Get Educated!
Frequently Asked Hep-C Questions

     I strongly urge you to learn everything you can about your liver. When you visit your doctor always ask for a copy of your test results and learn to read them and what they mean. The more you know the better you will treat your body.

Q: What blood tests are available to check for hepatitis C?
Q: What are the confirmatory blood tests?
Q: What are liver enzymes and liver function tests?
Q: What does the term genotype mean?
Q: Is it necessary to do genotyping when managing a person with chronic hepatitis C?
Q: What's a liver biopsy for?
Q: What's an ultrasound for?
Q: What are the confirmatory blood tests?
Q: What are liver enzymes and liver function tests?
Q: What does the term genotype mean?
Q: Is it necessary to do genotyping when managing a person with chronic hepatitis C?
Q: How long after exposure to HCV does it take to test positive for anti-HCV?
Q: Can you have a "false-negative" anti-HCV test result?
Q: Can you have a "false-positive" anti-HCV test result?
Q: Can you have a normal liver enzyme (ALT) level and still have chronic hepatitis C?
Q: Should pregnant women be routinely tested for anti-HCV?
Q: When should babies born to mothers with hepatitis C be tested to see if they were infected at birth?
Q: Can HCV be spread by sexual activity?
Q: Can HCV be spread by oral sex?
Q: Can HCV be spread within a household?
Q: Is there any evidence that HCV has been spread during medical or dental procedures done in the United States?
Q: What is the risk that HCV-infected women will spread HCV to their newborn infants?
Q: Should a woman with hepatitis C be advised against breast-feeding?
Q: Can persons become infected with different strains of HCV?
Q: How can persons infected with HCV prevent spreading it to others?

Q: What blood tests are available to check for hepatitis C?

A: There are several blood tests that can be done to determine if you have been infected with HCV. Your doctor may order just one or a combination of these tests. The following are the types of tests your doctor may order and the purpose for each.

Anti-HCV (antibody to HCV)
EIA (enzyme immunoassay)
This test is usually done first. If positive, it should be confirmed.

RIBA (recombinant immunoblot assay) A supplemental test used to confirm a positive EIA test. Neither EIA nor RIBA can tell whether the infection is new (acute), chronic (long-term) or is no longer present (past infection).

Qualitative test to detect presence or absence of virus (HCV RNA) called "PCR". This is a very sensitive test that can measure small amounts of virus in the blood sample. The results are reported as either "positive" or "negative". A single positive qualitative PCR test indicates infection with HCV. However, a single negative test does not prove that a person is not infected. Virus may be under the detectable limi

Quantitative test to detect amount (titer) of virus (HCV RNA) Quantitative PCR measures the amount of virus in the bloodstream (viral load) and is used both before and during drug therapy to determine if the treatment is effective

Q: What are the confirmatory blood tests?

A: A positive hepatitis C antibody test indicates that you've been EXPOSED to the hepatitis C virus, but doesn't tell you whether or not you STILL HAVE the virus in your system. There are additional tests that need to be done to determine whether you have chronic hepatitis C and to what extent your liver may be damaged.

HCV-EIA/ELISA/anti-HCV. This test is used to detect the presence of hepatitis C antibodies in your blood. It doesn't tell whether you have a current / ongoing infection or not. Additional tests are indicated to CONFIRM your hepatitis C diagnosis.

RIBA. This test is used to confirm the results of the HCV-EIA, especially in people with anti-HCV+ results who are considered low-risk.

HCV RNA. PCR Qualitative: This test detects the presence or absence of hepatitis C virus in your blood. This test is most often used during initial diagnosis process to confirm a positive HCV-EIA test.

HCV RNA. PCR Quantitative: This test measures the amount of viral particles in a specific sample of your blood. The result is often called a VIRAL LOAD, and is used most often in monitoring the effects of anti-viral drug therapy. Your viral load can be read in the millions, so don't be alarmed.

 

Q: What are liver enzymes and liver function tests?

