What to Do With a Positive Hepatitis C Test

TESTING AND SCREENING

HCV antibody testing is sensitive and inexpensive. Anti-HCV screening assays include the enzyme immunoassay (EIA) or the enhanced chemiluminescence immunoassay (CIA). Positive results are reportable and should be confirmed with a repeat test. The recombinant immnunoblot assay (RIBA), a more specific serologic anti-HCV assay, is no longer used. Once the antibody test is positive, HCV-polymerase chain reaction (PCR) RNA test measures how much HCV is in the bloodstream.

The American Association for the Study of Liver Disease (AASLD) recommends that all persons be screened for behaviors that place them at risk for hepatitis C infection as part of comprehensive health screening. Universal testing is not required at this time. The groups that are most strongly recommended for testing include:


• Recent and current injection drug users (even if they have only used once)

• HIV-infected individuals

• Hemodialysis recipients

• Hemophilia patients who received clotting factor concentrates before 1987

• Patients with unexplained elevated liver abnormalities

• Recipients of organ transplant or transplantation before July 1992

• Children born to women infected with hepatitis C

• Healthcare workers who have had a needle exposure 

• Current sexual partners of individuals with hepatitis C 

• Persons who have used illicit noninjectible drugs (e.g., intranasal cocaine)

The CDC has updated its guidelines for testing individuals born between 1945 and 1965. This group accounts for 73% of HCV mortality, and 35% of undiagnosed “baby boomers” have already progressed to advanced stages of liver disease. A one-time test for HCV is recommended without prior ascertainment of risk.

In addition to the viral load measurement or the PCR RNA testing, genotyping should also be performed. Of the six genotypes, genotypes 1, 2, and 3 are the most common in the United States.

CONSEQUENCES OF HEPATITIS C

Some of the consequences of chronic hepatitis C include hepatic fibrosis, cirrhosis, hepatocellular carcinoma, end-stage liver disease requiring transplantation, and various extra-hepatic manifestations.


Hepatitis C causes inflammation of the tissue, resulting in fibrosis, which leads to scarring. This affects liver function, which further progresses the scarring to cirrhosis, eventually leading to liver failure and ultimately transplant. About 30% of those with hepatitis C will experience liver scarring leading to potential cirrhosis. Hepatocellular carcinoma occurs in about 3% of the population infected with hepatitis C. This incidence has increased over the past two decades and is identified through imaging studies or jaundice and in elevated alpha-fetoprotein levels in the blood. Surgical resection or ablative procedures increase the chance for cure.

This article originally appeared on Clinical Advisor