Early testing questions

[Beautifulsky]

I might have been exposed to hepatitis c about a month ago and would like to test to make sure everything is ok.

How early can infection be detected? And what testing method would provide an accurate result this early on?

Thanks and best regards.

[adam422]

I am a medical researcher working with HCV and recently i pricked myself with a glass pipette in the tissue culture hood.  The pipette may or may not have been used to aspirate off viral infected media the day before and since then had been sitting in intermittent UV and may have also been bleached but im not sure.  The genotype is HCV 3b so it is one of the weaker strains.  The ***** did bleed pretty good so the pipette definitely got in there good, and it should be noted i was wearing gloves (latex).  How worried should I be?  I am trying to stay positive that the UV did indeed kill any possible virus and that hopefully the pipette had not actually been exposed to viral sample media but all of this I am unsure of.  What I do know is that i am told the virus can only live in air for a few minutes and in liquid for approx. 3 hours and the hood had not been used in that time and I believe the only culturing work done that day was non-viral.  I plan on getting a PCR test but how worried do you think i should be?

[Jakied]

If you want to worry about something, worry about winning the lottery or getting run over by a bus today.  Imo, yu have -0- chance for hcv infection from your activity.  Hep a is a possibility but is not nearly as serious as b or c.

Get tested to put your mind at ease and move on with life.  Call request a test if you don't have any other options for testing.  Do this for your peace of mind.

[Beautifulsky]

Last quick question then I promise I'm going to take your advice.

Is my logic completely faulty that rubbing my face could open up the wound, start bleeding, and the blood to blood transmission could occur there or am I just clouded with fear and not seeing things clearly(being irrational, etc)?

Is the idea that microscopic bits of blood could appear on her excrement also irrational, too? or the amounts needed to infect too mimimal?

Thank you.

[Jakied]

In my opinion your risk of Hcv is -0- or close to it.  Hep A is much more likely that hep c from the activity you mention.  Hep A is a MINOR illness which clears on its own after a month or so, not nearly as serious as hep b or c.

To put your mind at ease, get a hepatitis panel,(A,B and C).  I have a feeling you will be pleased with the result.

Call 'request a test' at 1888-732-2348 and they will set you up.  After you find out you are neg, get on with life.  DON'T become a 'worried well.'

[Beautifulsky]

The escort did comment that she went to prison(the next day when I called because I was nervous), as I started to read more about Hep c, I started to think about rough gay sex, prison tattoos, and my mind kind of started to think of the worst.

Jakied, I think my thought of risk was the idea that the escort could have bled even microscopic trace amounts as she relieved herself, and me wiping the excrement on my face that had a open wound from a boil/zit that I popped from a day or so ago. I wasn't sure if you read that part or if I was clear.

If you did read that I apologize in advance.

I will get tested for hep a, b, and c but do you guys think I'm needlessly worrying and that my exposure is somewhat minimal regarding hcv?

I know you guys addressed this in your previous posts but wasn't sure you guys got the whole picture, since some of it was in a link and not on the same page, and my thoughts and writing is a bit confusing and scattered.

Mike congratulations on being svr. That is awesome. :)

Thank you.



If this doesn't look a high exposure risk

[Jakied]

In reading your posts, i did not see what your risk was.  Did I miss something?

Sexual transmission of Hcv is rare but NOT impossible.  Sexual transmission is more likely male to female than female to male.

Drug use and blood transfusion, (before 1992) are the most common ways to transmit Hcv.

If possible, could you ask the other party to be tested?  That would be a good way to relieve some of your anxiety.

[Jakied]

Absolutely, we are talking about Hcv.  The pcr was qualitative, not quantitative.  Qualitative is more sensitive than the quantitative beacuse, I believe, the test is checking for the presence or absence of Hcv only, not looking for amount.

Also, the Riba test is very specific for hcv and is used to confirm or rule out an indeterminate screening test.

