How Is Hepatitis C Test Done

What Is Being Tested

Hepatitis C is a virus that causes an infection of the liver that is marked by liver inflammation and damage. Hepatitis C tests are a group of tests that are performed to diagnose hepatitis C infection and to guide and monitor treatment of the infection.

Hepatitis C tests include:

Hepatitis C is one of five viruses identified so far, including A, B, D, and E, that are known to cause hepatitis.

HCV is spread when contaminated blood enters the body, primarily though sharing needles and syringes during IV drug use. HCV is spread less commonly by sharing personal items contaminated with blood , through sex with an infected person, needlestick injuries to healthcare workers, unregulated tattooing, and from mother to baby during pregnancy and childbirth. Before tests for HCV became available in the 1990s, HCV was often transmitted by blood transfusions. Currently, there is no vaccine to prevent hepatitis C.

What Does The Test Result Mean

Screening and diagnosis

An HCV antibody test is typically reported as “positive” or “negative.”

Results of HCV viral load testing are reported as a number of virus copies present. If no virus is present or if the amount of virus is too low to detect, the result is often reported as “negative” or “not detected.”

Interpretation of the HCV screening and follow-up tests is shown in the table below.

• In general, if your HCV antibody test is positive, then you have likely been infected at some time with hepatitis C.
• If the laboratory reports results as weakly positive, most of these results are false positive and some laboratories will retest your sample with another test before reporting it as positive.
• If your HCV RNA test is positive, then you have a current infection.
• If no HCV viral RNA is detected, then you either do not have an active infection or the virus is present in very low numbers.

Guiding and monitoring treatment

The result of your HCV genotype test identifies which strain of HCV you have and helps guide the selection and the length of your treatment. Treatments may differ depending on a variety of factors, including HCV genotype and the health of your liver.

An HCV viral load can indicate whether or not treatment is effective.

How Is Hepatitis C Diagnosed

There are two blood tests needed to diagnose chronic hepatitis C.

• Antibody test

This test checks whether someone has ever been exposed to the virus. It doesn’t determine whether the virus is present now or was there in the past. After you have had the virus this test will always be positive, even after you’ve been cured.

• Hepatitis C viral load

This test counts the amount of virus particles present in someone’s blood. If not detected then it means the person does not have hepatitis C. If the virus is present it will give a number . If the virus is present you should speak to their healthcare provider about starting hepatitis C treatment. This is the main test used in New Zealand to confirm current infection.

• HCV RNA/hepatitis C antigen test

This tests looks for virus particles. It will give a positive or negative result. If negative it means the virus isn’t present and you don’t have hepatitis C. If positive it means the virus is present and you should speak to their healthcare provider about starting hepatitis C treatment. This test does not need to be done if an HCV RNA test has already been done.

I have hepatitis C. How can I be treated?

Regional district health boards manage hepatitis C patient services. Contact your GP if you think you have hepatitis C or would like to access treatment. If you have questions about hepatitis C or need support please contact us.

If you live elsewhere please see your GP for referral to a hepatitis C programme near you.

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What Is An Hcv Antibody Test

An HCV antibody test is used to determine whether youve contracted the hepatitis C virus.

The test looks for antibodies, which are proteins made by the immune system that are released into the bloodstream when the body detects a foreign substance, such as a virus.

HCV antibodies indicate exposure to the virus at some point in the past. It can take anywhere from a few days to a few weeks to get results back.

. The blood panel will either show that you have a nonreactive result or a reactive result.

Will I Need Any Other Tests Along With The Hepatitis Panel

Apart from the tests for hepatitis viruses, your doctor may want to know the impact of disease or medical conditions on your liver. Your healthcare provider may recommend liver enzyme tests such as alkaline phosphatase aminotransferase , and aspartate alanine aminotransferase . Further, you may also be asked to undergo a test for prothrombin time and bilirubin to ascertain the extent of liver damage.

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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
• Loss of appetite, nausea, vomiting
• Dark urine
• Yellowing of eyes and skin

An HCV RNA test is ordered when:

Hepatitis C: What Blood Tests

DOCTOR’S VIEWS ARCHIVE

Topic: Hepatitis C, June 2000

Dr. Lee:In an otherwise healthy person who was found to have abnormal liver tests and you suspect Hepatitis C, what tests are available to determine whether this person is infected with Hepatitis C?

Dr. Edward Block: There are several tests, Dennis. The first commonly ordered test is the hepatitis C antibody test . A positive hepatitis C antibody test usually indicates previous exposure to hepatitis C. In other words not everyone testing positive to hepatitis C antibody actually has active hepatitis C infection.

To determine active hepatitis C infection, the doctor orders hepatitis C RNA test . This is an actual measure of virus in the blood and in the liver. Therefore a positive hepatitis C RNA test indicates active hepatitis C infection.

We can even take this one step further now and do specialized genotype testing. We now can actually determine the genotype of hepatitis C that is infecting the patient. It turns out that different genotypes of hepatitis C virus may have very different responses to treatment.

The published answers represent the opinions and perspectives of the doctors and pharmacists of MedicineNet.com and are for educational purposes only. They should not be used to replace or substitute for timely consultation with your doctor. Accuracy of information cannot be guaranteed.

Please remember, information can be subject to interpretation and can become obsolete.

