Should I Be Tested for Hepatitis C?
For most people (people not in the risk categories listed below), the chance of contracting hep C is very low. Those in these categories have increased risk, and testing is therefore more critical. That said, the Centers for Disease Control and Prevention (CDC) recommends that most people be tested at least once in their lifetime.
Why get tested?
Assuming one is psychologically and emotionally prepared for a positive diagnosis and accepts the potential shock and adaptation, it’s hard to see a downside to taking a hepatitis C test. For some it could be a life saver, for others, verification to pursue treatment, and for the majority, a sense of relief with a negative result. The blood test takes a few minutes and in some cases may involve pre-counseling with a medical personnel. So who should get tested?
Who should be tested
The CDC recommends hep C testing for all adults age 18 and older at least once in their lifetime, and all pregnant women during each pregnancy.
The CDC also recommends one-time testing for people with HIV, people who have ever injected drugs and/or shared needles, people who ever received maintenance hemodialysis, and people with persistently abnormal ALT levels.
The CDC also recommends one-time testing people who received clotting concentrates prior to 1987 or blood transfusions or components or organ transplants before 1992, as well as people who received blood from a donor who later tested positive for HCV infection, and children born to a mothers with HCV infection.1
Today's treatments are better than ever
Many decline the test out of fear of the treatment. This was justified with older treatments in the 1980’s when recombinant interferon-alfa (IFNa) with low cure rates and horrible side effects was used. It wasn’t until 2014/201515 that genotype-specific direct-acting antivirals (DAA's) with higher cure rates and minimal side effects (like Harvoni) became available. In 2016, Epclusa (sofosbuvir/velpatasvir) effective on all genotypes was introduced that is taken orally. DAA’s continue to evolve and are ~90% effective for all genotypes.2 A limiting factor is cost, with treatments costing $60,000 - $70,000 in the US. Aside from cost, treatment should not be a limiting factor when considering testing.
What are the risk factors for hep C?
The risk factors closely align with the testing recommendations. The following groups are at increased risk for hepatitis C:
- People with HIV infection
- Current or former use of injection drugs
- People with selected medical conditions, including those who ever received maintenance hemodialysis
- Early recipients of transfusions or organ transplants
- Healthcare, emergency medical, and public safety personnel who have been stuck by needle sharps or mucosal exposures to HCV-positive blood
- Children born to HCV infected mothers
- Those who have received unregulated tattoos or piercings
- Rarely through the sharing of personal items contaminated with blood (such as razors)
Is hepatitis C testing included in routine blood work?
To test for hepatitis C a blood test, called an HCV antibody test, is used. This test determines if someone has ever been infected with the hepatitis C virus.3 The test, also called an anti-HCV test, identifies if antibodies (which are proteins released into the bloodstream upon infection) are present. When a positive test is documented, a second follow up test is administered to verify that the patient has an active infection. The tests results usually take a few days to a few weeks to receive. Rapid HCV tests are available in some health clinics, which offer result in 20-30 minutes.
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