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What Lab Test For Hepatitis C

Hepatitis C: Diagnosis And Treatment

UNM Mobile lab brings hepatitis C testing to South Valley

THAD WILKINS, MD JENNIFER K. MALCOLM, DO DIMPLE RAINA, MD and ROBERT R. SCHADE, MD, Medical College of Georgia, Augusta, Georgia.

Am Fam Physician. 2010 Jun 1 81:1351-1357.

An estimated 170 million persons, or 3 percent of the worlds population, are chronically infected with the hepatitis C virus .1 In the United States, the prevalence of hepatitis C antibody is 2 percent in adults 20 years and older, but the prevalence is higher in groups at increased risk .2,3 HCV, a single-stranded RNA virus, is transmitted through percutaneous exposure to infected blood.4 HCV is categorized into nine genetically distinct genotypes.5 In the United States, 72 percent of patients with HCV infection have genotype 1 16 to 19 percent have genotype 2 8 to 10 percent have genotype 3 and 1 to 2 percent have other genotypes.6 This article focuses on chronic HCV infection in adults and excludes special groups, such as children, pregnant women, transplant recipients, and persons coinfected with hepatitis B virus or human immunodeficiency virus .

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Persons who are not at increased risk should not be screened for HCV infection.

HCV = hepatitis C virus.

*Recommendation for treatment is C because the outcome is a surrogate marker rather than mortality.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Persons who are not at increased risk should not be screened for HCV infection.

HCV = hepatitis C virus.

Is It Possible To Prevent Hepatitis

Hepatitis prevention is very much a possibility with the right strategies. A vaccine is available for hepatitis A. Healthcare providers recommend this vaccine for all people who are at high risk of exposure to the virus. Children- one year and above, should take this vaccine. Prevention of hepatitis A is possible with good hygiene and sanitation. Washing hands especially after using the toilet and before consumption of food can help with cutting hepatitis A transmission. Hepatitis B vaccine has become the norm in developed nations and most new-borns are given these shots. The hepatitis B shots are recommended for children and adolescents as well as adults in high-risk groups. Hepatitis C vaccine is not developed yet, and efforts are in the process to have a vaccine for this infection. Prevention of hepatitis C is possible by avoiding contact or exposure to blood and bodily fluids. Further, avoiding the sharing of needles or other instruments to inject drugs can cut the rate of transmission of this disease.

Are Test Results Accurate

Although no test is perfect, hepatitis C testing is an important and accepted method of testing for HCV. In order to reduce the risk of inaccurate results, doctors take steps to verify a patients diagnosis. For example, a positive test result for hepatitis C antibody requires confirmation with HCV RNA testing.

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Preparation Prior To Transport

Label the specimen container with the patients full name, date of collection and one other unique identifier such as the patients date of birth or Health Card Number. Failure to provide this information may result in rejection or testing delay.

Centrifuge if using SST. Place specimen in biohazard bag and seal. Specimens should be stored at 2-8°C following collection.

Specimens more than 7 days post collection will not be tested.

Questions For Your Doctor About Test Results

Do I Need to be Tested for Hepatitis C? Understanding Risk ...

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?

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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

Positive Hcv Antibody And Negative Hcv Rna

Individuals with a positive HCV antibody test and a negative HCV RNA should be informed they do not have evidence of current hepatitis C infection. It should be explained to the patient that most likely they were infected at some time with HCV, but cleared the infection on their own and they do not have current infection. They do not need further follow-up HCV testing, unless they had recent exposure to HCV. A single negative HCV RNA value does not prove that a patient is not infected, given the potential fluctuations of the viral level early in HCV infection a follow-up HCV RNA level would be indicated depending on the clinical case. Patients should be reevaluated if they have exposure to HCV in the future. In addition, they should receive counseling that prior infection does not make them immune to reinfection with HCV.

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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.

Dried Blood Spot Testing

Hepatitis C: CDC Viral Hepatitis Serology Training

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.

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Besides Hcv Testing What Other Tests Might Be Done

Healthcare practitioners may also order a liver panel, which is a group of tests that help assess the health of your liver. Liver tests such as ALT and AST may be used to detect ongoing liver injury. You will likely be checked to see if you are immune to hepatitis A and hepatitis B, and if not, you will be offered vaccination, since infection with these other viruses can further damage your liver. Other tests such as albumin, prothrombin time, and bilirubin can also be used. They are typically normal unless you have developed cirrhosis. Sometimes a liver biopsy may be performed to determine the severity of liver damage. If you are going to be treated, you will be checked for exposure or infection with hepatitis B virus, as HCV treatment can cause a flare-up of hepatitis B.

Interpreting Hcv Rna Test Results

It is essential that the provider understands how to interpret HCV RNA test results, especially during the course of HCV treatment.

Result of HCV RNA TestInterpretation
A quantified viral load — any exact numberOngoing HCV infection
“Detected”The HCV RNA is detectable but the number of international units is so low that it cannot be quantified accurately. This indicates extremely low level of virus is present.
“< 12 IU/mL” or “< 15 IU/mL” or “< 25 IU/mL” All of these are “less than the LLOQ”HCV RNA is undetectable. No virus is detected at all in the patient’s serum specimen.

