How Are Hepatitis B And Hepatitis C Spread From Person To Person
Like HIV, the hepatitis B and hepatitis C viruses spread:
- From mother to child: Pregnant women can pass these infections to their infants. HIV-HCV coinfection increases the risk of passing on hepatitis C to the baby.
- Sexually: Both viruses can also be transmitted sexually, but HBV is much more likely than HCV to be transmitted sexually. Sexual transmission of HCV is most likely to happen among gay and bisexual men who are living with HIV.
When Should I Get Hepatitis C Testing
When used for early detection in patients without symptoms of hepatitis C, screening is recommended at least once for all adults aged 18 years or older, except in locations with very low prevalence of HCV. Screening is also recommended during pregnancy and for patients of any age with risk factors for HCV infection. In patients with risk factors, periodic screening is recommended for as long as risk factors persist.
Risk factors for HCV include:
- Current or past injectable drug use
- Having a blood transfusion or organ transplant before July 1992
- Receiving kidney dialysis
- Pain in the abdomen or joints
- Nausea, vomiting, or loss of appetite
- Jaundice or yellowish skin and eyes
Hepatitis C testing may also be performed when liver tests are abnormal or when diagnosing the cause of existing liver damage.
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.
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Question 5 How Do You Interpret Hcv Antibody Reactive And Hcv Rna Not
A reactive HCV antibody test result combined with a not-detected HCV RNA result indicates no laboratory evidence of a current active HCV infection no further action is required in most cases.
If distinction between a true positive and a biologic false-positive result for HCV antibody is desired, the CDC suggests that one can consider testing with another HCV antibody assay. If there is concern regarding the handling or storage of the test specimen, obtain a new sample for repeat testing.6
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.
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Do Medical Conditions Outside The Liver Occur In Persons With Chronic Hepatitis C
A small percentage of persons with chronic hepatitis C develop medical conditions outside the liver . These conditions are thought to occur due to the body’s natural immune system fighting against itself. Such conditions include: glomerulonephritis associated with kidney disease, essential mixed cryoglobulinemia, and porphyria cutanea tarda-a skin condition.
Nat: Detection Of Hcv Rna
Molecular virological techniques play a key role in diagnosis and monitoring of treatment for HCV. Because it is difficult to cultivate the virus in cell culture, molecular techniques were instrumental in first identifying HCV, making it one of the first pathogens to be identified by purely molecular methods. NAT is considered the gold standard for detecting active HCV replication. HCV NAT is extremely useful in establishing the diagnosis of acute HCV infection, since RNA is detectable as early as 1 week after exposure via needle-stick or blood transfusion, and at least 4-6 weeks prior to seroconversion as demonstrated in a number of transmission settings. The diagnosis of HCV infection is established with antibody screening followed by NAT for HCV RNA for confirmation as well as for follow-up of patients on treatment. Viral load assessment at baseline is also critical for determining response kinetics during therapy. enumerates the role of NAT in HCV diagnosis.
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What Does Reactive Mean On A Hep C Test
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.
Appropriate Uses Of The Hcv Rna Test
There are 4 major reasons that HCV RNA tests are used:
More rarely, HCV RNA is used when either very acute HCV infection is suspected or a false HCV Ab is suspected.
It would not be appropriate to repeatedly order HCV RNA viral load screening for a patient who is not on or was recently on HCV treatment, or to use the HCV viral load to determine the severity of the patient’s infection or the patient’s risk of developing significant liver disease.
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Who Should Get A Hepatitis C Screening
If youre under 18, you may or may not need a parents or guardians consent to get tested. State laws on minor consent for medical care vary. If youve been exposed to hepatitis C or feel that you need a test for any reason, dont let your age stop you from getting the medical help you need.
If left untreated, hepatitis C can have serious consequences for your health. If you test positive, you can also pass the virus onto others.
The recommends universal hepatitis C screening for:
- all adults aged 18 and over
- pregnant people
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.
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Is Hepatitis Testing Recommended For People With Hiv
Yes. Everyone living with HIV should be tested for HBV and HCV when they are first diagnosed with HIV and begin treatment. People living with HIV who have ongoing risk factors for getting hepatitis B or hepatitis C should be tested annually.
In addition, new HCV screening recommendations from the Centers for Disease Control and Prevention call for:
- One-time screening for all adults 18 years and older
- Screening of all pregnant women during every pregnancy
- Testing for all persons with risk factors, with testing continued periodic testing those with ongoing risk.
Can Hepatitis C Be Treated
Yes, since 2010 enormous progress has been made in the treatment of chronic hepatitis C. New therapies called direct-acting antivirals are pills that act on the virus itself to eradicate it from the body, unlike older medicines like interferon injections which work by stimulating an immune response. These new treatments are very effective and can achieve cure rates of over 90%. In most situations now, there is no need for interferon, which was responsible for many of the side effects previously associated with HCV treatment. The new treatment combinations require shorter treatment durations , have reduced side effects and appear to be effective at all stages of the disease.
