What is hepatitis C?
Hepatitis C is a liver disease caused by the hepatitis C
virus (HCV), which is found in the blood of persons who
have this disease. HCV is spread by contact with the blood
of an infected person.
What blood tests are available to check for hepatitis C?
There are several blood tests that can be done to determine
if you have been infected with HCV. Your doctor may order
just one or a combination of these tests. The following
are the types of tests your doctor may order and the purpose
(antibody to HCV)
test is usually done first. If positive, it should be
(recombinant immunoblot assay
supplemental test used to confirm a positive EIA test
does not tell whether the infection is new (acute),
chronic (long-term) or is no longer present.
tests to detect presence or absence of virus (HCV RNA)
polymerase chain reaction (PCR)
tests to detect amount (titer) of virus (HCV RNA)
HCV RNA (bDNA)
and other tests to directly detect virus are not licensed
tests and are only available on a research-basis. A single
positive PCR test indicates infection with HCV. A single
negative test does not prove that a person is not infected.
Virus may be present in the blood and just not found by
PCR. Also, a person infected in the past who has recovered
may have a negative test. When hepatitis C is suspected
and PCR is negative, PCR should be repeated.
Can you have a "false positive" anti-HCV test
Yes. A false positive test means the test looks as if it
is positive, but it is really negative. This happens more
often in persons who have a low risk for the disease for
which they are being tested. For example, false positive
anti-HCV tests happen more often in persons such as blood
donors who are at low risk for hepatitis C. Therefore, it
is important to confirm a positive anti-HCV test with a
supplemental test as most false positive anti-HCV tests
are reported as negative on supplemental testing.
Can you have a "false negative" anti-HCV test
Yes. Persons with early infection may not as yet have developed
antibody levels high enough that the test can measure. In
addition, some persons may lack the (immune) response necessary
for the test to work well. In these persons, research-based
tests such as PCR may be considered.
How long after exposure to HCV does it take to test positive
Anti-HCV can be found in 7 out of 10 persons when symptoms
begin and in about 9 out of 10 persons within 3 months after
symptoms begin. However, it is important to note that many
persons who have hepatitis C have no symptoms.
How long after exposure to HCV does it take to test positive
It is possible to find HCV within 1 to 2 weeks after being
infected with the virus.
Who should get tested for hepatitis C?
persons who ever injected illegal drugs, including those
who injected once or a few times many years ago
persons who were treated for clotting problems with a
blood product made before 1987 when more advanced methods
for manufacturing the products were developed
persons who were notified that they received blood from
a donor who later tested positive for hepatitis C
persons who received a blood transfusion or solid organ
transplant before July 1992 when better testing of blood
donors became available
long-term hemodialysis patients
persons who have signs or symptoms of liver disease (e.g.,
abnormal liver enzyme tests)
healthcare workers after exposures (e.g., needle sticks
or splashes to the eye ) to HCV-positive blood on the
children born to HCV-positive women
What is the next step if you have a confirmed positive anti-HCV
Measure the level of ALT ( alanine aminotransferase, a liver
enzyme) in the blood. An elevated ALT indicates inflammation
of the liver and you should be checked further for chronic
(long-term) liver disease and possible treatment. The evaluation
should be done by a healthcare professional familiar with
chronic hepatitis C.
Can you have a normal liver enzyme (e.g., ALT) level and
still have chronic hepatitis C?
Yes. It is common for persons with chronic hepatitis C to
have a liver enzyme level that goes up and down, with periodic
returns to normal or near normal. Some persons have a liver
enzyme level that is normal for over a year but they still
have chronic liver disease. If the liver enzyme level is
normal, persons should have their enzyme level re-checked
several times over a 6 to 12 month period. If the liver
enzyme level remains normal, your doctor may check it less
frequently, such as once a year.
How is HCV spread from one person to another?
How could a person have gotten hepatitis
HCV is spread primarily by direct contact with human blood.
For example, you may have gotten infected with HCV if:
you ever injected street drugs, as the needles and/or
other drug "works" used to prepare or inject
the drug(s) may have had someone else's blood that contained
HCV on them.
you received blood, blood products, or solid organs from
a donor whose blood contained HCV.
you were ever on long-term kidney dialysis as you may
have unknowingly shared supplies/equipment that had someone
else's blood on them.
you were ever a healthcare worker and had frequent contact
with blood on the job, especially accidental needlesticks.
your mother had hepatitis C at the time she gave birth
to you. During the birth her blood may have gotten into
you ever had sex with a person infected with HCV.
you lived with someone who was infected with HCV and shared
items such as razors or toothbrushes that might have had
his/her blood on them.
there any evidence that HCV has been spread during medical
or dental procedures done in the United States?
and dental procedures done in most settings in the United
States do not pose a risk for the spread of HCV. There have,
however, been some reports that HCV has been spread between
patients in hemodialysis units where supplies or equipment
may have been shared between patients.
Can HCV be spread by sexual activity?
Yes, but this does not occur very often. See section on
counseling for more information on hepatitis C and sexual
Can HCV be spread by oral sex?
