Testing For Hcv Infection
The recommendations for testing are derived from published evidence and expert opinions.22,23 There are many options for HCV testing and, as newer diagnostic technologies are introduced, HCV testing should become more streamlined. Also, some providers will have limited choices for testing because of laboratory testing protocols and reimbursement issues. Providers are advised to consult with their laboratories for information regarding available tests and testing protocols.
All patients suspected of having infection with HCV should be tested for antibody to HCV using an EIA screening test. In low-risk patients with a positive EIA test, confirmatory testing with the recombinant immunoblot assay should be performed. For patients at low risk with a positive EIA and RIBA, confirmatory testing with a qualitative PCR test for detection of HCV RNA should be performed.
For patients at moderate or high risk and/ or unexplained elevated serum alanine aminotransferase value, a positive EIA should be followed by a qualitative test for HCV RNA in the blood.
For immunocompromised patients at high risk with unexplained elevated ALT value and a negative screening EIA, a qualitative test for detection of HCV RNA should be performed to diagnose HCV infection.
Can You Test Negative For Hepatitis C And Still Have It
While simple blood tests are used to test for hepatitis C, there can still be discrepancies in a patient’s blood test results. Usually, these discrepancies arise from testing at the wrong time or due to other factors.
It is a major possibility to test negative for hepatitis C and still have it. If you test negative but still have the infection, the test result is described as false-negative. Discrepancies in blood testing results for hepatitis C usually take on the form of false-negative and false-positive results. False-negative and false-positive results can arise in all kinds of blood tests used to diagnose hepatitis C, including the anti-HCV antibody test and the HCV RNA test.
While getting false results on a blood test is worrisome, healthcare professionals often have an algorithm to eliminate the chances of getting a false result. These algorithms are designed to provide the most accurate results through the implication of a multi-tiered testing system.
AMBIGUOUS HEPATITIS C TEST RESULTS
As mentioned before, the tests routinely employed to detect hepatitis C are fairly simple. These tests are usually effective and accurately assess a person’s HCV status. However, these tests can return a false assessment of a person’s disease status and mislead the medical proceedings under certain circumstances.
ANTI-HCV ANTIBODY TEST
HCV RNA test
While false and ambiguous results are possible with the HCV RNA test, they are far more unlikely than in the anti-HCV antibody test.
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.
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Questions To Ask Your Healthcare Provider
- What treatment is best for me?
- Do I need treatment?
- 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?
When Should I Test For Hep C
Many people dont feel sick when they first get hep C. If you are exposed to hep C, your body will try and fight the virus for 6 months. 1 in 4 people will clear hep C in those first 6 months.
People who dont clear their hep C will have whats called chronic hep C. You can get tested for hep C straight after you think you have been exposed, but you will need to go back for another test after 12 weeks and possibly again at 6 months.
You might be able to access testing and healthcare via your computer or phone.
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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.
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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What Are The Treatments For Viral Hepatitis
The treatment for viral hepatitis depends on the type and stage of the infection. Over the last several years, excellent treatments for both hepatitis B and C have become available. More and improved treatments are being evaluated all the time.
Your primary care doctor should be able to provide adequate care of your hepatitis. However, if you have severe hepatitis, you may require treatment by a hepatologist or gastroenterologist — specialists in diseases of the liver. Hospitalization is normally unnecessary unless you cannot eat or drink or are vomiting.
Hepatitis A usually requires minimal treatment and your liver usually heals within 2 months. Make sure you stay hydrated and well-nourished. While a vaccination can prevent you from getting hepatitis A, once you have had it, you cannot be re-infected.
Doctors sometimes recommend drug therapy for people with hepatitis B and C. Antiviral medication for hepatitis B includes adefovir , entecavir , interferon, lamivudine , peginterferon , telbivudine , and tenofovir.
Until recently, the standard treatment for chronic hepatitis C was a course of peginterferon plus ribavirin for people with genotype 2 and 3, and peginterferon plus ribavirin plus a protease inhibitor for people with genotype 1. These treatments had been shown to be effective in from 50% to 80% of those infected with hepatitis C but the side effects were very difficult for people to tolerate.
Hepatitis in Pregnant Women
Other Points to Consider
How Common Is Hepatitis C In The United States
In the United States, hepatitis C is the most common chronic viral infection found in blood and spread through contact with blood.14
Researchers estimate that about 2.7 million to 3.9 million people in the United States have chronic hepatitis C.13 Many people who have hepatitis C dont have symptoms and dont know they have this infection.
Since 2006, the number of new hepatitis C infections has been rising, especially among people younger than age 30 who inject heroin or misuse prescription opioids and inject them.15,16
New screening efforts and more effective hepatitis C treatments are helping doctors identify and cure more people with the disease. With more screening and treatment, hepatitis C may become less common in the future. Researchers estimate that hepatitis C could be a rare disease in the United States by 2036.17
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Meaning Of Hcv Viral Load
The number of HCV RNA international units per milliliter of blood must be measured before treatment and during the course of treatment, to assess response. Before treatment, however, the HCV viral load is not related to the patient’s liver disease severity or HCV prognosis. This is important for patients and providers to understand.
Note: In hepatitis B, unlike hepatitis C, a higher HBV DNA viral load does correlate with increased disease severity and increased likelihood of outcomes such as hepatocellular carcinoma.