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.
Your primary care physician may refer you to a specialist to determine whether you are eligible for treatment. A specialist will help you decide which drug therapy is best for you based on the severity of your liver disease, your virus genotype and whether or not you have been treated in the past.
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How Can You Prevent Hepatitis B And Hepatitis C
Hepatitis B: Vaccination is the best way to prevent all of the ways that hepatitis B is transmitted. People with HIV who do not have active HBV infection should be vaccinated against it. In addition to the 3-dose series of hepatitis B vaccine given over 6 months, as of 2017, there is a 2-dose series given over 1 month.
Hepatitis C: No vaccine exists for HCV and no effective pre- or postexposure prophylaxis is available. The best way to prevent hepatitis C infection is to never inject drugs or to stop injecting drugs by getting into and staying in drug treatment. If you continue injecting drugs, always use new, sterile needles or syringes, and never reuse or share needles or syringes, water, or other drug preparation equipment.
How Can I Make A Difference For People With Hepatitis C
Anyone can help raise awareness about this widespread disease. Citizens can write letters to their state representatives or local newspapers and get involved in volunteer efforts with liver disease or Veteran-affiliated organizations . Speaking at support groups and sharing your experience is also a good way to help others with HCV.
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How Do People Get Hepatitis C
Hepatitis C virus is found in the blood of people with HCV infection. It enters the body through blood-to-blood contact.
Until reliable blood tests for HCV were developed , people usually got hepatitis C from blood products and blood transfusions. Now that blood and blood products are tested for HCV, this is no longer the typical means of infection.
Currently, people usually get hepatitis C by sharing needles for injection drug use. An HCV-infected woman can pass the infection to her baby during birth. It is also possible to get hepatitis C from an infected person through sexual contact, an accidental needlestick with a contaminated needle, or improperly sterilized medical, acupuncture, piercing, or tattooing equipment.
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.
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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.
Recommended Laboratory Evaluation Prior To Referral
All persons referred for further evaluation and management of HCV infection should have a confirmed positive HCV RNA level, preferably a quantitative HCV RNA level and not a qualitative HCV RNA level. It is ideal, but not imperative, that the clinician who makes the diagnosis of HCV infection can perform some preliminary tests to provide advanced information in anticipation of the initial referral visit. These initial preliminary tests include an HCV genotype, tests of synthetic liver function , hepatic inflammation , and assays to detect relevant coinfection . For primary care providers taking on a more comprehensive role for the initial evaluation and management, see Module 2, Lesson 1 for a detailed discussion in the Core Concept Initial Evaluation of Persons with Chronic Hepatitis C.
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Clinical Information Discusses Physiology Pathophysiology And General Clinical Aspects As They Relate To A Laboratory Test
Hepatitis B e antigen is a small polypeptide that exists in a free form in the serum of individuals during the early phase of hepatitis B infection, soon after hepatitis B surface antigen becomes detectable. Serum levels of both HBeAg and HBsAg rise rapidly during the period of viral replication. The presence of HBeAg in serum correlates with hepatitis B virus infectivity, the number of infectious virions, and the presence of HBV core antigen in the infected hepatocytes.
During recovery from acute hepatitis B, HBeAg level declines and becomes undetectable in the serum, while hepatitis B e antibody appears and becomes detectable in the serum. Anti-HBe usually remains detectable for many years after recovery from acute HBV infection.
In HBV carriers and patients with chronic hepatitis B, positive HBeAg results usually indicate presence of active HBV replication and high infectivity. A negative HBeAg result indicates very minimal or no HBV replication. Positive anti-HBe results usually indicate inactivity of the virus and low infectivity. Positive anti-HBe results in the presence of detectable HBV DNA in serum also indicate active viral replication in these patients.
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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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The Hepatitis C Testing Process
In the case of a suspected new infection, two test results are usually required to confirm if someone currently has hepatitis C.
The first test is a screening test, which is an antibody test. This test detects antibodies in the blood to determine if a person has ever had a hepatitis C infection.
- A non-reactive screening test result indicates that the person does not have hepatitis C antibodies and has never had a hepatitis C infection. No further testing is usually performed.
- If the antibody test is reactive , this means that the person has antibodies to hepatitis C and therefore has had a hepatitis C infection at some point in their life.
The antibody test alone cannot tell whether the person has a current hepatitis C infection. A person will test positive for hepatitis C antibodies if they have hepatitis C at present, but also if they had a hepatitis C infection in the past. In other words, people will still have hepatitis C antibodies even if they spontaneously cleared the virus in the past or if they were treated and cured.
The second test is a confirmatory test, which detects the hepatitis C virus itself. This test detects genetic material of the virus to determine if a person currently has a hepatitis C infection.
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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