Tests To Diagnose Hepatitis C
How is Hepatitis C diagnosed?
There are two main blood tests typically used to diagnose Hepatitis C. First, youll have a screening test that shows if youve ever had Hepatitis C at some point in your life. If this test is positive, youll have a second test to see if you have Hepatitis C now. These blood tests are described below:
Hepatitis C antibody test
This is the screening test used by doctors to show whether or not you have ever been exposed to Hepatitis C at some time in your life, by detecting antibodies in your blood. Antibodies are substances your body makes to fight off all kinds of infections. If you were ever infected with Hepatitis C, your body would have made antibodies to fight the virus.
If the test result is:
- Negative, it means you have not been exposed to Hepatitis C and further testing is usually not needed.
- Positive, you have had Hepatitis C at some point. However, it does not tell you whether you have it now. Youll need to see your doctor for another test the Hepatitis C RNA test to determine if the virus is still active and present in your blood.
Hepatitis C RNA Qualitative Test
This test will determine whether or not you are currently infected with Hepatitis C. It is often called the PCR test because of the process used . It looks for the genetic material of the Hepatitis C virus in your blood.
If the test result is:
Hepatitis C RNA Quantitative Test
What Other Tests Diagnose Hepatitis C
Once the diagnosis of hepatitis C is established, other tests may be done to determine whether the patient has developed liver fibrosis or scarring . This can be done with a needle biopsy of the liver, and examining the biopsied liver tissue under the microscope. Liver biopsy is less commonly done today because noninvasive tests are more readily available, more easily accomplished and less costly.
Liver imaging can evaluate fibrosis using ultrasound and MRI scans. Additionally, calculations using a variety of blood tests also can predict the degree of inflammation and fibrosis present. Genotype testing will typically be done to determine what subtype of hepatitis C the patient has, as this will impact what drugs are used for treatment. Testing for other infections including HIV, hepatitis A, and hepatitis B is typically done to determine if the patient might have other conditions that could impact patient’s treatment and prognosis.
With the newest forms of antiviral treatment, the most common types of chronic hepatitis C can be cured in most individuals.
What Are The Risk Factors For Hepatitis C
In the United States, having been born between 1945 and 1965, and the use of illicit injection drugs are the two most common factors associated with hepatitis C. Other risk factors include
- having received blood transfusions prior to 1990,
- hemodialysis, and
- having greater than 10-lifetime sex partners.
Population studies show that hepatitis C is more common among males, non-Hispanic blacks, those with low income, and those with less than a high school education.
People who have HIV/AIDS have an increased risk for hepatitis C, because both these diseases are transmitted in the same ways, through blood and body fluids. If someone has both infections, that person is said to be co-infected with HIV and HCV.
What Is Chronic Hepatitis C
Doctors refer to hepatitis C infections as either acute or chronic:
- An acute HCV infection is a short-term illness that clears within 6 months of when a person is exposed to the virus.
- A person who still has HCV after 6 months is said to have a chronic hepatitis C infection. This is a long-term illness, meaning the virus stays in the body and can cause lifelong illness. An estimated 3.2 million people in the U.S. have chronic HCV.
What Are The Symptoms Of Chronic Hepatitis B
About 1 in 20 people who get hepatitis B as adults become carriers, which means they have a chronic hepatitis B infection. Carriers are more likely to pass hepatitis B to other people. Most carriers are contagious meaning they can spread hepatitis B for the rest of their lives.
Hepatitis B infections that last a long time may lead to serious liver diseases like cirrhosis and liver cancer. About 1 in 5 people with chronic hepatitis B die from it. There are medicines that can help treat chronic hepatitis B infections.
Most babies who get hepatitis B develop chronic infection, unless they get treated right away. But treatments almost always work if your baby gets them quickly. Thats why its important for pregnant people to get tested for hepatitis B.
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How Is Hepatitis C Treated
Significant progress has been made in treating and even curing hepatitis C. Older hepatitis C treatments usually required weekly injections, had serious side effects, and often were not effective.
New and better oral medicines now can cure HCV for many people within 3 months. The new medicines were very expensive at first, but their prices have come down, a trend that health experts hope will continue as the incidence of HCV rises and increased screening brings more cases to light.
These medicines successfully cure about 90% of HCV patients. A new oral medicine under development looks promising for the 10% who don’t respond to the standard treatment. This new antiviral combination pill is currently under review by the U.S. Food and Drug Administration .
Cost Of Hepatitis C Medicines
The newer direct-acting antiviral medicines for hepatitis C can be costly. Most government and private health insurance prescription drug plans provide some coverage for these medicines. Talk with your doctor about your health insurance coverage for hepatitis C medicines.
Drug companies, nonprofit organizations, and some states offer programs that can help pay for hepatitis C medicines. If you need help paying for medicines, talk with your doctor. Learn more about financial help for hepatitis C medicines.
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Early Signs Of Liver Disease
Some people will develop symptoms within two weeks to six months after being infected by the hepatitis C virus. This is called an acute infection.
