Sunday, November 27, 2022

How To Screen For Hepatitis C

Prevention Of Hcv Disease

Woman’s Doctor: Why it’s important to screen for Hepatitis C

Compared with no screening scenario, 1Yr-Risk, 1Yr-All, 5Yr-All and 10Yr-All scenarios would prevent 5500 , 8000 , 10 900 and 12 700 new HCV infections, respectively, in the next 30 years. Of these cases prevented by prison screening programs, 89%â92% of averted infections would have occurred in the general population . For all scenarios, infections averted would peak between years 2020 and 2024 and decline afterwards . Interventions in prisons would reduce the number of HCV-infected people in prisons over time, and the benefits of screening would peak around year 2035 and decline afterwards . Furthermore, compared with no screening, HCV screening in prisons could prevent 4200â11 700 liver-related deaths, 300â900 liver transplants, 3000â8600 cases of hepatocellular carcinoma and 2600â7300 cases of decompensated cirrhosis in the next 30 years. Of note, among liver-related deaths averted, 80% would have occurred in the outside community.

Projected Reduction of Hepatitis C Virus Transmission and Hepatitis C Virus -Associated Costs

Identifying Patterns Of Risky Behavior

Screening is an opportunity to draw attention to the clients behaviors that put him or her at risk for contracting :

  • Ask for the clients perception of his or her risk for having contracted : How likely do you think it is that the test will be positive?
  • Listen for and identify behaviors that put the client at risk for contracting , B, and C and HIV, especially unprotected sex and sharing injection drug paraphernalia.
  • Assess the clients alcohol consumption.

Does The Law Require Insurance Companies To Pay For The Hepatitis C Test What If The Patient Doesnt Have Insurance

No, the law does not require insurance companies to pay for the test. However, the U.S. Preventive Services Task Force issued a B grade on screening for hepatitis C among persons born between 1945 and 1965. The USPSTF recommendation signifies that hepatitis C screening among this population will be covered by most public and private insurance. This is because the Affordable Care Act requires that private insurance plans cover USPSTF A or B recommended services without cost sharing. Medicaid Managed Care plans must also cover these services. Currently, hepatitis C testing is not covered by Medicare.

If a patient accepts the offer of a test but lacks insurance or has insurance that may not pay for the test, clinicians should follow their normal protocol for any other test that might be ordered and may not be covered.

In addition, there are a number of free hepatitis C rapid testing sites throughout the state. For a complete list of those sites, go to:

  • the DOH web site at: or

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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?

How To Get Tested

Should I get tested for hepatitis C?

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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Laboratory Testing For Hepatitis C

Laboratory testing for hepatitis C

Neiva Sellan Lopes Gonçales Fernando Lopes Gonçales Junior

Hepatitis Study Group MI/FCM/UNICAMP Campinas, SP, Brazil

Serological Detection of Hepatitis C Virus

Serological diagnosis of patients infected with the hepatitis C virus can be performed using two categories of tests: indirect tests, which detect antibodies against HCV and direct tests, which detect, quantify, or characterize components of the viral particle, such as HCV RNA testing and testing for detection of the HCV core antigen.

Anti-HCV antibodies are usually detected using third- and fourth-generation immunoenzymatic assays enzyme immunoassay /enzyme-linked immunosorbent assay 3 and EIA/ELISA 4, respectively which contain HCV core antigens and HCV nonstructural genes. The specificity of the EIA tests available on the market that detect anti-HCV was determined to be higher than 99%, whereas their sensitivity, which was more difficult to determine due to the lack of gold standard tests with high sensitivity, was 95-99% . However, false-positive results for anti-HCV can occasionally occur, especially in populations with prevalence rates below 10% .

The gold standard consists of the careful use of NAT, standardized for detection of HCV RNA, together with EIAs .

In immunocompetent patients, EIAs present excellent reproducibility however, in hemodialyzed or immunocompromised patients, EIA sensitivity is significantly reduced .