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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.

Do I Need A Hepatitis Panel

Lab Tests to Diagnose and Monitor Hepatitis C and Liver ...

Few reasons that have prompted your healthcare provider to order the hepatitis panel for you are: You have exhibited some acute symptoms of hepatitis and the type of virus A, B, or C is not known. You carry an elevated risk of hepatitis infection due to recent exposure and a hepatitis panel may be recommended to determine the type of virus behind the hepatitis infection. Your doctor may ask you to undergo the test even in the absence of symptoms. If you show signs of liver damage, then the hepatitis panel test is a must for you. Some of the overriding symptoms that prompt a hepatitis panel test are: Loss of appetite Illegal drugs

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Hepatitis C Is Often Asymptomatic

Offer testing to anyone with a risk factor or clinical indication.

Risk factors:

  • shared drug-use equipment, even once
  • received personal services , with nonsterile equipment
  • exposed to blood during sexual activity
  • received blood, blood products, or organ transplant before 1992
  • received medical care where non-sterile equipment may have been used
  • born, travelled, or lived in a region where hepatitis C is common
  • born to a mother with hepatitis C
  • diagnosis of HIV or hepatitis B
  • clinical clues or symptoms of liver disease
  • occupational exposure

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.

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Adverse Effects Of Treatment

Adherence to treatment remains a major factor influencing the rates of sustained virologic response.33,42 Discontinuation of therapy because of adverse events is common and has been reported in up to one third of patients. Approximately 50 to 60 percent of patients may exhibit self-limited influenza-like symptoms with interferon-based therapy.2 Effective management of treatment-related adverse events is essential to improve adherence to treatment therefore, patients should be monitored closely for hematologic, renal, and thyroid abnormalities. Approximately 30 percent of patients undergoing treatment for HCV infection experience depression, emotional lability, or anger, but treatment is rarely associated with suicidal ideation or hallucinations.43 Treatment for HCV infection is contraindicated in persons with uncontrolled major depression.32 A recent randomized trial found that the overall adverse effects of pegylated interferon alfa-2b plus ribavirin and pegylated interferon alfa-2a plus ribavirin were similar.40 Adverse effects of pegylated interferon and ribavirin for the treatment of HCV infection are listed in Table 8.32

Adverse Effects of Pegylated Interferon and Ribavirin for the Treatment of Hepatitis C Virus Infection

Information from reference 32.

Adverse Effects of Pegylated Interferon and Ribavirin for the Treatment of Hepatitis C Virus Infection

Information from reference 32.

Hepatitis C Is Curable

Hepatitis A: CDC Viral Hepatitis Serology Training

Link to care: interferon-free direct acting antiviral treatments have a sustained virologic response > 90%.

  • treatment regimens range from 8 to 24 weeks and have few side effects
  • consult a health professional experienced in the management of viral hepatitis

For more information, please visit Canada.ca and search ‘hepatitis C for health professionals’.

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Once I Have Been Treated And/or Recovered From Hepatitis C Can I Get Infected Again

Yes. A prior infection with HCV does not protect you from another infectionit does not make you immune to HCV. Most people do not have an effective immune response to the virus. Changes that the virus undergoes as it replicates during an infection make it difficult for the body to fight against the initial or subsequent infections.

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.

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Educating Clients About Viral Hepatitis

Clients may believe they know about viral , but their understanding of the disease may not be accurate. It is easy to confuse the three main types of viral , B, and C. Clients may have formed impressions based on limited or incorrect information. Counselors should briefly describe hepatitis A, B, and C, including their prevalence, , and relationship to drug use, as well as to other infections, such as HIV and sexually transmitted diseases. Specific strategies for speaking with clients include:

  • Speak clearly and keep the message simple, focused, and brief.
  • Use language, examples, and concepts that the client understands.
  • Use appropriate visual aids.
  • Frame numerical statements in terms that are easy to visualize. Say 5 out of 100 people rather than 5 percent of the population say more than half instead of the majority.
  • Repeat the information at different times in different ways. The average client retains only approximately one-third of what he or she is told. Summarize essential points.
  • Pay attention to a clients response to the information. For example, if a client stiffens his or her posture, consider saying, I notice that this topic seems to make you uncomfortable. It does for a lot of people. Please tell me what youre feeling right now. Id really like to help you with this.
  • Use the opportunity to describe the potential detrimental effects of alcohol and other substance use on the liver of a person who is infected with HCV.

Testing For Hepatitis C

Lab Tests to Monitor Hep C: Test Types &  What They Measure

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

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Gap In Linkage To Care

Unfortunately, many individuals diagnosed with HCV infection do not get linked to appropriate care for their HCV infection. Multiple reasons for the gap in linkage to care have been cited, including failure of the medical provider to make the referral, lack of medical insurance, and substance use or mental health disorders that interfere with making or keeping the referral appointment. Linkage to care rates have been lower among racial and ethnic minorities. Failure to link to care negatively impacts health outcomes in persons living with HCV infection. With highly effective HCV treatment now available for all HCV genotypes, referral for evaluation and management of HCV has taken on even greater importance.

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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