Testing For Acute Hepatitis C
Between 1-8 weeks after transmission of hepatitis C, HCV RNA becomes detectable by PCR testing. Although most patients will have some liver function test abnormalities from 6-12 weeks after transmission, only about a quarter will have the syndrome of malaise, abdominal pain, and jaundice that characterizes acute hepatitis C disease. By 12 weeks after development of hepatitis C viremia, up to 25% of patients will spontaneously and permanently clear the virus.40 Spontaneous clearance appears to be much more common in those with the syndrome of acute hepatitis C than in those with asymptomatic viremia.41 Development of hepatitis C antibodies occurs as early as 8-10 weeks after transmission.42 Some immunosuppressed individuals may not develop hepatitis C antibodies despite the presence of viremia.43
|COBAS Amplicor HCV test 2.0||PCR Roche|
|qPCR Abbott||25 – 5 x 108|
|*Results may vary at the lower limit of detection depending on the laboratory performing the testÂ§Research Use Only – Not approved for patient usebDNA: branched chain DNAqPCR: quantitative polymerase chain reactionTMA: transcription mediated assayThe use of proprietary names does not constitute endorsement by the NYS DOH.|
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What To Do If The Hcv Antibody Test Is Reactive
If the antibody test is reactive or positive, you need an additional test to see if you currently have hepatitis C. This test is called a nucleic acid test for HCV RNA. Another name used for this test is a PCR test.
If the NAT for HCV RNA is:
- Negative you were infected with hepatitis C virus, but the virus is no longer in your body because you were cured or cleared the virus naturally.
- Positive you now have the virus in your blood.
If you have a reactive antibody test and a positive NAT for HCV RNA, you will need to talk to a doctor about treatment. Treatments are available that can cure most people with hepatitis C in 8 to 12 weeks.
Hepatitis C Virus Rna Test
If a blood test finds hepatitis antibodies, meaning youve been infected with the virus at some point, your doctor will order a blood test to see if HCV is still present in your blood. This is called an RNA test and it can measure how much of the virus is in your blood. This test can confirm hepatitis C as early as two to three weeks after exposure.
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Noninvasive Testing To Assess Liver Fibrosis
The use of non-invasive tests to assess liver fibrosis is not yet recommended.
Various non-invasive tests are being investigated for staging degree of liver fibrosis. These tests may be used in decisions regarding whether or not to initiate antiviral therapy and to monitor the effects of such therapy. 44 An array of such tests would be highly desirable if adequately validated, since liver biopsy may not be readily available in view of the large number of affected patients with hepatitis C, the risks involved in performing liver biopsies, and the problem of sampling error on biopsy that can underestimate cirrhosis in 10-30% of cases.
Standard liver biochemical tests, measures of liver function such as coagulation studies, and radiological imaging of the liver may be sufficiently sensitive to diagnose advanced cirrhosis but have not been accurate in defining evolving hepatic fibrosis and early stages of cirrhosis.44 A number of studies have been published employing a variety of indirect markers of liver fibrosis including standard liver chemistries, platelet count, prothrombin index, and lipoprotein A1 concentrations. These tests have gained acceptance in Europe as alternatives to liver biopsy.45, 46 However, the utility of these tests requires further validation in prospective studies.
How Do Doctors Treat The Complications Of Hepatitis C
If hepatitis C leads to cirrhosis, you should see a doctor who specializes in liver diseases. Doctors can treat the health problems related to cirrhosis with medicines, surgery, and other medical procedures. If you have cirrhosis, you have an increased chance of liver cancer. Your doctor may order an ultrasound test to check for liver cancer.
If hepatitis C leads to liver failure or liver cancer, you may need a liver transplant.
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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
Taking A Hepatitis C Test
Hepatitis C testing is conducted on a sample of blood. Blood samples can be collected by a doctor, nurse, technician, or other health care provider from an adult patients vein using a small needle or a skin prick on a childs heel.
For an at-home hepatitis C test, patients collect a blood sample according to the manufacturers directions. Instructions provided in the test kit detail the steps to obtain a small sample of blood and mail it for testing.
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What Is An Hcv Antibody Test
An HCV antibody test is used to determine whether youve contracted the hepatitis C virus.
The test looks for antibodies, which are proteins made by the immune system that are released into the bloodstream when the body detects a foreign substance, such as a virus.
HCV antibodies indicate exposure to the virus at some point in the past. It can take anywhere from a few days to a few weeks to get results back.
. The blood panel will either show that you have a nonreactive result or a reactive result.
Treatments Can Suppress Or Even Wipe Out The Virus
Hepatitis C is treated with a combination of medications called antivirals. For many people, they get rid of the virus completely. They do have serious side effects and they donât work for everyone. New drugs recently approved by the FDA are more effective and have fewer side effects. But some are expensive.
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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.
You Can Protect Your Family And Friends
You can pass the hepatitis C virus to others through your blood, even if you don’t have any symptoms. To prevent this, cover wounds carefully and avoid sharing:
- Razors, nail clippers, toothbrushes, or diabetes supplies
- Needles for injecting drugs, or steroids
- Tools for body piercings or tattoos
Hepatitis C doesn’t spread through kissing, coughing, sneezing, or sharing eating utensils. Although it’s uncommon, you can get it from unprotected sex.
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Testing For Chronic Hcv Infection
The initial screening test to be used in all circumstances is a test for antibody to hepatitis C viral proteins . These tests become positive as early as 8-10 weeks after infection, will be positive in 97% of patients by 6 months after infection, and probably will persist for life. Presence of anti-HCV does not define activity of infection. Up to 25% of patients will resolve infection spontaneously, but will still have detectable anti-HCV. Antibody tests currently recommended for anti-HCV screening include the EIA test and the more specific RIBA the latter being used to confirm a positive EIA test in some situations . These antibody tests are highly reliable for determining HCV infection at some time in the past.
Detection of HCV RNA in blood is the currently accepted “gold standard” for diagnosis of active HCV infection. Tests for HCV RNA are both qualitative and quantitative, vary in technical aspects, and report values differently.
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.
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