Ask a Pharmacist: Common Questions about Hepatitis C - Part 1

Some pharmacists specialize in hepatitis C treatment and have ample experience in medication side effects and management. Having a pharmacist like this as part of your health care team can be beneficial as pharmacists are so accessible. For example, you are often not able to speak to your physician in the evenings on short notice; On the other hand, you can speak directly to a pharmacist well into the evenings. In our Ask the Pharmacist Series, a pharmacist (me!) will answer some common questions posed by our community.

What does 'hep C non-reactive' mean on test results?

Answer: Results of a hep C antibody test can be either reactive or non-reactive. For most people, a non-reactive test indicates that you are not infected with the hepatitis C virus. Usually this means that you haven't been exposed to the virus, and therefore hep C can be ruled out as a diagnoses.

However, in a minority of cases, a non-reactive test does not rule out a hepatitis C diagnosis. This may be the case for people who are:

• Immunocompromised, for example in people with HIV AIDS, cancer, or autoimmune conditions like lupus. These groups of people have low immune defenses and are susceptible to getting infections
• Undergoing hemodialysis, also known as an artificial kidney
• Infected with HIV
• Exposed to the hepatitis C virus within the past 6 months
  • For people who think they may have been infected with the virus within the past 6 months (for example, they came in contact with contaminated blood), they would need another test

For people who are immunocompromised, undergoing hemodialysis, or have HIV, a viral load test will also be used to confirm the diagnosis, because the antibody test is not reliable on its own in this population.

Can I take treatment for hep C during pregnancy?

Answer: No, hep C is not treated during pregnancy because the medications have not been studied in pregnant women. This means we do not have enough information on the safety and success of these drugs, and the risks associated with use may outweigh the benefits of treating hep C.  Generally, a doctor would advise that women delay treatment until after pregnancy.

In women who are trying to conceive, the general recommendation is to treat hep C prior to getting pregnant. This is to reduce the risk of  hep C transmission to the baby during delivery. It is important to note that not all babies will also be infected with hep C. The risk of transmission to a baby is 5% in women infected with hep C, and 10% in women who have both hep C and HIV infections.¹ For women who have only hep C, that means for every 20 women who give birth, only 1 of them will pass the infection to their baby.

My HCV antibody test shows positive but my HCV PCR RNA test shows not detected - what does this mean?

Answer: This indicates that there is no current infection. This is observed in people who are able to clear the virus naturally, without treatment. In people who have been treated with Hep C medications, this indicates a good response to treatment. It is something to celebrate! If the HCV RNA test continues to show undetectable for 12 weeks after treatment, that means a sustained virologic response (SVR), or a cure, has been achieved.

Read Part 2 here.