A: ALT and AST. ALT and AST are enzymes that are located in liver cells, which leak out and make their way into the general circulation when liver cells are injured. An elevation of these enzymes means that liver inflammation and cell injury is present, but is not an indicator of how well your liver is working. The ALT is a more specific indicator of liver inflammation, since the AST can be elevated in disease of other organs such as heart or muscle disease. As many as 30% of people with chronic hepatitis C have NORMAL or intermittently normal ALT's but can have slowly progressive liver damage.

GGT and ALKALINE PHOSPHATASE. GGT and Alkaline Phosphatase are elevated in a large number of disorders that affect the drainage of bile; such as a gallstone or tumor blocking the common bile duct, drug induced hepatitis, or alcoholic liver disease. Both the GGT and Alkaline Phosphatase can be elevated due to other diseases, but mild or moderate elevation of GGT with a normal Alkaline Phosphatase, is often caused by changes in the liver cell enzymes induced by alcohol or medications.

BILIRUBIN, ALBUMIN, PLATELETS, PROTHROMBIN TIME, COMPLETE BLOOD COUNT. These are your TRUE liver function tests. Changes to these tests indicate that your liver is not working properly. When these results become abnormal, it's likely that you have scarring of your liver tissue and possibly the early stages of cirrhosis.

Q: What does the term genotype mean?

A: Genotype refers to the genetic make-up of an organism or a virus. There are at least six distinct HCV genotypes identified, and > 90 subtypes. Genotype 1 is the most common genotype seen in the United States, and is generally the least responsive to drug therapy.

Q: Is it necessary to do genotyping when managing a person with chronic hepatitis C?

A: Yes, if considering interferon therapy. Studies show that people with genotype 1 benefit from 12 months of combination interferon/ribavirin treatment (instead of the FDA approved 6 months of treatment), or higher doses of consensus interferon for 12 months.

Q: What's a liver biopsy for?

A: A liver biopsy is the removal of a small piece of liver tissue for examination under a microscope. This test is the benchmark test for determining the amount of damage the hepatitis C virus caused to your liver. A liver biopsy IS an invasive procedure and carries a small risk of complications that your physician will discuss with you. The procedure itself is performed most often in an outpatient setting, usually by a radiologist using ultrasound guidance to locate the liver.

After the biopsy site is located, a shot similar to Novocain (like your dentist uses) is administered to numb the needle insertion site. A small incision is made and a special needle is quickly inserted into your liver and a sample of liver tissue is withdrawn. This tissue is sent to a laboratory to be viewed by a pathologist under a microscope. The results are "graded" based on a scale that measures both inflammation and scarring.

A liver biopsy can (although infrequently) be uncomfortable or even painful. The positive side is that it's over very quickly. If you're concerned about pain: request that you be pre-medicated for the procedure. Some practitioners insist the procedure cannot be done under medication; but our area's leading hepatologists routinely pre-medicate their biopsy patients with a mild sedative or Demerol/Versed drug combination.

After the liver biopsy is done, you'll be asked to remain in the hospital or procedure room for at least 4 - 8 hours for monitoring. It's standard procedure to be asked to lay on your right side for a few hours to put pressure on the biopsy site and prevent internal bleeding. Most people are able to return to work the next day and can fully resume all physical activities within 4 to 7 days. Once you have your biopsy results in hand - you and your doctor can make informed decisions about your health.

Q: What's an ultrasound for?

A: An ultrasound examination of the abdomen is a common diagnostic procedure that most physicians order. An abdominal ultrasound is used to detect liver tumors and/or masses, and provides information about your liver, gallbladder, and biliary architecture, as well as the pressure of blood flow through your liver.

The ultrasound exam uses sound waves (like sonar) to view your liver and surrounding organs. A clear gel is applied to your upper right abdomen and a paddle that produces sound waves is passed over the area on the outside of your skin. The procedure itself is painless and is performed on an outpatient basis. An ultrasound DOES NOT show whether there's inflammation, fibrosis (scarring), or cirrhosis (scarring with the formation of nodules) present. That's where a liver biopsy comes in.

 Q: What are the confirmatory blood tests?

