infection versus a chronic or previously acquired infection.
A positive anti-HCV test doesnt necessarily mean that you have hepatitis C. Antibodies picked up by the test may have been triggered by an infection other than HCV, leading to a positive result.
This phenomenon is known as cross-reactivity, and it often results in a false positive. The results may be verified through a second blood test.
The hepatitis C viral load test, also called an RNA test, will show whether you have chronic hepatitis C or a false positive.
2017 report , 22 percent of 479 subjects received a false-positive anti-HCV test.
According to a 2020 report, the rate of false-positive test results among 1,814 reactive serum samples was 10 percent.
Hepatitis C Virus Antibody Screen With Reflex To Hcv Rna Pcr Asymptomatic Serum
Screening for hepatitis C in primary care settings in high-risk persons with a current or past history of illicit injection drug use or a history of receiving a blood transfusion prior to 1992
Screening for hepatitis C in primary care settings in non-high-risk persons born from 1945 through 1965
Screening at least once in a lifetime for all adults greater or equal to 18 years old, except in settings where the prevalence of HCV infection is less than 0.1%
This test is not offered as a screening or confirmatory test for hepatitis C in blood or human cells/tissue donors.
This test profile is not useful for detection or diagnosis of acute hepatitis C virus , since HCV antibodies may not be detectable until after 2 months following exposure and HCV RNA testing is not performed on specimens with negative HCV antibody screening test results.
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