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How Does It Occur
Hepatitis C is caused by the hepatitis C virus.The virus is spread mainly through contact with infected blood. Sometimesit is spread through sexual contact. You can get it from:
- Receiving infected blood, blood products,or transplanted organs
- Long-term kidney dialysis if you unknowinglyshared supplies or equipment that had someone else’s blood on them
- Contact with infected blood on the jobif you are a health care worker, especially from accidental needlesticks
- Your mother if she had hepatitis C at thetime she gave birth to you
- Intravenous drug abuse
- Sharing nasal cocaine equipment with otherpeople
- Sharing razors or toothbrushes with aninfected person
- Getting a permanent tattoo with unsterileequipment
- Having unprotected sex with someone infectedwith hepatitis C.
Before 1990 one of the most common ways to gethepatitis C was blood transfusion. However, now blood donors are screenedfor the virus.
The disease can be spread by people who do nothave any symptoms and may not know they carry the virus. These people arecalled asymptomatic carriers.
A Tailored Approach To Hepatitis C Testing In Canada
Reflex testing has been implemented by some regions with the intent to address a significant challenge with standard two-step testing: multiple visits required for a hepatitis C diagnosis. Although reflex testing makes a valuable contribution to ensuring confirmatory testing is completed and hepatitis C is diagnosed for people who get tested, challenges also exist in ensuring that people at high risk for hepatitis C initiate the testing process. Although reducing the number of visits with reflex testing will certainly have its advantages, there are other forms of hepatitis C testing that address other known challenges associated with standard two-step testing.2 These approaches are used to different extents across Canada and may not be available for use in all regions.
DBS is a sampling method that can be used to screen for and diagnose hepatitis C and other blood-borne viruses. If technology to ensure the proper storage and transportation of a blood sample is unavailable, use of DBS can ensure blood remains stable on a card in transit to a laboratory for testing. This can be helpful in rural and remote settings where standard two-step testing can be a challenge because of limited access to laboratories .11-13
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Question 7 The Test Result Is 1a With The Comment We Cannot Rule Out Genotype 6 Subtypes C
Not necessarily. The HCV genotype assay is performed by analyzing LiPA banding patterns that are indicative of the genotype. Two regions of the genome are assessed: the 5′ UTR and the core region. Genotype 6 subtypes c-l have the same LiPA banding pattern as genotype 1 when this technique is performed. Therefore, the core region is used to differentiate type 1 from type 6. If the core region LiPA banding pattern is not conclusive, we report a result of HCV genotype 1 but cannot rule out type 6 subtypes c-l.
Implications For The Future
Reflex testing is a reliable and convenient method of testing that has been demonstrated to ensure that a confirmatory test is completed for everyone who receives a positive result on a screening test for hepatitis C antibodies. This is a critical step in the pathway to a cure for individuals, as getting tested is the only way to receive a diagnosis, which is required for a person to be eligible for and formally linked to treatment.
Beyond simplifying the testing process, another advantage of ensuring that a confirmatory test is completed for everyone with a positive test result for hepatitis C antibodies is the potential for Canada to accumulate better data to create a more accurate national picture of current hepatitis C infections in this country.
The expansion of available testing methods for hepatitis C is promising progress on the road to elimination of hepatitis C. There is no one-size-fits-all option for hepatitis C testing because of the differences in populations, settings and availability of various testing technologies across the country, but testing methods can be tailored to improve testing uptake and eventual linkage to care and treatment. As such, the Blueprint to Inform Hepatitis C Elimination Efforts in Canada recommends that reflex testing be made available across Canada.15
Related resources
References
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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 patient’s response to antiviral treatment.
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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Hepatitis C Reflex Testing
To ensure complete and timely diagnosis of HCV, HCV reflex testing is recommended following a reactive hepatitis C antibody screening test. Reflex testing means the laboratory will perform the hepatitis C antibody test, and if the result is positive, the laboratory will immediately perform an HCV RNA test on the same specimen. If the subsequent HCV RNA test is negative, HCV infection is effectively ruled out for most patients. If the reflex HCV RNA test is positive, a diagnosis of active HCV infection has been confirmed, and the individual should be referred directly for HCV care and treatment.
