What Other Information Should Patients With Hepatitis C Be Aware Of
Sneezing, hugging, coughing, food or water does not spread HCV nor does sharing eating utensils or drinking glasses, or casual contact.
Persons should not be excluded from work, school, play, child-care or other settings on the basis of their HCV infection status.
Involvement with a support group may help patients cope with hepatitis C.
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 patient’s 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.
What Are The Recommendations For Follow
Anti-viral agents or immune globulin should not be used for postexposure prophylaxis.
For the source, baseline testing for anti-HCV.
For the person exposed to an HCV-positive source, baseline and follow-up testing including baseline testing for anti-HCV and ALT activity and follow-up testing for anti-HCV and ALT activity.
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Sensitivity And Specificity Of Serological Assays
The overall sensitivity and specificity of second generation assays are both 95-98%. They may be increased somewhat by third generation tests which incorporate extra HCV antigens. The results obtained within each generation of tests are very similar, regardless of the commercial source of the test.
The results of screening tests can be divided into two sets based on the risk of infection:
- low-risk populations, including blood donors and individuals with no risk factors for HCV infection
- high-risk populations, including individuals with a risk factor for HCV infection or documented liver disease presumed to be due to hepatitis C.
The first generation tests suggested that between 0.3% and 1.5% of blood donors world-wide were positive for anti-HCV. In Australia, 0.45% of blood donors in New South Wales were found to be anti-HCV positive. At first, HCV was only identified in 95-98% of the units of blood responsible for post-transfusion hepatitis C infections. This suggested that some infected units of blood were being missed.
Second generation assays detected one additional anti-HCV positive donor per 1000 tested. However, the introduction of these two generations of tests led to successive reductions in the incidence of post-transfusion hepatitis. The third generation tests are thought to detect a single additional infectious unit of blood for every 10 000 units screened.
The Australian situation
Search Strategy And Identification Of Studies
Search strategies were developed by a medical librarian with expertise in designing systematic review searches. Our search algorithm consisted of the following components: hepatitis C, diagnostic tests, and diagnostic accuracy. We searched MEDLINE , EMBASE , the Cochrane Central Register of Controlled Trials , Science Citation Index Expanded , Conference Proceedings Citation Index-Science , SCOPUS , Literatura Latino-Americana e do Caribe em Ciências da Saúde and WHO Global Index Medicus. The search was supplemented by searching for ongoing studies in WHOs International Clinical Trials Registry. The literature search was limited to English language and human subjects that available until April 30th, 2015. In addition to searching databases, we contacted individual researchers and authors of major trials to address whether any relevant manuscripts are in preparation or in press. The references of published articles found in the above databases were searched for additional pertinent materials.
Study selection proceeded in three stages: 1) titles/abstracts were screened by a single reviewer according to standard inclusion and exclusion criteria 2) full manuscripts were obtained and evaluated by two independent reviewers to include or not 3) two independent reviewers extracted all data. Differences were resolved by a third independent reviewer.
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How Can A Person Protect Themselves From Getting Hepatitis C And Other Diseases Spread By Contact With Human Blood
Don’t ever shoot drugs. Intranasal is also a risk factor. If you shoot or inhale drugs, stop and get into a treatment program. If you can’t stop, never reuse or share syringes, water, or drug works, and get vaccinated against hepatitis A and hepatitis B.
Do not share toothbrushes, razors, or other personal care articles. They might have blood on them.
If you are a healthcare worker, always follow routine barrier precautions and safely handle needles and other sharps. Get vaccinated against hepatitis B
Consider the health risks if you are thinking about getting a tattoo or body piercing: You can get infected if:
the tools that are used have someone else’s blood on them.
the artist or piercer doesn’t follow good health practices, such as washing hands and using disposable gloves.
HCV can be spread by sex, but this does not occur very often. If you are having sex, but not with one steady partner:
You and your partners can get other diseases spread by having sex .
You should use latex condoms correctly and every time. The efficacy of latex condoms in preventing infection with HCV is unknown, but their proper use may reduce transmission.
You should get vaccinated against hepatitis B.
Other Hepatitis C Tests
After an individual has received a reactive or positive result from a hepatitis C antibody test, they will need to have two follow-up tests.
The first test checks to see whether a person still has the virus the other measures the amount of the virus in the blood.