Exposure can take place through contact with infected blood or needles. This sometimes can happen on the job or recreationally.
In general, early signs of hepatitis C are flu-like, mild and fairly nonspecific, meaning that they can be caused by a laundry list of other illnesses and infections. They include , sore muscles, , , nausea, itchy skin, , and a yellow discoloration of the skin and whites of the eyes . For most people, acute hepatitis C infection will lead to chronic or long-term infection.
If you notice any of these symptoms and think you may have been exposed to hepatitis C, contact your doctor. A blood test can help determine if these symptoms are, in fact, a result of hepatitis C.
Stages Of Hepatitis C
The hepatitis C virus affects people in different ways and has several stages:
- Incubation period. This is the time between first exposure to the start of the disease. It can last anywhere from 14 to 80 days, but the average is 45
- Acute hepatitis C. This is a short-term illness that lasts for the first 6 months after the virus enters your body. After that, some people who have it will get rid of, or clear, the virus on their own.
- Chronic hepatitis C. For most people who get hepatitis C — up to 85% — the illness moves into a long-lasting stage . This is called a chronic hepatitis C infection and can lead to serious health problems like liver cancer or cirrhosis.
- Cirrhosis. This disease leads to inflammation that, over time, replaces your healthy liver cells with scar tissue. It usually takes about 20 to 30 years for this to happen, though it can be faster if you drink alcohol or have HIV.
- Liver cancer. Cirrhosis makes liver cancer more likely. Your doctor will make sure you get regular tests because there are usually no symptoms in the early stages.
Learn more about the stages and progression of hepatitis C.
Who Is More Likely To Get Hepatitis C
People more likely to get hepatitis C are those who
- have injected drugs
- had a blood transfusion or organ transplant before July 1992
- have hemophilia and received clotting factor before 1987
- have been on kidney dialysis
- have been in contact with blood or infected needles at work
- have had tattoos or body piercings
- have worked or lived in a prison
- were born to a mother with hepatitis C
- are infected with HIV
- have had more than one sex partner in the last 6 months or have a history of sexually transmitted disease
- are men who have or had sex with men
In the United States, injecting drugs is the most common way that people get hepatitis C.13
Treatment And Medication For Hepatitis C
If you have acute hepatitis C, there is no recommended treatment. If your hepatitis C turns into a chronic hepatitis C infection, there are several medications available.
Interferon, peginterferon, and ribavirin used to be the main treatments for hepatitis C. They can have side effects like fatigue, flu-like symptoms, anemia, skin rash, mild anxiety, depression, nausea, and diarrhea.
Now youâre more likely to get one of these medications:
Find out more on treatment options for hepatitis C.
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Causes And Risk Factors Of Hepatitis C
Hepatitis C is transmitted when the blood of an infected person enters the body of someone who isn’t infected.
Before 1992, when widespread screening of the blood supply began, people could contract the virus through blood transfusions and organ transplants.
Today, the most common ways that transmission occurs are:
- Through the sharing of needles and syringes for intravenous drug use
- Through accidental needle injuries in healthcare settings
- During birth, if the mother has hepatitis C
“Hepatitis C can be easily transmitted with any blood-to-blood contact ,” Dr. Malvestutto says. “There have been cases of transmission through sharing of razors or sharing ‘straws’ to inhale drugs nasally.”
Though less common, it’s also possible to acquire a hepatitis C infection by having unprotected sex with someone who has the virus.
Given that hepatitis C is spread through blood contact, an infected mother cannot give her baby hepatitis C through breastfeeding and you cannot contract the virus through saliva .
Some factors that increase your risk of hepatitis C:
Hepatitis C has some surprising ways of showing up. For example, your birth date alone may put you at a higher risk. Healthcare professionals and members of the military are also at greater risk.
Staying Healthy With Hepatitis
Not everyone needs treatment right away, but its important to be monitored regularly by an experienced doctor and discuss treatment options of the best way to keep you healthy.
- Get vaccinated against Hepatitis A and Hepatitis B
- Avoid alcohol and drugs
- Eat a healthy & balanced diet. Include a lot of vegetables and fruits try to stay away from too much salt, sugar and fat.
- Exercise regularly. Walking is one of the best exercises, and it helps to make you feel less tired.
- Check with a health professional before taking any prescription pills, supplements, or over-the-counter medications.
- Do not share razors, nail clippers, needles or other items that come in contact with blood with other people.
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Is Screening For Hepatitis C Recommended During Pregnancy
There is a 4%-7% risk of transmitting HCV from mother to infant with each pregnancy. Currently, there is no CDC recommendation for routine hepatitis C screening during pregnancy, and there is no currently recommended medicine to prevent transmission from mother to infant . However, CDC is monitoring research findings and may make recommendations in the future as evidence arises.