There is no evidence that HCV has been spread by oral sex.
See section on counseling for more information on hepatitis
C and sexual activity.
Can HCV be spread within a household?
Yes, but this does not occur very often. If HCV is spread
within a household, it is most likely due to direct exposure
to the blood of an infected household member.
more advanced tests have been developed for use in blood
banks, what is the chance now that a person can get HCV
infection from transfused blood or blood products?
1 chance out of 100,000, per each transfused unit.
and Breast feeding
Should pregnant women be routinely
tested for anti-HCV?
No. Pregnant women have no greater risk of being
infected with HCV then non-pregnant women. If pregnant women
have risk factors for hepatitis C, they should be tested
What is the risk that HCV infected women will spread HCV
to their newborn infants?
About 5 out of every 100 infants born to HCV infected women
become infected. This occurs at the time of birth, and there
is no treatment that can prevent this from happening. Most
infants infected with HCV at the time of birth have no symptoms
and do well during childhood. More studies are needed to
find out if these children will have problems from the infection
as they grow older. There are no licensed treatments or
guidelines for the treatment of infants or children infected
with HCV. Children with elevated ALT (liver enzyme) levels
should be referred for evaluation to a specialist familiar
with the management of children with HCV-related disease.
Should a woman with hepatitis C be advised against breast-feeding?
No. There is no evidence that breast-feeding spreads HCV.
HCV-positive mothers should consider abstaining from breast-feeding
if their nipples are cracked or bleeding.
When should babies born to mothers with hepatitis C be tested
to see if they were infected at birth?
Children should not be tested for anti-HCV before 12 months
of age as anti-HCV from the mother may last until this age.
If testing is desired prior to 12 months of age, PCR could
be performed at or after an infant's first well-child visit
at age 1-2 months.
How can persons infected with HCV
prevent spreading HCV to others?
not donate blood, body organs, other tissue, or semen.
(Note from Lyric: Organs MAY be donated to other people
who have HepC. A HepC liver in good condition can save
a life. Just be sure that everyone involved knows you
are HepC positive!)
not share personal items that might have your blood on
them, such as toothbrushes, dental appliances, nail-grooming
equipment or razors.
your cuts and skin sores to keep from spreading HCV.
How can a person protect themselves from getting hepatitis
C and other diseases spread by contact with human blood?
ever shoot drugs. If you shoot drugs, stop and get into
a treatment program. If you can't stop, never reuse or
share syringes, water, or drug works, and get vaccinated
against hepatitis A and hepatitis B.
not share toothbrushes, razors, or other personal care
articles. They might have blood on them.
you are a healthcare worker, always follow routine barrier
precautions and safely handle needles and other sharps.
Get vaccinated against hepatitis B
the health risks if you are thinking about getting a tattoo
or body piercing: You can get infected if:
tools that are used have someone else's blood on them.
artist or piercer doesn't follow good health practices,
such as washing hands and using disposable gloves.
can be spread by sex, but this does not occur very often.
If you are having sex, but not with one steady partner:
and your partners can get other diseases spread by having
sex (e.g., AIDS, hepatitis B, gonorrhea or chlamydia).
should use latex condoms correctly and every time.
should get vaccinated against hepatitis B.
Should patients with hepatitis C change their sexual practices
if they have only one long-term steady sex partner?
There is a very low chance of spreading HCV to that partner
through sexual activity. If you want to lower the small
chance of spreading HCV to your sex partner, you may decide
to use barrier precautions such as latex condoms. Ask your
doctor about having your sex partner tested.
What can persons with HCV infection do to protect their
your doctor regularly.
start any new medicines or use over-the-counter, herbal,
and other medicines without a physician's knowledge.
vaccinated against hepatitis A if liver damage is present.
What other information should patients with hepatitis C
be aware of?
is not spread by sneezing, hugging, coughing, food or
water, sharing eating utensils or drinking glasses, or
should not be excluded from work, school, play, child-care
or other settings on the basis of their HCV infection
with a support group may help patients cope with hepatitis
Should persons with chronic hepatitis C be vaccinated against
If persons are in risk groups for whom hepatitis B vaccine
is recommended, they should be vaccinated. A Comprehensive
Strategy for Eliminating Transmission in the United States
Through Universal Childhood Vaccination)
Consequences of HCV Infection
What are the chances of persons with
HCV infection developing long term infection, chronic liver
disease, cirrhosis, liver cancer, or dying as a result of
Of every 100 persons infected with HCV about:
persons may develop long-term infection,
persons may develop chronic liver disease,
persons may develop cirrhosis over a period of 20 to 30
persons may die from the consequences of long term infection
(liver cancer or cirrhosis).
Do medical conditions outside the liver occur in persons
with chronic hepatitis C?
A small percentage of persons with chronic hepatitis C develop
medical conditions outside the liver (this is called extrahepatic).