Vertical Transmission

Chronic Infection

Preparing Clients For Screening

Once clients are comfortable talking about viral , they might be more willing to undergo screening. However, clients might be anxious about the test itself a reassurance that testing is a simple procedure can help allay these concerns. Many substance use treatment facilities do not offer screening, and clients might need to be referred elsewhere. The following strategies can enhance the discussion of the hepatitis screening process and hepatitis prevention:

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Under The New Law Do All Patients At

Under the new law, only those patients born between 1945 and 1965 are required to be offered a hepatitis C screening test. Although the new law requires the offer of a test only for those born between 1945 and 1965, CDC recommends hepatitis C testing be offered to all persons at risk for hepatitis C, such as injection drug users, those that received a blood transfusion or organ donation before 1992, persons living with HIV, anyone with abnormal liver tests, health and safety workers who have been exposed to blood on the job and persons on long term dialysis.

Aasld/idsa Hcv Testing Guidance

Get Screened for Hepatitis C

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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Hepatitis B Surface Antigen Test

This is a test to find out if you have a current infection. HBsAg is the earliest sign of the virus and disappears from your blood as the infection clears. A positive result indicates infection. If the antigen is not found , this shows that either you have never been exposed to hepatitis B or that you have recovered from infection and cleared the virus. The term surface refers to the outer surface of the virus itself.

Drawbacks To Screening For Hepatitis C

A patient’s worry or anxiety while waiting for test results, concerns about insurance coverage of evaluation and treatment, adverse effects of treatment, and complications associated with liver biopsy can limit screening for hepatitis C. However, the accuracy of HCV RNA testing, the availability of medication assistance programs for uninsured patients, and improved treatments with fewer side effects and shorter duration should allay some of the anxiety associated with the screening process.

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What Are Cdcs Hepatitis C Screening Recommendations

All patients 18 years and older should be screened for hepatitis C at least once in their lifetime, except in settings where the prevalence of HCV infection is < 0.1%.

Patients with recognized exposures should be tested for hepatitis C regardless of age or setting prevalence, and regular periodic testing should continue as long as risk persists.

Diagnosing Hepatitis A B & C

Basic Hepatitis C Facts (English)

At NYU Langone, hepatologists, or liver specialists, and infectious disease specialists use blood tests to diagnose hepatitis A, B, and C. These viral infections cause inflammation of the liver.

If the results of a blood test confirm a diagnosis of viral hepatitis, your doctor may recommend imaging tests or a liver biopsy to determine the extent of liver disease.

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Counseling Practices That Educate Support And Motivate Clients Undergoing Screening

Clients might need help deciding whether to get screened, understanding the test results, and determining their next steps. Even when services offered through the substance abuse treatment program are limited, discussing testing with clients presents an opportunity for counselors to motivate clients for change by confronting substance use and by making choices that improve their overall health. However, this may also be true when services are offered on-site through substance abuse treatment programs. A study at one methadone clinic that offered hepatitis screening and vaccination revealed that although the majority of clients completed screening , only 54.7 percent of clients who lacked for hepatitis A received vaccinations and only 2.9 percent of clients who lacked immunity for received vaccinations .

The Consensus Panel makes the following general recommendations while recognizing that, in some programs, the counselors role may be limited:

Key Clinical Points For Providers

Courtesy of the subject

Wilder: Are there key clinical points that you think would be important for medical providers to think about around acute hep C in taking care of their patients?

Kim: Just to expand on the shortened-course concept, there are some groups meeting about having long-acting injectable formulations of antivirals, which could get to the point where its test and treat. For instance, you can come in, you can get tested, confirm that you are acute somehow, and then receive a shorter course of therapy.

And so, the other aspect I would emphasize is that during the COVID-19 pandemic, we have seen a decrease in hepatitis C testing, which is understandable but is unfortunately interfering with our ability to diagnose patients, link them to care, and, ultimately, eliminate the virusnot only from the individuals, but also from our population.

And so, given that setback, diagnosing more hepatitis C, especially the newest caseswhere patients may be transmitting to othersis going to be key moving forward.

The other clinical pearl is that if one is already hepatitis C antibody positive but cleared the virus, either on their own or through treatment, that one has to look for it again with a different test or with the hepatitis C RNA test to look for reinfection.

Kim: Absolutely. I hope that all the participants and researchers who reoriented towards COVID-19 research can apply those lessons to not only hepatitis C, but other infections around the world.