I am sure I am not telling you anything you don't already know.  You are obviously very knowledgable about Hcv

[mikesimon]

I wouldn't think you're at high risk but if you're worried do what it takes to alleviate your worry and put your mind at ease. I don't see any blood to blood exchange so I don't see a high risk of infection.  Mike

[jmjm530]

High risk sexual practices such as anal sex can transmit Hep C, assuming of course that your partner was infected. From what you describe, it would seem you would be more at risk for Hep B and Hep A, but none of us are doctors here and can only give you some general information, but not specific advice as to what tests you should take and how often. A liver specialist (hepatologist) would be the ideal person to ask.

[mikesimon]

For a normal person that would be enough, in my opinion - if it was a negative sensitive PCR 4 months after exposure. Me, I love to test. I have been SVR since June 2004 and I get monthly Heptimax tests. In fact, it was weekly for a while but that was a mistake on the lab order. So it's never enough for me .....or my transplant team. We are talking about HCV, aren't we?  
Mike

[Beautifulsky]

From the scenario I posted would my exposure be very high?

Thank you.

[Jakied]

Mike, what about someone with an indeterminate screening test (1.0 score) and neg riba/neg pcr qualitative at 4 months after exposure?  Is that enough testing?

[jmjm530]

Forgot to mention that the intial diagnosis and subsequent test scheduling  is often (and nderstandably) heavily dependent on the likelihood of infection from a particular exposure. So, if someone presents a "I kissed my cousin on the cheek who later told me he had Hep C" scenario, and then tests antibody negative (after they request the test) the physician would probably just send the person home with a pat on the back. At the other end of the spectrum would be an IV drug user who found out they were sharing needles mutltiple times with a HCV positive person. In that case, I would assume any knowledgeable doctor would go beyond the antibody test, or even an early PCR negative.

[jmjm530]

Yes, any RNA positive suggests Hepatitis C exposure with 100% certainty, and frankly I would start testing immediately upon suspected exposure and then probably test monthly, or even more often if symptomatic, or overly concerned.

But like you say, in the average physcian's office setting where time and medical economics often rule -- then I wouldn't be surprised if they just run an antibody test at first, and if negative tell you to come back in six months. Or, if they're a bit better, they might follow up with a viral load test in month, but if negative probably would tell you that "you don't have it" but to be sure let's run another test in six months or so. My guess is that either of us were in that circumstance, we would get a bit more agressive with the testing.

[jmjm530]

I'm sure Shiffman means it as a general principle, that also applies to hemodialsis patients as well as others, but probably more studied in settings like hemodialysis where high-risk exposure can be more easily identified. Note that the other study did not mention hemodialysis, and you research this out, there are other similar articles, but at least the ones I found required either a subscription or a fee to access. But again, if it were me, and I really needed to know, I'd test on a periodic basis.

-- Jim

[mikesimon]

Early testing could give a false negative and, if the results were negative, follow up testing would be prudent.
But, if virus was detected with RNA, which seems likely with infection, then you'd be ahead of the curve and my thinking is always - the earlier the better. So,  though I too like absolutism, I would want to know as early as possible so I would test.
But, if  financial  concerns make this approach out of reach, then I guess you wait a few weeks or a month and run the whole gamut of tests. We're probably not too far apart on this really.
Mike

[mikesimon]

Perhaps a portion of those who fall into the "sometimes" category Shiffman alluded to are hemodialysis patients because some of those can display intermittent viremia. Mike

[jmjm530]

Our last two posts crossed.

Yes, you're correct about the antibody test not picking up HCV in the early stages as well, and that's why I suggested monitoring all three indicators -- HCV RNA, antibodies and liver enzymes -- especially in cases where a high risk exposure occured or where someone really wanted to be sure.

So "what would I do" -- I generally fall into the "really want to be sure" camp, so I'd do Heptimax (or a TMA qual) plus sensitivity antibody plus liver enzyme testing on a monthly basis starting at what I deemed to be exposure, and probably continue for six months or more, depending on symptons and risk level of exposure.

What it seems to come down to is that early-on, testing can often be inconclusive and therefore the more tests, the better chance of early diagnosis.

