Summary

• Hepatitis C is an infection caused by a virus that attacks the liver.
• Often there are no symptoms or else they are mild and the only way to know if you have it, is through testing.
• Testing is important because there are treatments that can keep you healthy.
• Two tests are used to show if you have it, if the virus is active and what will be the best treatment. A third test may be requested in some cases to guide treatment.

What causes hepatitis C?

Hepatitis C infection is caused by the hepatitis C virus that attacks and injures the liver. Infections by hepatitis C can range from being mild to a more severe form which can last for years and can eventually lead to liver cancer.

In most cases, it is contracted through exposure to blood, usually from sharing contaminated needles while injecting drugs or, before 1990, through a blood transfusion. It can also be passed from mother to baby. Other ways it can be transmitted include needlestick injuries, tattooing, body piercing and rarely, through sexual transmission. It cannot be spread by casual contact such as staying in the same house.

More than half of people with hepatitis C do not have symptoms which means they do not know they have it and can pass on the infection to other people. Testing is the only way to know for sure if you have it. Knowing if you have hepatitis C is important as there are effective drug therapies that can manage the infection and keep you well.

Acute and chronic hepatitis C

For most people, hepatitis C is a short-term (also known as acute) illness. Acute hepatitis C lasts less than six months. However, sometimes, the infection lasts more than six months and is termed a chronic infection. Chronic hepatitis C can lead to permanent scarring of the liver (cirrhosis) and may mean your liver cannot function properly. Eventually the cirrhosis can lead to liver failure and liver cancer.

Who should get tested?

It is important to be tested if you are at risk from hepatitis C infection. You are at risk of hepatitis C infection if you:

• Have ever injected illegal drugs.
• Have ever been in a custodial setting (such as a prison).
• Have received a blood transfusion or organ transplantation before 1993 – after this time all donated blood has been screened for the hepatitis C virus.
• Have a coagulation disorder and received blood products or plasma-derived clotting factor treatment products before 1993.
• Are a child born to an hepatitis C-positive mother.
• Are infected with HIV or hepatitis B virus.
• Have a sex partner who is hepatitis C positive.
• Anyone with chronic liver disease.
• Are a migrant from a high-prevalence region (Egypt, Pakistan, Mediterranean and Eastern Europe, Africa and Asia).

How to get tested?

Diagnosing and managing treatment of hepatis C may require three different tests.

Usually, the first test to be performed is one that looks for antibodies to hepatitis C. When you are infected with the hepatitis C virus, as with all infections, your immune system makes antibodies to fight off the virus. In the case of hepatitis C, these antibodies may not develop until several months after you have been infected but will be present for life, even if you receive treatment.

If the result from the first antibody test is positive your result will be confirmed using a second test which looks for different antibodies that your body also produces when you have a hepatitis C infection.

If your antibody test is positive, then a second test will be performed looking for RNA in the hepatitis C virus. RNA is the genetic material of the virus. This is the most sensitive of hepatitis C tests and a positive result indicates you have active hepatitis C virus in your bloodstream. This test can also be used to tell how much of the virus is in your blood – called the viral load.

The third test, called viral genotyping, shows what type of hepatitis C virus you have. This is not always required for treatment, although in some cases your treating doctor may use this to guide your management. The tests your doctor orders will depend on your medical history and symptoms.

In addition to these tests your doctor may order other tests related to your liver function such as LFTs.

Having the test

Sample

Blood

Any preparation?

None

Your results

Reading your test report

Your results will generally be presented along with those of your other tests on the same form. You will see separate columns or lines for each of these tests.

Positive result

If your first hepatitis C antibody test is positive your sample will be tested using a second but different type of antibody test. If the repeat test is positive your doctor will then use a test for hepatitis C RNA to see if the infection is active.

If the second antibody test is negative your doctor may still ask you to be tested using an RNA test. If this is negative then they may suggest retesting in 6 months.

A positive hepatitis C RNA assay confirms that you are infected with hepatitis C and you will be referred for treatment including a possible measurement of viral load and virus genotyping. Your doctor will also notify your state health department as hepatitis C is a notifiable infectious disease.

Negative result

If the antibody test is positive but the RNA test is negative, it may mean that:

• You have had hepatitis C in the past and have been treated
• You have had hepatitis C in the past and are one of the 25% of people who clear the virus spontaneously without treatment
• the first antibody assay was a false positive. You may be referred for repeat testing six months later, particularly if you have symptoms suggestive of hepatitis C.

Any more to know?

There is no vaccine for hepatitis C although it is an area of active research. Challenges to vaccine development include the fact that the virus has many variations and mutates very quickly.

Annual hepatitis C serology is recommended for people who test negative but have ongoing risk factors.

You can become infected with hepatitis C virus again, even if you have had it before.

Questions to ask your doctor

The choice of tests your doctor makes will be based on your medical history and symptoms. It is important that you tell them everything you think might help.

You play a central role in making sure your test results are accurate. Do everything you can to make sure the information you provide is correct and follow instructions closely.

Talk to your doctor about any medications you are taking. Find out if you need to fast or stop any particular foods, medications or supplements. These may affect your results. Ask:

• Why does this test need to be done?
• Do I need to prepare (such as fast or avoid medications) for the sample collection?
• Will an abnormal result mean I need further tests?
• How could it change the course of my care?
• What will happen next, after the test?

More information

Pathology and diagnostic imaging reports can be added to your My Health Record. You and your healthcare provider can now access your results whenever and wherever needed.

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