While data is still limited, a recent study of over 1,000 cases in the United Kingdom found that 11% of infants had been infected at birth, and that these infants were likely to develop cirrhosis in their early 30s. The case for screening for HCV during pregnancy includes the potential to safely treat mothers during pregnancy with direct-acting antiviral agents to treat the mother before cirrhosis develops, prevent infant transmission, and prevent transmission to others. Children born to HCV-infected mothers may also be offered treatment at an early age to prevent cirrhosis, as well as transmission to others. Coordination of care between multiple specialists will be important to accomplish these goals.
Children of HCV-infected mothers may be screened for hepatitis C as early as 1-2 months of age using hepatitis C viral load or PCR testing . Antibodies to hepatitis C passed from the mother to child will be present for up to 18 months, so children should be tested for HCV antibody no earlier than this.
Who Is At Risk For Hepatitis C
You are more likely to get hepatitis C if you
- Have injected drugs
If you have chronic hepatitis C, you probably will not have symptoms until it causes complications. This can happen decades after you were infected. For this reason, hepatitis C screening is important, even if you have no symptoms.
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When To See Your Doctor
Also make an appointment if a friend or member of your family comes down with the disease. There’s a risk you could get infected, too.
Be on the lookout for symptoms of hepatitis if you travel to a country where the disease is common. Call your doctor if you think you’re showing any signs.
Questions To Ask Your Doctor
- Do I need treatment?
- What treatment is best for me?
- What medicines should I take?
- Are there any medicines I should avoid?
- How can I cope with the side effects of treatment?
- Is there a therapist I can talk to?
- How long will my treatment last?
- Can hepatitis C be cured?
- Are organ transplants and blood transfusions safe?
- Is it safe for me to get pregnant?
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Cirrhosis Of The Liver
When permanent scar tissue replaces healthy liver cells and your liver loses the ability to function, its called cirrhosis. In this condition, your liver can no longer heal itself. This can cause a variety of health concerns, including a buildup of fluid in your abdomen and bleeding from veins in the esophagus.
When the liver fails to filter toxins, they can build up in your bloodstream and impair brain function. Cirrhosis of the liver can sometimes develop into liver cancer. This risk is greater in people who drink excess alcohol. Treatment of cirrhosis depends on the progression of the condition.
Chronic hepatitis C can cause serious long-term health consequences. End-stage hepatitis C occurs when the liver is severely damaged and can no longer function properly.
Symptoms may include:
How Can You Tell If You Have Chronic Hepatitis C
While most people dont feel unwell even with chronic hepatitis C, this isnt true for everyone. Some potential signs and symptoms of chronic hepatitis C that has led to liver damage include:
- Swelling of the legs or ankles
- Accumulating fluid in the abdomen
- The appearance of spidery blood vessels on the skin
- Drowsiness, confusion, and slurred speech
Without treatment, a hepatitis C infection can cause severe liver damage and, potentially, liver failure, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Within 20 years of becoming infected, 5 to 20 percent of people with hepatitis C develop cirrhosis of the liver, says the CDC.
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Complications Of Hepatitis C
According to the CDC, 10 to 20 percent of people with HCV develop cirrhosis irreversible scarring of the liver that prevents the organ from functioning as it should over a period of two to three decades.
People with cirrhosis have an increased risk for liver cancer.
- Buildup of fluid in the abdomen, feet, ankles, or legs
- Enlarged spleen
- Enlarged blood vessels in the esophagus and stomach, which are more susceptible to tear and cause internal bleeding
Cirrhosis can eventually lead to end-stage liver disease, or liver failure, which is accompanied by several debilitating symptoms, including a buildup of toxins in the brain that can result in cognitive decline and coma. Cirrhosis also increases the risk for liver cancer.
“Unfortunately, HCV can destroy the liver and cause a horrendous death,” says Andrea Branch, PhD, a professor of medicine and liver diseases at the Icahn School of Medicine at Mount Sinai in New York City. “To get the maximum benefit of treatment, it is important to treat HCV as soon as the infection is diagnosed.”
Who Is At High Risk And Should Be Tested For Hepatitis C Infection
The U.S. Preventive Health Services task force recommends that all adults born between 1945 and 1965 be tested once routinely for hepatitis C, regardless of whether risk factors for hepatitis C are present. One-time testing also is recommended for:
- People who currently inject drugs or snort drugs, or ever did so, even once many years previously
- People with persistently elevated alanine aminotransferase level, a liver enzyme found in blood
- People who have HIV infection
- Children born to HCV- or HIV-infected mothers
- People who were ever on long-term hemodialysis
- People who got a tattoo in an unregulated setting, such as prison or by an unlicensed person
- People who received clotting factor produced before 1987
- People who received transfusions or organ transplants before July 1992, or who were notified that they received blood from a donor who later tested positive for hepatitis C infection
- Health care, emergency medical, and public safety workers after a needlestick, eye or mouth exposure to hepatitis C-infected blood
People who may have been exposed to hepatitis C in the previous 6 months should be tested for viral RNA load rather than anti-HCV antibody, because antibody may not be present for up to 12 weeks or longer after infection, although HCV RNA may be detectable in blood as soon as 2-3 weeks after infection.
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