These conditions are thought to occur due to the body's
natural immune system fighting against itself. Such conditions
include: glomerulonephritis, essential mixed cryoglobulinemia,
and porphyria cutanea tarda.
and Treatment of Chronic Hepatitis C
When might a specialist (gastroenterologist
or hepatologist) be consulted in the management of HCV-infected
A referral to or consultation with a specialist for further
evaluation and possible treatment may be considered if a
person is anti-HCV positive and has elevated liver enzyme
levels. Any physician who manages a person with hepatitis
C should be knowledgeable and current on all aspects of
the care of a person with hepatitis C.
is the treatment for chronic hepatitis C?
Antiviral drugs such as interferon used alone or in combination
with ribavirin, are approved for the treatment of persons
with chronic hepatitis C. Interferon works in 10 to 20 persons
out of 100 treated. Interferon combined with ribavirin works
(on the viral strain that is mostly found in the U.S.) in
about 30-40 persons out of 100. Ribavirin, when used alone,
does not work.
What are the side effects of interferon therapy?
persons have flu-like symptoms (fever, chills, headache,
muscle and joint aches, fast heart rate) early in treatment,
but these lessen with continued treatment. Later side effects
may include tiredness, hair loss, low blood count, trouble
with thinking, moodiness, and depression. Severe side effects
are rare (seen in less than 2 out of 100 persons). These
include thyroid disease, depression with suicidal thoughts,
seizures, acute heart or kidney failure, eye and lung problems,
hearing loss, and blood infection. Although rare, deaths
have occurred due to liver failure or blood infection, mostly
in persons with cirrhosis. An important side effect of interferon
is worsening of liver disease with treatment, which can
be severe and even fatal. Interferon dosage must be reduced
in up to 40 out of 100 persons because of severity of side
effects, and treatment must be stopped in up to 15 out of
100 persons. Pregnant women should not be treated with interferon.
What are the side effects of combination (ribavirin + interferon)
In addition to the side effects due to interferon described
above, ribavirin can cause serious anemia (low red blood
cell count) and can be a serious problem for persons with
conditions that cause anemia, such as kidney failure. In
these persons, combination therapy should be avoided or
attempts should be made to correct the anemia. Anemia caused
by ribavirin can be life-threatening for persons with certain
types of heart or blood vessel disease. Ribavirin causes
birth defects and pregnancy should be avoided during treatment.
Patients and their healthcare providers should carefully
review the product manufacturer information prior to treatment.
Can anything be done to reduce symptoms or side effects
due to antiviral treatment?
You should report what you are feeling to your doctor. Some
side effects may be reduced by giving interferon at night
or lowering the dosage of the drug. In addition, flu-like
symptoms can be reduced by taking acetaminophen before treatment.
Can children receive interferon therapy for chronic hepatitis
drugs are not licensed for persons under 18 years of age.
Children with hepatitis C should be referred to a children's
specialist in liver diseases. You may want to ask your doctor
about clinical trials that may be on-going for children.
MORE INFORMATION ON THE TREATMENT OF PATIENTS WITH
CHRONIC HEPATITIS C - CLICK
HERE FOR THE NIH WEBSITE
What does the term genotype mean?
Genotype refers to the genetic make-up of an organism or
a virus. There are at least 6 distinct HCV genotypes identified.
Genotype 1 is the most common genotype seen in the United
Is it necessary to do genotyping when managing a person
with chronic hepatitis C?
Yes, as there are 6 known genotypes and more than 50 subtypes
of HCV, and genotype information is helpful in defining
the epidemiology of hepatitis C. Knowing the genotype or
serotype (genotype-specific antibodies) of HCV is helpful
in making recommendations and counseling regarding therapy.
Patients with genotypes 2 and 3 are almost three times more
likely than patients with genotype 1 to respond to therapy
with alpha interferon or the combination of alpha interferon
and ribavirin. Furthermore, when using combination therapy,
the recommended duration of treatment depends on the genotype.
For patients with genotypes 2 and 3, a 24-week course of
combination treatment is adequate, whereas for patients
with genotype 1, a 48-week course is recommended. For these
reasons, testing for HCV genotype is often clinically helpful.
Once the genotype is identified, it need not be tested again;
genotypes do not change during the course of infection.
Why do most persons remain infected?
Persons infected with HCV mount an antibody response to
parts of the virus, but changes in the virus during infection
result in changes that are not recognized by preexisting
antibodies. This appears to be how the virus establishes
and maintains long-lasting infection.
Can persons become infected with different genotypes?
Yes. Because of the ineffective immune response described
above, prior infection does not protect against reinfection
with the same or different genotypes of the virus. For the
same reason, there is no effective pre- or postexposure
prophylaxis (i.e, immune globulin) available.
C and Healthcare Workers
What is the risk for HCV infection from a needle-stick exposure
to HCV contaminated blood?
After needle stick or sharps exposure to HCV positive blood
, about 2 (1.8%) healthcare workers out of 100 will get
infected with HCV (range 0%-10%).
What are the recommendations for follow-up of healthcare
workers after exposure to HCV positive blood?
Anti-viral agents (e.g., interferon) or immune globulin
should not be used for postexposure prophylaxis.