A: A positive hepatitis C antibody test indicates that you've been EXPOSED to the hepatitis C virus, but doesn't tell you whether or not you STILL HAVE the virus in your system. There are additional tests that need to be done to determine whether you have chronic hepatitis C and to what extent your liver may be damaged.

HCV-EIA/ELISA/anti-HCV. This test is used to detect the presence of hepatitis C antibodies in your blood. It doesn't tell whether you have a current / ongoing infection or not. Additional tests are indicated to CONFIRM your hepatitis C diagnosis.

RIBA. This test is used to confirm the results of the HCV-EIA, especially in people with anti-HCV+ results who are considered low-risk.

HCV RNA. PCR Qualitative: This test detects the presence or absence of hepatitis C virus in your blood. This test is most often used during initial diagnosis process to confirm a positive HCV-EIA test.

HCV RNA. PCR Quantitative: This test measures the amount of viral particles in a specific sample of your blood. The result is often called a VIRAL LOAD, and is used most often in monitoring the effects of anti-viral drug therapy. Your viral load can be read in the millions, so don't be alarmed.

Q: What are liver enzymes and liver function tests?

A: ALT and AST. ALT and AST are enzymes that are located in liver cells, which leak out and make their way into the general circulation when liver cells are injured. An elevation of these enzymes means that liver inflammation and cell injury is present, but is not an indicator of how well your liver is working. The ALT is a more specific indicator of liver inflammation, since the AST can be elevated in disease of other organs such as heart or muscle disease. As many as 30% of people with chronic hepatitis C have NORMAL or intermittently normal ALT's but can have slowly progressive liver damage.

GGT and ALKALINE PHOSPHATASE. GGT and Alkaline Phosphatase are elevated in a large number of disorders that affect the drainage of bile; such as a gallstone or tumor blocking the common bile duct, drug induced hepatitis, or alcoholic liver disease. Both the GGT and Alkaline Phosphatase can be elevated due to other diseases, but mild or moderate elevation of GGT with a normal Alkaline Phosphatase, is often caused by changes in the liver cell enzymes induced by alcohol or medications.

BILIRUBIN, ALBUMIN, PLATELETS, PROTHROMBIN TIME, COMPLETE BLOOD COUNT. These are your TRUE liver function tests. Changes to these tests indicate that your liver is not working properly. When these results become abnormal, it's likely that you have scarring of your liver tissue and possibly the early stages of cirrhosis.

Q: What does the term genotype mean?

A: Genotype refers to the genetic make-up of an organism or a virus. There are at least six distinct HCV genotypes identified, and > 90 subtypes. Genotype 1 is the most common genotype seen in the United States, and is generally the least responsive to drug therapy.

Q: Is it necessary to do genotyping when managing a person with chronic hepatitis C?

A: Yes, if considering interferon therapy. Studies show that people with genotype 1 benefit from 12 months of combination interferon/ribavirin treatment (instead of the FDA approved 6 months of treatment), or higher doses of consensus interferon for 12 months.

Q: How long after exposure to HCV does it take to test positive for anti-HCV?

A: Antibodies to the hepatitis C virus can take from 12 weeks - to 6 months to develop after the initial exposure. HCV RNA can be found in the bloodstream as early as 1 - 2 weeks after initial exposure. The HCV RNA can be measured by qualitative PCR. This testing method would be recommended if the person was directly exposed (through a blood-to-blood contact) to a known HCV+ source.

Q: Can you have a "false-negative" anti-HCV test result?

A: Yes. People with early infection may not have developed antibody levels high enough for the test to measure.

In addition, some persons may lack the (immune) response necessary for the test to work well. This includes people with HIV and people who have had organ transplants (due to immune suppression drugs).In these persons, PCR testing may be considered.

Q: Can you have a "false-positive" anti-HCV test result?

A: Yes. A false-positive test means the test looks as if it is positive, but it is really negative. This happens more often among people who have a low risk for the disease for which they are being tested.