Reflex testing obviates the need for the patient to return for follow-up testing should the initially HCV antibody test be reactive. If the RNA test is negative, the work-up is done, and the patient may be reassured.
- Rationale for reflex testing:
How Can I Take Care Of Myself
- Follow your health care provider’s instructionsfor taking medicine to relieve your symptoms. When the hepatitis C virusis active, you need to avoid taking certain medicines .Ask your health care provider which medicines you can safely take foryour symptoms .
- Follow your health care provider’s advicefor how much rest you need and when you can return to your normal activities,including work or school. As your symptoms improve, you may graduallyincrease your level of activity. It is best to avoid too much physicalexertion until your health care provider tells you it’s OK.
- Eat small, high-protein, high-calorie meals,even when you feel nauseated. Sipping soft drinks or juices, and suckingon hard candy may help you feel less nauseated.
- Do not drink alcohol unless your healthcare provider says it is safe.
- Ask your health care provider if you needshots to prevent hepatitis A and hepatitis B.
- Contact your health care provider if:
- Your appetite continues to decrease.
- You have worsening fatigue.
- You have vomiting, diarrhea, or abdominalpain.
- You develop jaundice.
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North Polar Ice Cap Melting
Earth’s North Pole is covered by floating pack ice over the Arctic Ocean. Portions of the ice that do not melt seasonally can get very thick, up to 34 meters thick over large areas, with ridges up to 20 meters thick. One-year ice is usually about 1 meter thick. The area covered by sea ice ranges between 9 and 12 million km2. In addition, the Greenland ice sheet covers about 1.71 million km2 and contains about 2.6 million km³ of ice. When the ice breaks off it forms icebergs scattered around the northern Atlantic.
According to the National Snow and Ice Data Center, “since 1979, winter Arctic ice extent has decreased about 4.2 percent per decade”. Both 2008 and 2009 had a minimum Arctic sea ice extent somewhat above that of 2007. At other times of the year the ice extent is still sometimes near the 19792000 average, as in April 2010, by the data from the National Snow and Ice Data Center. Still, between these same years, the overall average ice coverage appears to have declined from 8 million km2 to 5 million km2.
Earth’s south polar land mass, Antarctica, is covered by the Antarctic ice sheet. It covers an area of about 14.6 million km2 and contains between 25 and 30 million km3 of ice. Around 70% of the fresh water on Earth is contained in this ice sheet.
Data from the National Snow and Ice Data Center shows that the sea ice coverage of Antarctica has a slightly positive trend over the last three decades .
All Adults Pregnant Women And People With Risk Factors Should Get Tested For Hepatitis C
Most people who get infected with hepatitis C virus develop a chronic, or lifelong, infection. Left untreated, chronic hepatitis C can cause serious health problems, including liver damage, cirrhosis, liver cancer, and even death. People can live without symptoms or feeling sick, so testing is the only way to know if you have hepatitis C. Getting tested is important to find out if you are infected so you can get lifesaving treatment that can cure hepatitis C.
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Question 5 Which Hcv Genotypes May Be Reported By The Lipa Assay At Quest Diagnostics
The LiPA genotype assay can identify all 6 major HCV genotypes . In many cases, it can also differentiate among HCV subtypes, including 1a, 1b, 2a-c, 3a, 3b, 3c, 3k, 4a/c/d, 4f, 4h, 5a, 6a/b, and 6c-l. However, if the LiPA banding pattern for a patient specimen does not sufficiently differentiate between subtypes, only the genotype may be reported .
What Does A Reactive Hcv Antibody Test Result Mean
A reactive or positive antibody test means you have been infected with the hepatitis C virus at some point in time.
Once people have been infected, they will always have antibodies in their blood. This is true if they have cleared the virus, have been cured, or still have the virus in their blood.
A reactive antibody test does not necessarily mean that you currently have hepatitis C and a follow-up test is needed.
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How Is It Treated
The usual treatment is rest and a healthy diet.In addition, your health care provider will recommend that you avoid alcoholfor at least 6 months. Usually it is not necessary to stay at the hospital.
You may be given interferon, a drug that boostsyour immune system, or other antiviral drugs.
