Diagnosis And Hepatitis C Elimination
In one report, the National Academies of Sciences, Engineering, and Medicine explored the feasibility of hepatitis C elimination and concluded that hepatitis C could be eliminated as a public health problem in the United States, but that substantial obstacles exist . In another report, specific actions were recommended to achieve elimination considering information, interventions, service delivery, financing, and research . These reports were the culmination of decades of progress in the development of HCV infection diagnostic and therapeutic tools.
In 1990, serologic tests to detect immunoglobulin G anti-HCV by enzyme immunoassay were licensed and became commercially available in the United States, and U.S. blood banks voluntarily began testing donations for anti-HCV . In 1991, U.S. Public Health Service issued interagency guidelines addressing hepatitis C screening of blood, organs, and tissues . These guidelines recommended hepatitis C testing for all donations of whole blood and components for transfusion, as well as testing serum/plasma from donors of organs, tissues, or semen intended for human use .
When Is It Ordered
The CDC, the Infectious Diseases Society of America , the American Association of the Study of Liver Diseases , and the U.S. Preventive Services Task Force recommend screening with an HCV antibody test at least once in your lifetime when you are 18 years old or older . The CDC also recommends HCV screening for women with each pregnancy or for anyone who requests it.
One-time screening is recommended regardless of age if you:
- Have ever injected illegal drugs
- Received a blood transfusion or organ transplant before July 1992*
- Have received clotting factor concentrates produced before 1987
- Were ever on long-term dialysis
- Are a child born to HCV-positive women
- Have been exposed to the blood of someone with hepatitis C
- Are a healthcare, emergency medicine, or public safety worker who had needlesticks, sharps, or mucosal exposure to HCV-positive blood
- Have evidence of chronic liver disease
- Have HIVabout 21% of those with HIV are also infected with HCV .
*The blood supply has been monitored in the U.S. since 1992, and any units of blood that test positive for HCV are rejected for use in another person. The current risk of HCV infection from transfused blood is about one case per two million transfused units.
Screening at regular intervals is recommended if you have ongoing risk of HCV infection, such as current injection drug use and sharing needles or syringes.
- Fatigue
- Yellowing of eyes and skin
An HCV RNA test is ordered when:
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.
- Negative
- 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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Hepatitis C Testing Strategy
The goal of hepatitis C screening is to identify persons who are currently infected with HCV. Hepatitis C testing should be initiated with a U.S. Food and Drug Administration -approved anti-HCV test. Persons who test anti-HCV positive are either currently infected or had past infection that has resolved naturally or with treatment. Immunocompetent persons without hepatitis C risks who test anti-HCV negative are not infected and require no further testing. Persons testing anti-HCV positive should have follow-up testing with an FDA-approved nucleic acid test for detection of HCV RNA. NAT for HCV RNA detection determines viremia and current HCV infection. Persons who test anti-HCV positive but HCV RNA negative do not have current HCV infection. CDC encourages use of reflex HCV RNA testing, in which specimens testing anti-HCV positive undergo HCV RNA testing immediately and automatically in the laboratory, using the same sample from which the anti-HCV test was conducted. Hepatitis C testing should be provided on-site when feasible.
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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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 “1,215,422 IU/L.” Many people refer to the quantitative measurement as the hepatitis C “viral load.”
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.
Aasld/idsa Hcv Testing Guidance
The American Association for the Study of Liver Diseases and Infectious Diseases Society of America guidance for hepatitis C addresses HCV testing in the section HCV Testing and Linkage to Care. The AASLD/IDSA recommends one-time, routine, opt out HCV testing for all individuals aged 18 years and older, one-time testing for persons younger than age 18 who have increased risk for acquiring HCV, periodic testing for persons who have risk activity for acquiring HCV, and annual testing for men with HIV who have condomless sex with men men who have sex with men and are on HIV preexposure prophylaxis and people who inject drugs . The AASLD/IDSA recommendations for testing incorporate birth-cohort screening as well as testing based on risk behaviors, risk exposures, and medical conditions associated with acquisition of HCV.
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Persons At Risk For Hcv Infection
IDU is the most common means of HCV transmission in the United States. Invasive medical procedures pose risks for HCV infection when standard infection-control practices are not followed . Health carerelated hepatitis C outbreaks also stem from drug diversion . Although HCV infection is primarily associated with IDU, high-risk behaviors , primarily among persons with HIV, are also important risk factors for transmission . Other possible exposures include sharing personal items contaminated with blood , unregulated tattooing, needlestick injuries among health care personnel, and birth to a mother with hepatitis C. Receipt of donated blood, blood products, and organs was once a common means of transmission but is now rare in the United States .