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Why It Is Done

Hepatitis C virus testing is done to:

  • Find out if a hepatitis C infection is the cause of abnormal liver function tests.
  • Screen people who have an increased chance of getting or spreading a hepatitis C infection.
  • Screen potential blood donors and donor organs to prevent the spread of hepatitis C.
  • Screen people born from 1945 to 1975. People in this age group are more likely to have hepatitis C and not know it.
  • Identify the type of hepatitis C virus causing the infection.

Take An Active Approach To Testing

How to screen for a HCV infection early.

Testing for HCV: the diagnosis of HCV infection requires 2 tests.

  • The first test is the hepatitis C antibody test :
  • a negative anti-HCV test result indicates no HCV infection
  • a positive anti-HCV test result indicates current or resolved HCV infection, which requires further testing with a second test called the hepatitis C ribonucleic acid test
  • The second test is the hepatitis C ribonucleic acid test :
  • a negative HCV RNA result indicates no HCV infection
  • a positive HCV RNA test result indicates current HCV infection
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    Cdc Recommendations For Hepatitis C Screening Among Adults In The United States

    • Universal hepatitis C screening:
    • Hepatitis C screening at least once in a lifetime for all adults aged 18 years and older, except in settings where the prevalence of HCV infection is less than 0.1%*
    • Hepatitis C screening for all pregnant women during each pregnancy, except in settings where the prevalence of HCV infection is less than 0.1%*
  • Onetime hepatitis C testing regardless of age or setting prevalence among people with recognized conditions or exposures:
  • People with HIV
  • People who ever injected drugs and shared needles, syringes, or other drug preparation equipment, including those who injected once or a few times many years ago
  • People with selected medical conditions, including:
  • people who ever received maintenance hemodialysis
  • people with persistently abnormal ALT levels
  • Prior recipients of transfusions or organ transplants, including:
  • people who received clotting factor concentrates produced before 1987
  • people who received a transfusion of blood or blood components before July 1992
  • people who received an organ transplant before July 1992
  • people who were notified that they received blood from a donor who later tested positive for HCV infection
  • Children born to mothers with HCV infection
    • Any person who requests hepatitis C testing should receive it, regardless of disclosure of risk, because many persons may be reluctant to disclose stigmatizing risks

    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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    Hepatitis C Virus Infection In Adolescents And Adults: Screening

    Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

    Adults aged 18 to 79 years The USPSTF recommends screening for hepatitis C virus infection in adults aged 18 to 79 years. B
    • View the Clinician Summary in PDF

    What Is A Hepatitis Panel

    Testing for hepatitis C

    Table

    Positive Acute or chronic hepatitis C additional tests are required to make the determination
    Where and How the Test Is Administered

    * Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

    * Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

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    Preparing For Your Appointment

    Hepatitis B e-antigen Detects protein produced and released into the blood Often used as a marker of ability to spread the virus to other people it may also be used to monitor the effectiveness of treatment. However, there are some types of HBV that do not make e-antigen these are especially common in the Middle East and Asia. In areas where these strains of HBV are common, testing for HBeAg is not very useful to determine whether the virus can be spread to others.
    Anti-hepatitis B e antibody Detects antibody produced by the body in response to the hepatitis B “e” antigen Used to monitor acute infections in those who have recovered from acute hepatitis B infection anti-HBe will be present along with anti-HBc and anti-HBs.
    Hepatitis B viral DNA Detects hepatitis B viral genetic material in the blood A positive test indicates that the virus is multiplying in a person’s body and that person is contagious. The test is often used to monitor the effectiveness of antiviral therapy in people with chronic HBV infections.
    Hepatitis B virus resistance mutations Detects mutations in the particular virus causing a person’s infection that allows the virus to be resistant to treatments Helps to select appropriate treatment, especially in people who have been treated previously or in those who are not responding to treatment

    Getting A Hepatitis C Test From Your Doctor

    Ideally, you should talk with a doctor about hepatitis C screening. Theyll ask you about any potential exposures or risk factors and will probably order a blood test to check for HCV antibodies. You can get your blood tested anywhere that does routine blood work.

    Its the same procedure as getting a routine blood test.

    We reviewed each brands business and medical practices, checking:

    • their BBB rating, if they have one
    • whether theyve been involved in any lawsuits
    • whether they provide help interpreting your results
    • whether they make any unacceptable health claims

    All companies on the list also state they use accredited labs to process their testing kits.

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