Doctors are continuing to search for the best waysto treat hepatitis C. As new information becomes available, treatmentschange. You should discuss possible new treatments with your health careprovider.
Question 9 How Does The Hcv Genotype Test Differ From The Hcv Ns3 Ns5a And Ns5b Tests For Drug Resistance
The LiPA genotype test is designed to identify all 6 major HCV genotypes. In contrast, the NS3, NS5a, and NS5b drug resistance tests detect mutations associated with drug resistance for a particular HCV genotype. They are not intended for determining HCV genotype and subtype. Separate test codes for drug resistance testing are available, depending on the HCV genotype and the gene of interest:
- Hepatitis C Viral RNA Genotype 1 NS3 Drug Resistance
- Hepatitis C Viral RNA Genotype 1 NS5a Drug Resistance
- Hepatitis C Viral RNA Genotype 1 NS5b Drug Resistance
- Hepatitis C Viral RNA Genotype 3 NS5a Drug Resistance
The HCV genotype test should be performed before ordering an applicable HCV drug resistance test.
References
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Hepatitis C Ab With Reflex To Hcv Rna Qn Pcr
The Hepatitis C AB with reflex to HCV RNA, QN, PCR test contains 1 test with 2 biomarkers.
Hepatitis C AB with reflex to HCV RNA, QN, PCR
IMPORTANT – THIS IS A REFLEX TEST AND AN ADDITIONAL CHARGE OF $129 WILL BE APPLIED IF THE Hepatitis C Antibody is reactive.
If Hepatitis C Antibody is reactive, then Hepatitis C Viral RNA, Quantitative, Real-Time PCR will be performed at an additional charge of $129.00
For the detection of active HCV infection in HCV antibody positive individuals.
Clinical Significance
Hepatitis C Virus is a major cause of hepatitis. The clinical symptoms of an HCV infection are variable. Infection with HCV results in a chronic infection in 50 to 80% of cases. The “window” between HCV acquisition and seroreactivity is highly variable up to six months.
Hepatitis C Antibody Blood Test With Reflex On Positives
Assess exposure to hepatitis C virus infection and tests blood safety.
Also Known As: HCV, Hep C.
Methodology: Immunoassay
Preparation: No fasting required. Stop biotin consumption at least 72 hours prior to the collection.
Test Results: 2-3 days. May take longer based on weather, holiday or lab delays.
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Reflex Testing Closes The Gap From Screening To Confirmatory Testing
Numerous studies from multiple contexts and care settings have demonstrated that the proportion of individuals who receive a confirmatory test is significantly higher in the context of reflex testing compared with standard two-step testing.7-10 For example, a pilot study from the United Kingdom examined the feasibility, clinical impact and cost of replacing standard two-step testing with reflex testing among primary care patients. Before the implementation of reflex testing, only 70% of primary care patients who were tested for hepatitis C completed confirmatory testing after receiving a positive hepatitis C antibody test. Following the implementation of reflex testing, 100% of patients had a confirmatory test completed after they received a positive hepatitis C antibody test.9
What Is Reflex Testing
Reflex testing, also called âone-step diagnosis,â is a relatively new method of hepatitis C testing in Canada. Reflex testing uses a single blood sample to complete both screening and confirmatory tests. This means that a person does not have to have blood taken a second time if they test positive for hepatitis C antibodies. Instead, some of the original blood sample that tested positive for hepatitis C antibodies is automatically used for confirmatory testing.5 This makes the testing process more convenient for the person being tested and reduces the risk of not completing the testing process.
Reflex testing can also be performed on dried blood spot samples, where a sample of blood drops is collected from a finger prick on a piece of filter paper, dried and transported to a laboratory. This form of sample collection is not yet widely used across Canada for hepatitis C testing. For most regions, reflex testing would require drawing blood from a personâs vein for sample collection.
Types of tests used in Canada
A hepatitis C RNA test is the most commonly used test for confirmatory testing in Canada.6 With this test, the current presence of the hepatitis C virus in the blood is confirmed by analyzing the sample for RNA, the genetic material of the virus. Another type of confirmatory test, called a core antigen test, is used in some jurisdictions. This test detects proteins that are part of the hepatitis C virus.
Reliability
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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.