Questions For Your Doctor About Test Results
Patients receiving hepatitis C testing may find it helpful to ask questions about their test results. Questions to consider include:
- What type of hepatitis C test did I receive?
- What was my test result?
- How do you interpret the results of the hepatitis C tests that I had?
- Do I need any follow-up tests based on my test result?
What The Qualitative Results Mean
The qualitative results indicate that HCV is present in your blood. The test result will be either detected or undetected.
Detected means that you do have the virus in your blood. Undetected means that you dont have the virus in your blood, or you have a tiny amount that cant be detected by this test.
The qualitative test results may still be positive even if your viral load has decreased drastically due to treatment.
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Why The Test Is Performed
Your provider may order this test if you have signs of hepatitis. It is used to:
- Detect current or previous hepatitis infection
- Determine how contagious a person with hepatitis is
- Monitor a person who is being treated for hepatitis
The test may be performed for other conditions, such as:
- Chronic persistent hepatitis
Hepatitis A Test Results
A total antibody test detects both IgM and IgG antibodies but does not distinguish between them. If the total antibody test or hepatitis A IgG result is positive and someone has never been vaccinated against HAV, then the person has had past exposure to the virus.
Hepatitis A infection is typically diagnosed through blood tests. Fortunately, blood tests are widely available to accurately diagnose hepatitis A, including tests for antibodies, or the affected persons immune response to hepatitis A proteins. The IgG antibodies are present for life, indicating immunity.
Treatment generally involves supportive care, with specific complications treated as appropriate. Liver transplantation, in selected cases, is an option if the patient has fulminant hepatic failure . Patients at risk of developing acute hepatitis A virus infection should undergo immunization for the virus.
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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.
What The Quantitative Results Mean
The quantitative test results indicate the exact amount of HCV in your blood. This number helps your doctor confirm whether you have a high or low viral load.
Measuring your viral load before treatment allows your doctor to monitor your viral load during and after treatment.
The viral load measurement doesnt indicate how severe your HCV infection or cirrhosis is. Your doctor will need to take a biopsy, or tissue sample, from your liver to learn more about how your liver has been affected by an HCV infection.
The viral load results from the quantitative PCR test can range from 15 to 100,000,000 IU/L.
If your results are:
- Fewer than 15 IU/mL: The virus is detected, but the amount cant be measured exactly. You may need to return later for another test to see if the measurement changes.
- Fewer than 800,000 IU/mL: A low viral load is detected.
- More than 800,000 IU/mL: A high viral load is detected.
- More than 100,000,000 IU/mL: The virus is detected and active infection is taking place.
- Inconclusive: HCV RNA cant be measured, and a new sample needs to be taken.
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Is It Possible To Get A False Negative
As previously discussed, the first test that is given to someone who questions their hepatitis C status is the ELISA test, which looks for antibodies in the body.
When a hepatitis C infection is brand new, the human body has not yet gathered antibodies to fight that infection. This means that, if the test is performed too early, an ELISA test will give a negative result, because there are not yet enough antibodies present – not because there is no hep C virus.
Unfortunately, many receive a negative result and choose not to get tested for a long period of time, continuing to carry the virus without realizing it.
In addition, some bodies can be so immunocompromised that their bodies may not be able to make enough antibodies to provide a positive ELISA test.
Treatment For Hcv Infection
Treatment for HCV infection is available. The role of treatment in acute infection is being evaluated and currently the existing data shows that response to 6 months of standard therapy with interferon in terms of absence of HCV RNA from serum is excellent and progression to chronicity is reduced. The recommended treatment for chronic HCV infection is a combination of a pegylated IFN alpha and ribavirin. The treatment duration depends on the genotype of the virus and it has two goals. The first is to achieve sustained eradication of HCV, that is, sustained virologic response , which is defined as the persistent absence of HCV RNA in serum for 6 months or more after completing antiviral treatment. The second goal is to prevent progression to cirrhosis, HCC, and decompensated liver disease requiring liver transplantation.
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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.
- Loss of appetite, nausea, vomiting
- Dark urine
- Yellowing of eyes and skin
An HCV RNA test is ordered when:
Other Things To Know:
- The viral load measurement does not tell us anything about the severity of a patient’s liver disease or the degree of fibrosis . For that information, the patient would need additional testing.
- It is not necessary to check the viral load repeatedly during treatment.
- If a quantitative HCV RNA result is reported as “< 15 IU/L,” this means that the quantitative test cannot measure the hepatitis C virus. It may mean that there is no detectable HCV RNA at all, but it may mean that the level of virus is just too low for the test to pick it up.
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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.
Testing Procedures And Costs
The test for HCV antibodies, as well as follow-up blood tests, can be done in most labs that perform routine blood work.
A regular blood sample will be taken and analyzed. No special steps, such as fasting, are needed on your part.
