Everyone Should Be Tested For Hcv
Theres no overstating the importance of HCV testing for people who dont know if they have the infection.
The U.S. Preventive Services Task Force recommends that all asymptomatic adults, regardless of risk factors and age, should be screened for HCV, says Joseph Yao, MD, a researcher for the Mayo Clinic, in Rochester, Minnesota, who focuses on the development of clinical diagnostic tests for viral hepatitis, HIV infection, and transplant-associated viruses. Those who have continued risk factors, such as engaging in intravenous drug use, need to be screened periodically. People who are on dialysis may also need to be screened.
For symptomatic individuals, if you have a history of liver disease, injection drug use, HIV, or other liver disorders, you should also be screened for HCV, he says. The symptoms of acute or chronic hepatitis C are indistinguishable from other hepatitis or liver disorders, but they usually include nausea, vomiting, weight loss, fatigue, jaundice, and general itchiness , he explains.
What Is A Hepatitis C Screening
Testing for hepatitis C involves a blood test called an HCV antibody test . This test determines if youve ever had a hepatitis C infection by checking your blood for HCV-specific antibodies.
If you test positive for HCV antibodies, youll need to undergo follow-up testing. Having antibodies doesnt mean you currently have an active infection. It may simply mean that you have had a prior exposure that your immune system cleared.
To check whether you have an active infection, a doctor will order a nucleic acid test . A positive result means the virus is currently active in your bloodstream. If you get a negative result, the virus was once in your body, but its not anymore.
- have HIV
- have ever had a needle-stick injury or potentially been exposed to HCV-positive blood
- have had a tattoo or piercing done outside of a professional sterile environment
According to the , HCV may be passed through sexual activity, though this isnt common. The agency notes that your risk may be increased if you:
- have a sexually transmitted infection
- have sex with multiple partners
- have anal sex
Is Hepatitis C Treatable
Yes, and treatment has changed remarkably in the past four years. It used to be that the treatment generally lasted about 12 months and had many side effectsalmost like some types of cancer chemotherapyand cured only about 40 percent of those treated. Todays medicines are generally taken for three months, have few side effectsalmost like taking a cholesterol pilland cure about 95 percent of those treated. It has become an exciting time in terms of hepatitis C treatment.
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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.
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.
Who Should Get Tested For Hepatitis C
The CDC recommends that you get tested at least once no matter what. Definitely get screened if any of these things apply to you:
- You were born between 1945 and 1965.
- You use or inject drugs.
- You have ever injected drugs — even if it was just once or a long time ago.
- Youâre on kidney dialysis.
- You have abnormal alanine aminotransferase levels .
- You had a blood transfusion, blood components, or an organ transplant before July 1992.
- Youâve ever gotten clotting factor concentrates made before 1987.
- You received blood from a donor who later tested positive for hepatitis C virus.
- Youâre a health care worker, first responder, or have another job that exposes you to HCV-infected needles.
- You were born to a mother with HCV.
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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.
Screening For Hcv Infection
HCV screening has several potential benefits. By detecting HCV infection early, antiviral treatment can be offered earlier in the course of the disease which is more effective than starting at a later stage. Further, early detection together with counseling and lifestyle modifications may reduce the risk of transmission of HCV infection to other people. The optimal approach to screen for HCV is to test the individuals having risk factors for exposure to the virus. The American Association for the Study of Liver Diseases recommends screening for HCV for the following individuals:
Recipient of blood or blood components .
Recipient of blood from a HCV-positive donor.
Injection drug user .
Persons with following associated conditions
persons with HIV infection,
persons who have ever been on hemodialysis, and
persons with unexplained abnormal aminotransferase levels.
Children born to HCV-infected mothers.
Healthcare workers after a needle stick injury or mucosal exposure to HCV-positive blood.
Current sexual partners of HCV-infected persons.
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What Is Hepatitis C And How Common Is It In The United States
Hepatitis refers to inflammation of the liver. There are a handful of viral hepatitis types , but hepatitis C is the cause of the majority of serious liver disease in the United States. The hepatitis C virus is spread when blood from a person infected with the virus enters the body of someone whos not infected. There is no vaccine to prevent hepatitis C, which makes early detection so important.
In the United States, its estimated that between 3 and 5 million people have chronic hepatitis C, and most of those people dont know theyre infected. The majority of people with chronic hepatitis C are from the baby boom generation.
Who Else Should Get Tested
Anyone who has hepatitis C symptoms should speak with a healthcare professional.
The HCV transmits via contact with blood, and it can pass from person to person through:
- sexual intercourse with someone who has the infection
- sharing personal items that may have come into contact with blood, such as razors
- tattooing in conditions that do not meet health and safety standards
- needle prick accidents in healthcare settings
Anyone who may have come into contact with the HCV should speak with a healthcare professional about having a test.
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Discussing Screening Results With Clients
The medical personnel who ordered or arranged the screening test, not counselors, usually explain the results. Hepatitis screening should be part of the intake physical examination in an opioid treatment program, and medical personnel may report the results. However, the client may want to discuss the results with the counselor or ask the counselor questions.
Anxiety might interfere with some clients ability to comprehend or retain information, which might need to be repeated.
Suggestions for conversations with clients when the test results are negative include the following:
- Explain results clearly and simply: So the HCV screening result was negative? This means that, as of 6 months ago, you did not have .