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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.
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 ‘works’ 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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Screening Strategies In A Low
Our study was integrated in an established population-based survey with repeated health surveys since 1974. The attendance rate was 64.3% and the estimated cost per newly detected chronic HCV infection was approximately NOK 90000 . HCV-screening of the general population outside such an established population survey would have been more laborious and at an expected considerably higher costs, thus making it less feasible. As discussed above, it is likely that persons belonging to risk groups for HCV infection attended the study to a lesser degree than the general population, reducing the efficiency of such an approach. On the other hand, the study has unmasked several individuals with chronic HCV infection that did not define themselves as belonging to known risk groups. A recent Spanish pilot study for an eventual population-based screening program included the adult population in a small health area with a participation rate of 46.2% . HCV RNA was detected in 13 persons , of whom five were unaware of the disease.
In low-prevalence countries, routine screening of the entire population has not been considered to be cost-effective , and screening are limited to high-risk populations. However, the high proportion of undiagnosed HCV infection clearly underscores the limitations of the risk-based screening approach and the need to reconsider screening strategies in order to achieve the diagnosis rate of 90% promoted by the WHO.
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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Drops In Hepatitis C Testing Treatment Spark Concern
May 19, 2021
Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.
The COVID-19 pandemic has coincided with sharp declines in routine testing for and treatment of hepatitis C virus infection, according to the results of a collaborative study between the Centers for Disease Control and Prevention and Quest Diagnostics. The authors say an associated increase in rates of transmission, morbidity, and mortality for this otherwise curable disease could result.
Dr Harvey Kaufman
Lead author Harvey W. Kaufman, MD, senior medical director and head of the Health Trends Research Program for Quest Diagnostics, told Medscape Medical News, “There are a lot of patients out there who have skipped care.”
Without treatment, he noted, this disease can progress to cirrhosis, hepatocellular carcinoma, and death.
Transmission is also a concern because the majority of people who have HCV are unaware of their disease and lack symptoms, thereby increasing the risk that they might spread it to others.
The study’s findings were May 10 in the American Journal of Preventive Medicine. Investigators compared 12,309,475 HCV antibody test results and 326,603 HCV RNA test results from the months of January to July for the years 2018, 2019, and 2020.
The results raise concerns that people living with undiagnosed HCV, the most commonly reported bloodborne infection in the United States, could develop more advanced disease before their status is confirmed.
How To Read Hepatitis C Test Results
Tests for hepatitis C are fairly simple and involve blood sampling. Testing a patient’s blood allows for both the detection and quantification of antibodies produced against the virus that causes hepatitis C, the hepatitis C virus.
Hepatitis C tests results can have two simple outcomes. However, most people are unsure about how to read their test results as they may include some confusing terms. Your test results can either be “reactive,” which would indicate that you have hepatitis C, or “non-reactive,” which simply means that you do not have hepatitis C. Moreover, your test results may also include the viral load along with its reference ranges, which also indicates whether you have hepatitis C or not.
While testing for hepatitis C is fairly simple, sometimes the test may need to be repeated as it can be inconclusive. Often, physicians order retesting to eliminate the possibility of a false-positive test result.
HOW DOES THE HEPATITIS C BLOOD TEST WORK?
As mentioned before, testing for hepatitis C is fairly simple. A routine blood test can detect if a person has been infected with the hepatitis C virus, also called HCV. This blood test checks for antibodies against HCV, so the test is also known as an anti-HCV antibody test. Before we move on to learning how to read your test results, it bodes well to understand how the test works.
HOW TO READ YOUR HEPATITIS C TEST RESULTS
WHAT TO DO IF YOUR HEPATITIS C TEST COMES BACK REACTIVE?
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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.
Taking A Hepatitis C Test
Hepatitis C testing is conducted on a sample of blood. Blood samples can be collected by a doctor, nurse, technician, or other health care provider from an adult patients vein using a small needle or a skin prick on a childs heel.
For an at-home hepatitis C test, patients collect a blood sample according to the manufacturers directions. Instructions provided in the test kit detail the steps to obtain a small sample of blood and mail it for testing.
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Current Hepatitis C Testing Recommendations
Recently, several organizations have issued hepatitis C virus screening recommendations. In general, major guidelines now recommend routine one-time universal HCV testing for adults 18 years of age and older, routine HCV screening of pregnant individuals, screening younger persons at risk of acquiring HCV, and repeat screening for those with ongoing risk for HCV acquisition.
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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