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The steps to getting tested for this viral infection

By Marijke Vroomen Durning, RN

According to the Centers for Disease Control and Prevention (CDC), more than 30,000 new cases of acute hepatitis C (or hep C, also known as HCV, for hepatitis C virus) are diagnosed in the US each year. What makes things even more complicated is that hep C is often a “silent” disease: you can be infected with the virus but not experience any symptoms. This is why screening blood tests can be so critical — they’re the only way to confirm the presence of the virus.

If you have hep C, diagnosis is also important because treatments and medication regimens are available, and they have a high success rate. Unfortunately, up to 8 out of 10 people infected with hep C end up developing a chronic liver condition, so the earlier the diagnosis, the better. If you fall into a high-risk category (examples include having a history of blood transfusions or being born between 1945 and 1965), your doctor might suggest you be tested for the virus — or you may want to ask about testing. Knowing your diagnosis is also important because once you know, you can take precautions to reduce the risk of spreading the virus to other people.

How Hep C Is Diagnosed

There are three things your doctor is trying to determine in the testing process:

1.  Is your body producing antibodies to the hep C virus? This blood test, called the hepatitis C antibody or anti-HCV test, is a screening test — it does not diagnose you with hep C. It works by looking for special proteins called antibodies, which your immune system produces in response to an antigen — a substance that is perceived as a threat to your body. Examples of antigens include bacteria, as well as viruses — including the hep C virus. If your anti-HCV test comes back positive, you don’t necessarily have hep C — but you have been exposed to it.

2. Is the hep C virus present in your blood? If your anti-HCV test comes back positive (meaning HCV antibodies were found in your bloodstream), the next step is to determine if the virus is actually in your blood. This test is called a qualitative RNA test because it looks for the virus’s genetic material, or RNA. If the test doesn’t detect any RNA, you don’t have hep C. (About 15 to 25% of the people who are exposed to the virus are able to clear it without receiving any treatment at all.) If RNA is detected, you’ve tested positive for hep C.

3.  How much and what kind of hep C virus is present? The final step is to determine how much virus is actually present — this is called the “viral load” — and what kind, or genotype, of hep C you have. There are seven different major genotypes, numbered 1 through 7, which are then further divided into subtypes. Different genotype and subtypes may require different treatment regimens, so this information is important. 

When you and your healthcare provider have discussed your test results, the next step is to determine whether treatment and medication regimens are the immediate next step. While it may seem like treatment is the obvious choice, keep in mind that not all patients receive immediate treatment for hep C. However, certain groups of people are typically treated right away. They include those who:

• Have fibrosis of the liver (early stages of scarring of the liver)
• Have cirrhosis of the liver (extensive scarring of the liver)
• Have had a liver transplant
• Are at high risk for complications of hepatitis C (examples include kidney disease and lymphoma)

Treating hep C as early as possible lowers the risk of passing the virus on to others and reduces your chances of liver damage (or further liver damage, if your doctor determines that some damage has already occurred).

Though a diagnosis of hep C may feel overwhelming, recent innovations in treatment have brought some good news: hep C medications are much more effective now than in the past, with much greater chances of a cure. Learn more about getting on treatment for hep C. 

Published on March 1, 2016. Updated April 7, 2017.

Marijke Vroomen Durning, RN, has written articles for numerous healthcare sites and is the author of Just the Right Dose: Your Smart Guide to Prescription Drugs & How to Take Them Safely.