- Emphasize that a negative result to an HCV test does not indicate to and that the client should take precautions to avoid . If a relapse to drug use occurs, advise clients to avoid sharing any drug paraphernalia or equipment. Specify that this includes cookers, cotton, water, needles, syringes, pipes, and straws.
- Emphasize the importance of getting HAV and HBV vaccinations. Provide information about the availability of low- or no-cost vaccinations.
Clients whose screening test results are positive for will need additional tests and examinationsusually with doctors who specialize in diseases of the liver to get accurate diagnoses and to determine their health status and the extent of liver damage. These tests are described in .
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.
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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.
What Are The Pros And Cons Of At
The primary benefit to at-home tests is access. At-home tests will help identify individuals who are infected and dont know their status otherwise, says Yao, who hopes more manufacturers will develop these devices and tests.
One potential pitfall is the cost. While HCV and sexual transmitted infection tests performed in a medical facility are typically covered by insurance or made available for free at a local public health clinic, at-home HCV tests arent covered by insurance, he says.
For some, the wait time may be a deal breaker. To a lot of people, at-home tests mean you can do self-testing, like for HIV, and receive a result in 20 minutes, he says. Other potential issues include a persons ability to follow instructions and whether theyre able to do a blood prick themselves.
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Screening For Hepatitis B & C
NYU Langone doctors provide screening for hepatitis B and hepatitis C, two forms of hepatitis that can become chronic and lead to serious liver damage without treatment.
Hepatitis is characterized by inflammation of the liver. Hepatitis B is caused by the hepatitis B virus, and hepatitis C is caused by the hepatitis C virus. These diseases are contagious and can be spread from person to person through contact with bodily fluids such as blood and semen. Hepatitis B and C can also be passed from mother to child during birth.
Hepatologists, or liver specialists, and infectious disease specialists at NYU Langone recommend screening for some people who may be at increased risk of becoming infected.
Even though hepatitis B and C may cause no symptoms for years or even decades after infection, the viruses still may damage the liver. For this reason, screening is an important tool for early detection and treatment. It can prevent serious illness, such as cirrhosis and liver cancer, and hinder the spread of infection.
Vaccination for hepatitis is also an important prevention tool.
Harms Of Detection And Early Intervention
The USPSTF found limited evidence on the harms of screening for HCV. Potential harms of screening include anxiety, patient labeling, and feelings of stigmatization.
The USPSTF found adequate evidence on the harms associated with the diagnostic evaluation used to guide treatment decisions . These harms include bleeding, infection, and severe pain in approximately 1% of persons who had a liver biopsy and death in less than 0.2%. However, the use of liver biopsy to guide treatment decisions is declining, and noninvasive tests have sufficient accuracy to diagnose fibrosis and cirrhosis. Thus, the absolute risk to persons who currently receive a diagnosis of HCV infection and subsequent treatment is probably declining.
The USPSTF found adequate evidence that antiviral therapy regimens are associated with a high rate of harms, such as fatigue, headache, influenza-like symptoms, hematologic events, and rash. However, antiviral therapy is given for a defined duration, serious adverse events are uncommon, and adverse events are self-limited and typically resolve after treatment is discontinued. The USPSTF found adequate evidence that these harms of treatment are small.
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Tests After The Diagnosis
Once the doctor knows you have hep C, theyâll do tests to find out more about your condition. This will help determine your treatment. They could include:
- Genotype tests to find out which of the six kinds of hepatitis C you have.
- Liver function tests. They measure proteins and enzymes levels, which usually rise 7 to 8 weeks after youâre infected. As your liver gets damaged, enzymes leak into your bloodstream. But you can have normal enzyme levels and still have hepatitis C.
- Tests to check for liver damage. You might get:
- Elastography. Doctors use a special ultrasound machine to feel how stiff your liver is.
- Liver biopsy. The doctor inserts a needle into your liver to take a tiny piece to examine in the lab.
- Imaging tests. These use various methods to take pictures or show images of your insides. They include:
Home Screening Tests For Hepatitis C
At-home screening tests provide privacy if you prefer not to go to a doctor or clinic for testing. These tests typically look for antibodies to hepatitis C, but they may not always test for active viral infection. Make sure you know what type of test youll be taking before you buy.
Many at-home tests have close to or the same reliability as blood tests received by a medical professional.
If youve recently been exposed to hepatitis C, wait several weeks before testing at home.
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So Who Should Be Screened For Hepatitis C
Well, ideally everyone should be screened for hepatitis C. The US Preventive Services Task Force recommends that doctors should ideally screen all of their patients by checking to see if they meet the at-risk criteria. Hepatitis C should be routinely screened for in all adults at their routine medical visits, says infectious disease expert Amesh A. Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security.
That criteria, according to the CDC, includes a long list of people:
- Current or former injection drug users
- Everyone born from 1945 to 1965
- Anyone who received clotting factor concentrates made before 1987
- Recipients of blood transfusions or solid organ transplants before July 1992
- Long-term hemodialysis patients
- People with known exposures to the hepatitis C virus, like healthcare workers after needle sticks involving blood from someone infected with hepatitis C
- People with HIV
- Children born to mothers with hepatitis C
The U.S. Preventive Services Task Force also recommends screening for people in jail, those who snort drugs, and those who have received an unregulated tattoo.
Then, if someone is determined to be at risk, USPSTF recommendations say that blood sample should be taken and tested to see if it contains antibodies that react to the hepatitis C virus. Its followed by a second test that determines the level of the virus in the blood. When the tests are used together, it can accurately determine whether someone has a hepatitis C infection.
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.
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