Back to Doctors’ Dialogue Index

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Testing For Hepatitis C

Two tests need to be done to discover if you have hepatitis C:

• Antibody test: Which establishes whether you have ever been exposed to the hepatitis C virus.
• PCR test: Which establishes whether the virus is still active and needs treating.

The two tests can often be done from one sample of blood which means you may only need to provide the sample once. Both tests can then be done on your sample at the laboratory. However, some services will perform one test and then call you back for a further blood sample to perform the second test.

Antibody test

A hepatitis C antibody test is the first test undertaken. This is to determine whether you have ever been exposed to the hepatitis C virus. It works by testing for the presence of antibodies to the virus generated by your immune system. If you receive a negative hepatitis C antibody test but have been experiencing symptoms or have been recently exposed to hepatitis C, then you are likely to be advised to have a second test.

It is important to remember that there is a ‘window period’. This is the short period of time when your immune system may not have had time to produce antibodies. It usually takes between six and twelve weeks for these antibodies to develop. However, in a few people it can take up to six months. So if you have the test within this window period and the result is negative, it does not necessarily mean that you don’t have the virus.

PCR test

What Tests Do I Need

Hepatitis C

There are usually only two blood tests that need to be done to determine if you have chronic hepatitis C.

The first test is called an “antibody” test. This tests looks to see if your body has developed antibodies to HCV . This test is sometimes called an anti-HCV test. A positive antibody result means that, at some point in your life, you were exposed to the hepatitis C virus, and you developed antibodies to fight off the virus. But just having a positive antibody test does not mean you have chronic hepatitis C infection.

If your hepatitis C antibody test is positive, then a second test will be done to see if you still have the hepatitis C virus in your body. This test is called a hepatitis C viral load test . If this test is positive, you have chronic hepatitis C and should talk to your provider about treatment.

You do not need a liver biopsy to determine if you have hepatitis C.

For more details about these tests, go to Understanding Lab Tests.

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Can Other Medical Conditions Have Similar Symptoms Like Hepatitis

Few viral infections also trigger similar symptoms like hepatitis. There are autoimmune conditions that may portray similar symptoms like hepatitis. In that case, the hepatitis panel test result may turn negative, which will prompt your doctor to order additional tests for you. Inherited disorders and drugs such as acetaminophen can cause hepatitis. Alcohol abuse can also result in this condition. Few viral infections such as Epstein-Barr virus and cytomegalovirus can cause hepatitis.

What Happens During A Hepatitis Panel

A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.

You may also be able to use an at-home kit to test for hepatitis. While instructions may vary between brands, your kit will include a device to prick your finger . Youll use this device to collect a drop of blood for testing. For more information on at-home testing for hepatitis, talk to your health care provider.

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Who Is Most At Risk Of Contracting Hepatitis C

You have a high risk of contracting hepatitis C if you:

• use or have used injection drugs even if it was just once or many years ago
• have received blood or blood products or an organ transplant before July 1990 in Canada
• have been in jail or
• have been injected or scratched during vaccination, surgery, blood transfusion or a religious/ceremonial ritual in regions where hepatitis C is common.

You have a high moderate risk of contracting hepatitis C if you:

• have tattoos or body piercing
• have multiple sexual partners
• have a sexually transmitted infection , including HIV or lymphogranuloma venereum
• have experienced traumatic sex or rough sex or have used sex toys or fisting that can tear body tissue
• have vaginal sex during menstruation
• have received a kidney treatment
• have received an accidental injury from a needle or syringe
• have another infectious disease
• were born to a hepatitis C infected mother or
• have a sexual partner infected with hepatitis C.

Hepatitis C is NOT passed from person to person by:

• coughing, sneezing
• breastfeeding unless your nipples are cracked and bleeding or
• oral sex, unless blood is present.

Why Early Diagnosis Is Important

Early diagnosis is important to prevent liver damage and disease. When a person is diagnosed with hepatitis C, they can access treatment, care and other supports to improve their health and prevent transmission to their contacts who may be at risk of being exposed.

Early diagnosis also has a positive effect on prevention efforts. A person who is cured of hepatitis C can no longer pass the virus to others. However, they can become reinfected if they are exposed to the virus again. Treatment can prevent transmission between individuals but it also reduces transmission at the community level. Treatment of individuals living with hepatitis C lowers the amount of virus circulating in the community, which reduces the chance of someone coming into contact with the virus. This contributes to reduced transmission in the community overall.

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Virological Tools For Diagnosis

Virological diagnosis of HCV infection is based on two categories of laboratory tests, namely serologic assays detecting specific antibody to HCV and assays that can detect, quantify, or characterize the components of HCV viral particles, such as HCV RNA and core antigen . Direct and indirect virological tests play a key role in the diagnosis of infection, therapeutic decision-making, and assessment of virological response to therapy.

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.

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Risk Of Hcv Infection In Recipients Of Blood Transfusion

Prior to 1992, blood transfusions carried a high risk of HCV infection, approximately 15-20% with each unit transfused. In 1988, 90% of cases of posttransfusion hepatitis were due to NANBH viruses which was later found out to be due to HCV. The move to all-volunteer blood donors instead of paid donors had significantly reduced the risk of posttransfusion hepatitis to 10%. Screening of blood further reduced the rate of posttransfusion hepatitis C by a factor of about 10,000 to a current rate of 1 per million transfusions. The few cases that still occur are due to newly infected people donating blood before they have developed antibodies to the virus, which can take up to 6-8 weeks.

How Is The Test Used

The various hepatitis C tests have different uses:

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