For example, false-positive anti-HCV tests happen more often among persons such as blood donors who are at low risk for hepatitis C. Therefore, it is important to confirm a positive anti-HCV test with a supplemental test in persons at low risk for exposure to the hepatitis C virus.

Q: Can you have a normal liver enzyme (e.g., ALT) level and still have chronic hepatitis C?

A: Yes. It is common for persons with chronic hepatitis C to have a liver enzyme level that goes up and down, with periodic returns to normal or near normal. Some persons have a liver enzyme level that is normal for over a year but they still have chronic liver disease. If the liver enzyme level is normal, persons should have their enzyme level re-checked several times over a 6 to 12 month period. If the liver enzyme level remains normal, your doctor may check it less frequently, such as once a year.

Q: Should pregnant women be routinely tested for anti-HCV?

A: No. Pregnant women have no greater risk of being infected with HCV then non-pregnant women. If pregnant women have risk factors for hepatitis C, they should be tested for anti-HCV.

Q: When should babies born to mothers with hepatitis C be tested to see if they were infected at birth?

A: Children should not be tested for anti-HCV before 12 months of age because anti-HCV from the mother may last until this age. If testing is desired prior to 12 months of age, PCR could be performed at or after an infant's first well-child visit at age 1-2 months

Q: Can HCV be spread by sexual activity?

A: Yes, but this does not occur very often. The risk of HCV transmission in long-term sexually monogamous partners is low but present - about 4%. HCV transmission in high-risk sex practices (unprotected sex with multiple partners, men who have sex with men, history of sexually transmitted diseases) -can elevate the risk as high as 20%.
In long-term sexually monogamous partners, the CDC does not recommend the use of barrier precautions.
Women should avoid intercourse during their menstrual cycle.

Q: Can HCV be spread by oral sex?

A: There is no evidence that HCV has been spread by oral sex.

Q: Can HCV be spread within a household?

A: Yes, but this does not occur very often. If HCV is spread within a household, it is most likely due to direct exposure to the blood of an infected household member. People with HCV should not share their personal care items, such as toothbrushes, razors, or manicure tools with others.

Q: Is there any evidence that HCV has been spread during medical or dental procedures done in the United States?

A: Medical and dental procedures done in most settings in the United States do not pose a risk for the spread of HCV. There have, however, been studies that demonstrate HCV transmission between patients in kidney dialysis units where supplies or equipment may have been shared between patients, and through contaminated endoscopy equipment. The risk of transmission of HCV during a medical or dental procedure relies directly on the infection control practices of individuals within the medical or dental facility.

Q: What is the risk that HCV-infected women will spread HCV to their newborn infants?

A: About 5 of every 100 infants born to HCV-infected women become infected. (The infection rate is higher, about 17 of 100, for infants born to HCV-infected women who are also infected with HIV.)

This occurs at the time of birth, and there is no treatment that can prevent it from happening. Most infants infected with HCV at the time of birth have no symptoms and do well during childhood.

More studies are needed to find out if these children will have problems from the infection as they grow older. There are no licensed treatments or guidelines for the treatment of infants or children infected with HCV. Children with elevated ALT (liver enzyme) levels should be referred for evaluation to a specialist familiar with the management of HCV-related disease in children.

Q: Should a woman with hepatitis C be advised against breast-feeding?

A: No. There is no evidence that breast-feeding spreads HCV. HCV-positive mothers should consider abstaining from breast-feeding if their nipples are cracked or bleeding.

Q: Can persons become infected with different strains of HCV?

A: Yes. Because of the ineffective immune response described above, prior infection does not protect against reinfection with the same or different genotypes of the virus. For the same reason, there is no effective pre- or postexposure prophylaxis (i.e., immune globulin) available.

Q: How can persons infected with HCV prevent spreading it to others?

A: Do not donate blood, body organs, other tissue, or semen. Do not share personal items that might have your blood on them, such as toothbrushes, dental appliances, nail-grooming equipment or razors. Cover your cuts and skin sores to keep from spreading HCV. Properly dispose of bloody items (such as sanitary products) and make sure bedding, towels, or clothing with blood on them are not handled by others in the household

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