Many insurance companies cover hepatitis C testing, but check with your insurer first to be sure.
Many communities offer free or low-cost testing, too. Check with your doctors office or local hospital to find out whats available near you.
Testing for hepatitis C is simple and no more painful than any other blood test.
But if youre at risk for the disease or think you may have been exposed to the virus, getting tested and starting treatment if necessary can help prevent serious health problems for years to come.
CDC recommends that all adults ages 18 years and older should be screened for hepatitis C except in settings where the prevalence of HCV infection is less than 0.1%.
Also, all pregnant women should be screened during each pregnancy, except in setting where the prevalence of HCV infection is less than 0.1%.
Hepatitis C is often associated with sharing needles . But there are other methods of transmission.
For example, healthcare workers who are regularly exposed to other peoples blood are at higher risk for contracting the virus.
Getting a tattoo from an unlicensed tattoo artist or facility where needles may not be properly sterilized also increases the risk of transmission.
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Is It Possible To Get A False Positive
It is possible to receive a false positive result. Initially, you are likely given the ELISA test, which is looking for the antibodies that interact with the hepatitis C virus. The general belief is that this test will only be positive and the antibodies will only exist if there is a hepatitis C virus present. However, sometimes there are other reasons why the test can be positive.
Approximately 25% of people who at one point had the hepatitis C virus in their bodies will rid themselves of the virus on their own. The person might not even know that their body is doing this while the process is happening. However, if that person takes the ELISA test after this has happened, there will be antibodies present, but there will not be a hepatitis C virus anymore.
In addition, the body sometimes gets confused. As a general rule, when the body experiences an illness or foreign body , the body creates antibodies in order to fight against this foreign internal intruder. However, sometimes, the antibodies are not specific to the exact intruder. Sometimes, those non-specific antibodies can lead to an ELISA test reading that is it positive, though the antibodies that cause the positive reading are actually not battling hepatitis C, but rather another kind of illness.
What To Think About
- There is no vaccine to prevent infections with the hepatitis C virus.
- All donated blood and organs are tested for hepatitis C before being used.
- Other tests that show how well the liver is working are usually done if your doctor thinks you may have hepatitis C. These may include blood tests for bilirubin, alkaline phosphatase, alanine aminotransferase, and aspartate aminotransferase.
- Aspartate Aminotransferase
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Ashley Flanders Bcba Clinical Director
Hi there! Im Ashley Flanders, a BCBA and Clinical Director of the South Austin clinic. Im originally from Georgia, but after learning more about ABA, we moved to Texas so I could pursue a M.Ed in Special Education at University of Texas. Ive worked with both adults and children, and in many different settings. I have a passion for working with learners with limited communication, as well as those focusing on daily living skills. When Im not at the clinic, I enjoy gardening, playing video games, reading, and spending time with my husband and 2 cats.
I firmly believe that our job is to provide learners with the tools to carve their own path with, and the support they need to help them discover who they want to be. Our team creates opportunities for learning with the use of learner led therapy and their natural interests. A learners strengths are found in what makes them unique, and we foster an environment that embraces those differences while teaching them essential skills. Im very thankful for all the insight our learners have given me, and know they will continue to touch lives.
When I look at you, and you look at me, I wonder what wonderful things you will be.
When To Get Tested
For screening: at least once when you are age 18 years or older when you are pregnant when you have risk factors for HCV infection, regardless of age
For diagnosis: when you may have been exposed to the hepatitis C virus, such as through injection drug use, or when you have signs and symptoms associated with liver disease
For monitoring: before, during, and after hepatitis C treatment
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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.
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.
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Dried Blood Spot Testing
Dried Blood Spot testing uses drops of blood from the end of your finger. It doesnt use a needle and syringe and you can do it free of charge in the privacy of your home. Your details and the results are kept private. If your test result shows you have hep C, the people who give your results can help you access hep C treatment and cure.
Natural History Following Infection With Hcv
Hepatitis C can present as acute or chronic hepatitis. Most of the cases of acute hepatitis C are asymptomatic. Symptomatic acute hepatitis with jaundice is seen in 10-15% of patients only and can be severe, but fulminant liver failure is rare. Spontaneous clearance is observed in 25-50% of those with symptomatic infection and in 10-15% of those with asymptomatic infection. The natural history following exposure to HCV is summarized in .
Natural history following infection with hepatitis C virus
Chronic hepatitis C is marked by the persistence of HCV RNA in the blood for at least 6 months after the onset of acute infection. The risk of progression to chronic infection by HCV is influenced by various factors including:
Age at the time of infection
Coinfection with human immunodeficiency virus , HBV
Concomitant alcohol consumption
Comorbid conditions like cancer, immunosuppression, insulin resistance, nonalcoholic steatohepatitis, obesity, etc.
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