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To screen for and diagnose a hepatitis C virus (HCV) infection; to guide and monitor treatment of the infection
For screening: at least once when you are age 18 years or older; when you are pregnant (with each pregnancy); 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
A blood sample drawn from a vein
Hepatitis C (HCV) is a virus that causes an infection of the liver that is marked by liver inflammation and damage. Hepatitis C tests are a group of tests that are performed to diagnose hepatitis C infection and to guide and monitor treatment of the infection.
Hepatitis C tests include:
Hepatitis C is one of five viruses identified so far, including A, B, D, and E, that are known to cause hepatitis.
HCV is spread when contaminated blood enters the body, primarily though sharing needles and syringes during IV drug use. HCV is spread less commonly by sharing personal items contaminated with blood (e.g., razors, toothbrushes), through sex with an infected person, needlestick injuries to healthcare workers, unregulated tattooing, and from mother to baby during pregnancy and childbirth. Before tests for HCV became available in the 1990s, HCV was often transmitted by blood transfusions. Currently, there is no vaccine to prevent hepatitis C.
The Centers for Disease Control and Prevention (CDC) estimates that there were approximately 44,700 cases of acute hepatitis C in the U.S. in 2017 and that there are 2.4 million people in the U.S. living with chronic hepatitis C. Many of these people don't know they are infected. The only way to know is to get tested for hepatitis C.
If you are diagnosed with hepatitis C, your healthcare practitioner may recommend an antiviral treatment to cure your infection or refer you to a healthcare practitioner who specializes in treating liver diseases or infectious diseases. The HCV RNA test may be repeated prior to starting treatment to determine whether the virus is still present and your infection persists, and also to provide a baseline to compare to during treatment.
There are several antiviral treatments available to treat hepatitis C. While some treat specific types (genotypes) of the virus, there are some that treat all genotypes. Treatment typically involves taking medication by mouth (oral) for about 8 to 12 weeks, although it can be longer in some cases. These medications can cure over 90% of people with chronic hepatitis C with relatively few side effects. Your infection is considered cured if you have no detectable HCV in your blood 12 weeks after completing treatment.
The various hepatitis C tests have different uses:
The HCV antibody test may be performed as part of an acute viral hepatitis panel to determine which of the most common hepatitis viruses is causing your symptoms.
The CDC, the Infectious Diseases Society of America (IDSA), the American Association of the Study of Liver Diseases (AASLD), and the U.S. Preventive Services Task Force (USPSTF) recommend screening with an HCV antibody test at least once in your lifetime when you are 18 years old or older (until age 79, says the USPSTF). The CDC also recommends HCV screening for women with each pregnancy or for anyone who requests it.
One-time screening is recommended regardless of age if you:
*The blood supply has been monitored in the U.S. since 1992, and any units of blood that test positive for HCV are rejected for use in another person. The current risk of HCV infection from transfused blood is about one case per two million transfused units.
Screening at regular intervals is recommended if you have ongoing risk of HCV infection, such as current injection drug use and sharing needles or syringes.
HCV antibody testing may be done when you have abnormal results on a liver panel or signs and symptoms associated with hepatitis and/or liver damage. In these cases, it may be done as part of an acute hepatitis panel. Most people newly infected with HCV have no symptoms or symptoms that are so mild that they rarely prompt a visit to a healthcare provider to get tested for HCV. However, about 10-20% of people may experience signs and symptoms such as:
An HCV RNA test (viral load) is ordered when:
HCV genotype testing is done when you have been diagnosed with a chronic HCV infection and will begin treatment.
Screening and diagnosis
An HCV antibody test is typically reported as "positive" or "negative."
Results of HCV viral load testing are reported as a number of virus copies present. If no virus is present or if the amount of virus is too low to detect, the result is often reported as "negative" or "not detected."
Interpretation of the HCV screening and follow-up tests is shown in the table below.
|HCV Antibody||HCV RNA||Interpretation|
|Negative||No infection or it is too soon after exposure and HCV antibody has not yet developed; if suspicion remains high, an HCV RNA test is done.|
|Negative||Positive||Early, acute HCV infection|
|Positive or weakly positive||Negative||Past infection or no infection (false-positive screen, most are weakly positive)|
|Positive||Positive||Current, active infection|
Guiding and monitoring treatment
The result of your HCV genotype test identifies which strain of HCV you have and helps guide the selection and the length of your treatment. Treatments may differ depending on a variety of factors, including HCV genotype and the health of your liver.
An HCV viral load (HCV RNA quantitative) can indicate whether or not treatment is effective.
Successful treatment usually leads to undetectable viral load after treatment is completed. According to guidelines from the AASLD and the IDSA, an undetectable viral load in your blood 12 weeks after the end of the treatment means that your HCV infection has responded to therapy.
Hepatitis C often leads to chronic hepatitis, which can progress to cirrhosis and liver cancer (hepatocellular carcinoma). Early detection of the virus can alert your healthcare provider to follow your liver function more closely than usual and to treat you if you are chronically infected.
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.
No. Currently, there is no vaccine available. Although research is ongoing to develop one, most attempts to develop a vaccine have so far been unsuccessful in protecting people.
Yes. A prior infection with HCV does not protect you from another infection—it 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.
There are several drugs that can be used to treat HCV infection. Most commonly, a combination of drugs is used, and new drugs are under development. Before 2000, chronic HCV was curable in only 10% of cases. Now, treatments for HCV can cure over 90% of people with hepatitis C before late complications occur, but even those with advanced liver disease often respond to treatment. This increases the opportunity to intervene early and prevent HCV-associated deaths.
There is an FDA-approved test kit available for collecting samples to send to a laboratory for testing. Confidential test results are provided over the telephone. You cannot actually perform the test yourself at home.
Maybe. There are rapid HCV antibody tests available that can be done at the point of care (POC), in settings such as your healthcare practitioner’s office, community health clinics, and emergency rooms. They provide results in about 20 minutes. However, a positive result requires confirmation of active disease with an HCV RNA test, which is performed in a laboratory.
If you have detectable HCV RNA in your blood, you have the potential to spread the disease to other people. Hepatitis C is spread by exposure to contaminated blood. The most common mechanism of exposure is the sharing of needles or other 'works' used in consuming drugs such as cocaine or heroin. Other routes of transmission include use of contaminated equipment for body piercing and tattooing, occupational exposure of healthcare workers to used needles or other sharp objects, and, less commonly, through sexual activity that results in tissue tears or from mother to baby during childbirth.
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