The first test is the hep C RNA qualitative test, also known as the PCR test. A positive result means that a person has the hepatitis C virus. A negative result means that the body has cleared the virus without treatment.
The second test is the hep C RNA quantitative test. The result of this test is given as a number rather than a positive or negative. This is because the test compares the amount of the virus in the body before, during, and after treatment.
The number given as a result of this test is known as the viral load. The lower amount of the hepatitis C virus in the blood, the better the chances that a person can eliminate the virus from their body.
After hepatitis C virus is diagnosed, other tests may be needed:
Certain behaviors, experiences, and medical procedures increase the risk of getting the hepatitis C virus, which is transmitted by contact with blood.
The following are risk factors for contracting the virus:
The Centers for Disease Control and Prevention advise all baby boomers get tested for hepatitis C. Baby boomers are people born between 1945 and 1965. They are five times more likely to have the virus than other adults.
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Molecular Hcv Rna Tests
Molecular diagnostic tests for hepatitis C specifically detect HCV RNA and the process is commonly referred to as a Nucleic Acid Test or Nucleic Acid Amplification Test . The HCV NAT becomes positive approximately 1 to 2 weeks after initial HCV infection. The NAT test has become the gold standard supplemental test for patients who have a positive HCV EIA screening test. The NAT can determine whether a patient with a positive HCV antibody test has current or resolved HCV infection. In addition, the NAT can be used in combination with other laboratory studies, such as prior antibody test results or hepatic aminotransferase levels, to suggest the possibility of acute HCV infection. The results for the commercially available quantitative HCV RNA assays, which were previously reported as copies/mL, are now given in International Units /mL.
Strategies For Improving Linkage To Care
Attempts at the public health level to implement an HCV testing and linkage-to-care program have shown that additional funds can be used to leverage existing program and provider networks. The CDC and other organizations are actively working to explore strategies, such as the Hepatitis Testing and Linkage to Care initiative, to enhance linkage to care for persons infected with HCV. It should also be noted that patients who have been previously diagnosed many years ago in the interferon era may have been counseled to not seek treatment given the relatively poor efficacy, long duration, and high rate of adverse effects associated with interferon-based therapy. These patients may require more intensive outreach efforts to educate and update on new greatly improved medications that are now available.
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Ecl Immunoassay For Anti
An ECL immunoassay was applied for anti-HCV testing using the Elecsys anti-HCV II assay on the Cobas 601 analyser . The kit was a third-generation test using peptides and recombinant antigens representing the core, NS3, and NS4 to capture the corresponding antibodies. The results were expressed as signal-to-cutoff ratios: S/CO< 1.0 indicated anti-HCV nonreactivity, and S/CO1.0 indicated anti-HCV reactivity. All S/CO1.0 sera were retested in duplicate according to the manufacturer’s instructions. If either of the two results remained S/CO1.0, then the subject was considered anti-HCV reactive. The anti-HCV reactive sera were retested using an Architect anti-HCV reagent kit.
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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What Blood Tests Are Available To Check For Hepatitis C
There are several blood tests that can be done to determine if you have been infected with HCV. You may need to be tested with one or two of the tests listed below to confirm the diagnosis: a) Anti-HCV
EIA This test is usually done first. If positive, it should be confirmed
RIBA A supplemental test used to confirm a positive EIA test Anti-HCV does not tell whether the infection is new , chronic or is no longer present. In most cases, this test is no longer used.
b) Qualitative tests to detect presence or absence of virus This test will be reported as either positive or negative c) Quantitative tests to detect amount of virus A single positive PCR test indicates infection with HCV. A single negative test does not prove that a person is not infected. Virus may be present in the blood and just not found by PCR. Also, a person infected in the past who has recovered may have a negative test. When hepatitis C is suspected and PCR is negative, PCR should be repeated. This test will be reported as a viral load, determining the amount of virus present. This viral load becomes most important during treatment to determine if the is a response to therapy.
Assessment Of Methodological Quality
Study quality was evaluated using the QUADAS-2 tool and the STARD checklist . QUADAS includes domains to evaluate bias in the following categories: risk of bias applicability concerns . The STARD checklist consists of a checklist of 25 items and flow diagram that authors can use to ensure that all relevant information is present.
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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.
What Do My Test Results Mean
A result for a lab test may be affected by many things, including the method the laboratory uses to do the test. If your test results are different from the normal value, you may not have a problem. To learn what the results mean for you, talk with your healthcare provider.