-- Jim

[jmjm530]

"...Another difficulty of this exam (of dx HCV acutes) is that it is carried out in specialized laboratories prepared for molecular biology studies. Besides the technical characteristics of this method, another problem related to the intermittent viremia in these patients, is the need to carry out the exams repeatedly, representing a technical limitation and increasing costs."

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1855320
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"...CONCLUSIONS: Intermittent low-level HCV viremia can occur as much as 2 months before the periods of exponential increase in viral load and the high-titer plateau-phase viremia that usually precede seroconversion. Animal inoculation studies are in progress to evaluate if transfusion of low-level viremic plasma can transmit HCV infection..."

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1537-2995.2005.04390.x

[mikesimon]

Thanks. That is the first I heard of this possibility though I believe that it is possible and perhaps somewhat dependent on the sensitivity of the test. But Jim, if you want to try and find out early what else could you do aside from a "watch and wait" approach other than get an  HCV RNA test? I think it's clear that an antibody test would not be reliable so soon after infection so what choice is there? We'd just have to assume the risk of falling into the "sometimes" category - whatever the statistical basis for "sometimes" is. I know what I would do - I'd get a Heptimax test without question. What would you do Jim? I am serious here and I would like to know how you would approach a possible acute infection from a few weeks ago.
Mike

[jmjm530]

Even the article you cite, hedges with words like "can be detected" as opposed to for example "will be present".

My source is Dr. Mitchell Shiffman's teaching module/web cast  "Hepatitiis C: Epidemiology, Diagnosis and Treatment". Slide 9 "Hepatitis C Virus” Response to Acute Infection"

"...During the acute phase of HCV infection, if you test for HCV, sometimes the virus will be detectable, but at other times the virus is undetectable. Because of this intermittent viremia, virologic assays are not the best assays to screen for acute hepatitis C..."

http://webcasting.clinicaloptions.com/p41111200/
(For those not familiar an excellent web site but free registration is required)

[mikesimon]

Everything I see indicates that an HCV RNA does detect acute HCV within weeks of infection - even in infected chimpanzees. What is your source for the premise that this test doesn't necessarily detect HCV?

"Confirmation of active infection is made by a qualitative HCV RNA test with a low limit of detection of 50 IU/ml (100 viral particles/ml).1,13 HCV RNA can be detected after 1–2 weeks of infection by commercially available assays which are 98% specific....Patients with acute hepatitis C would typically also have a negative antibody test but be positive for HCV RNA, as the RNA is detectable within 1–2 weeks of infection whilst HCV antibody may not appear for 7–8 weeks after infection".
http://bmb.oxfordjournals.org/cgi/content/full/70/1/51

:Hepatitis C diagnosis depends on demonstration of anti-HCV detected by an EIA. Anti-HCV is generally not detectable in patients with initial signs or symptoms of hepatitis C. Anti-HCV develop in acute infection generally between 2 and 8 weeks after evidence of liver injury. Some persons may not test positive for 6-9 months after onset of illness. Hepatitis C viremia may be detected by RT-PCR within days after infection."

"..... HCV RNA testing can be used to establish acute HCV infection after an exposure because HCV RNAcan be detected in 1 to 2 weeks while antibodies to HCV are detectable an average of 8 weeks later25-27. ...."
http://www.natap.org/2004/HCV/032204_01.htm

Mike

[Jakied]

What was your risk?  If sexual, you PROBABLY don't have to worry.  Hcv is not considered a Std as Hbv and Hiv are.

If your risk is Idu, then you are definitely at risk and should be tested.

One thing you might do is ask the other person to be tested.  If he/she is neg, then a lot of your worry is gone.

[Jakied]

The Pcr test is VERY expensive, $400 or so.  Anti body test is about $65.

With antibodody testing, the greater number of days since exposure, the more accurate the test is.

Average time to show antibody is 50 days or so, meaning 50% will be + at 50 days.  A three month neg is reliable and 6 month neg is home free.