Hep C Basics

Editor's Note: Always consult your medical team if you have any questions regarding your treatment or possible testing.

Hepatitis C is a virus that is transmitted from one person to another through blood contact. One can possibly live with hep C for decades without symptoms, even while liver damage occurs.

The virus can also cause damage to a range of systems of the body over time.

Testing for antibodies

Antibody testing confirms exposure to the virus and is done in different settings, like a clinic, as part of your community's testing event or program. Antibody testing can confirm if you have been exposed but will not indicate that you have chronic hep C.

A second test is called an RNA test or PCR. There are other tests that are used, as well.

RNA confirmatory testing is done with a blood test to determine whether you have chronic hep C or your immune response has eliminated the virus. This is called spontaneous clearance.

As many as 25% of people who test positive for antibodies will not have chronic hep c because of spontaneous clearance.

Having positive antibodies does not mean one has hep C. Having no RNA could mean you will not need to treat now. If you are negative RNA, there might not be a reason to re-test unless you think you may have an exposure sometime in the future.

Genotype testing is still used at the time of this update, but with Pan-genotypic (all genotype) therapy now available, genotype testing is primarily done as a scientific exercise for research purposes.

There are different ways to get hep C

People who are active substance users or return to their use, and are unable to practice harm reduction, should look at testing at least once yearly. One should also use pipes for smoking that are not shared and are for personal use only due to the possible risk of transmission.

Sexual transmission might occur, and people who are active with multiple partners should consider testing. This is true for men who are, or who are not seropositive for HIV and have unprotected sex with men, and yearly testing is advised for both groups as the prevalence dictates.¹

If a person is found to have chronic hep C, treatment is indicated. A variety of treatment regimens and protocols could be suggested based on whether a person has been treated before without attaining Sustained Virologic Response (SVR/cure), stage of liver fibrosis (scarring).

Getting treatment and being cured

A person who has compensated (managed) cirrhosis and decompensated cirrhosis might be treated successfully with new DAA (Direct-Acting Antiviral) therapy. The typical duration of treatment is around 8-12 weeks.

End of Treatment (EoT) is when treatment or therapy is completed. It is normally shown on a report as undetectable HCV RNA, and this means that at week 12 after EoT, there is no detectable virus, and the person is considered cured of hep C.

Follow-up monitoring of liver health for anyone diagnosed with cirrhosis and any extrahepatic manifestations (EHM) that some people may develop as part of their hep C experience can be crucial in assuring the best health and wellness outcome.

In general, once SVR/cure is achieved, all hep C-related care reverts to the primary care physician, if there is one. This can be sub-optimal if the care provider is not well informed about the long-term effects of hep C.

Too often, the follow-up care is left up to the person themselves, and even people who are not living in chaotic environments can find it difficult to navigate the sometimes-challenging health systems when there is little understanding about hep C.

Seek out support is my best advice if you are having difficulty accessing the care you need.