A test for hepatitis C antibodies is either positive or negative. If you test positive, you may have an HCV infection. But it could also mean that you had the infection in the past and are not currently infected. If you test negative, it is likely that you do not have the infection.
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Discusses Physiology Pathophysiology And General Clinical Aspects As They Relate To A Laboratory Test
AIDS is caused by 2 known types of HIV. HIV type 1 is found in patients with AIDS or AIDS-related complex and in asymptomatic infected individuals at high risk for AIDS. The virus is transmitted by sexual contact, by exposure to infected blood or blood products, or from an infected mother to her fetus or infant. HIV type 2 infection is endemic only in West Africa, and it has been identified in individuals who had sexual relations with individuals from that geographic region. HIV-2 is similar to HIV-1 in viral morphology, overall genomic structure, and its ability to cause AIDS.
Antibodies against HIV-1 and HIV-2 are usually not detectable until 6 to 12 weeks following exposure and are almost always detectable by 12 months. They may fall to undetectable levels in the terminal stage of AIDS when the patients immune system is severely depressed.
Routine serologic screening of patients at risk for HIV-1 or HIV-2 infection usually begins with a HIV-1/-2 antigen and/or antibody screening test, which may be performed by various FDA-approved assay methods, including rapid HIV antibody tests, enzyme immunoassays, and chemiluminescent immunoassays. In testing algorithms that begin with these methods, supplemental or confirmatory testing should be requested only for specimens that are repeatedly reactive by these methods according to assay manufacturers instructions for use.
Hepatitis C Testing And Diagnosis
Doctors will start by checking your blood for:
Anti-HCV antibodies: This blood test is the first — and sometimes only — one you may get. Also called the ELISA screen, it checks for antibodies that your body releases to fight the virus. These are proteins your body makes when it finds the hep C virus in your blood. They usually show up about 12 weeks after infection. Your test will be either negative or positive for antibodies. It usually takes a few days to a week to get results, though a rapid test is available in some places.
What the results mean
Negative . This is when your blood shows no signs of HCV antibodies. Most of the time, thatâs because you never came in contact with the virus and you do not have hep C.
Sometimes, your negative result can be false, meaning you have HCV. That may happen if you:
- Took the test too soon after your exposure. This test checks for only HCV antibodies, which can take several months to appear.
- Have HIV, a donated organ, or other conditions that weaken your immune system, which can suppress your antibodies
- Get hemodialysis for kidney problems
If youâve been exposed in the last 6 months, youâll need to be retested.
Positive . This means youâve been infected with HCV. But false positives are surprisingly common. More than 1 in 5 people who test positive donât actually have hepatitis C. Possible reasons include:
What the results mean
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The Fourth Or Reactivation Phase
The previous phase of HBeAg-negative/anti-HBe-positive inactive HBsAg carrier state is not synonymous with permanent termination of HBV replication and of HBV-induced chronic liver damage. Although the majority of patients may remain for life in an inactive HBsAg carrier state, and a number of them may also lose HBsAg and enjoy a complete recovery, others retain or redevelop over time significant HBV replication and progressive liver damage .
This state of HBV-induced liver damage has been first referred to as HBeAg-negative/anti-HBe-positive CHB, and similarly to HBeAg-positive CHB, it also represents an immune active phase in the natural course of chronic HBV infection. It is generally viewed as a fourth phase in the natural history of chronic HBV infection usually developing because of reactivation of HBV replication, though in some patients, it may immediately follow the second phase of HBeAg-positive CHB despite clearance and even seroconversion of HBeAg .
Stephen N.J. Korsman MMed FCPath, Wolfgang Preiser MRCPath, in, 2012
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Hepatitis C Antibody Test
Initially, doctors use the anti-HCV test. It detects antibodies that the immune system produces to fight the HCV.
However, the anti-HCV test cannot tell whether the antibodies are present because a person currently has an active hepatitis C infection or whether they have had this infection in the past.
The antibodies can remain, even if a person has had successful treatment, or if their body has cleared the virus on its own.
A negative result is interpreted as no HCV infection, assuming one has not had recent exposure to HCV. If one has had recent exposure to HCV in the last 6 months, anti-HCV testing will need to be repeated in the future.
Anyone who receives a positive result on an anti-HCV test will require further testing.
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