Hepatitis C, an inflammation of the liver caused by the hepatitis C virus (HCV), often goes undiagnosed until serious liver problems develop decades after contracting the virus. This is because the illness is asymptomatic for most people, according to the Centers for Disease Control and Prevention (CDC). ( 1 ) For these asymptomatic people, hepatitis C is generally detected when blood screenings (such as for blood donations) show they are HCV-positive, or routine examinations show they have elevated levels of liver enzymes, an indication of liver cell damage. ( 2 )
Who Should Get Tested for Hepatitis C? Who Should Get Tested Hepatitis C is transmitted mostly when the blood of an infected person gets into an uninfected person’s body, such as from sharing needles for intravenous drug use (the most common way people become infected today). Less commonly, a person can also get hepatitis C virus through sexual contact with someone who is infected. You should get tested for hepatitis C if you: ( 3 , 4 ) Are age 18 or older Currently use intravenous drugs or have in the past Received a blood transfusion or organ transplant before July 1992, when routine blood screenings became available Received a clotting factor concentrate made before 1987 Are a hemodialysis patient or ever spent many years on dialysis for kidney failure Were born to an HCV-positive mother Had tattoos or piercings done at an unlicensed or unregulated establishment Are a healthcare worker who has ever been injured by a needle at work Have HIV Have had unprotected sex with multiple partners or someone known to have HCV
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How Hepatitis C Is Diagnosed Diagnostic Tools To determine a hepatitis C diagnosis, your doctor will: Get your medical history (including any history of blood transfusions or intravenous drug use). Perform a physical exam, especially checking for changes in skin color, swelling in your lower extremities, and tenderness in your abdomen. Order certain diagnostic blood tests. ( 5 ) The first diagnostic tool in the screening process is a blood test that screens for HCV antibodies — proteins the body produces in response to the virus. An enzyme immunoassay (EIA) is used to perform this test. (4, 6 ) A negative result for the antibody test could mean that you’ve never had HCV in your blood or your body has not yet produced the HCV antibody (called a false-negative test), and you may need to be tested again in a few months. A positive result means you were exposed to the virus at some point in your life. Up to half of people spontaneously clear the virus from their blood within six months of contracting it. If you have a positive antibody test, your doctor will then use another blood sample to conduct a polymerase chain reaction (PCR) test, which looks for the presence or absence of RNA (genetic material) of HCV in your blood. ( 8 , 9 ) Your doctor may also order an HCV RNA test while you are undergoing treatment to find out if the amount of virus in your blood is changing. (5)
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Other Tests for Diagnosing Hepatitis C Other Hepatitis C Tests Before recommending a treatment plan, your doctor will likely conduct other tests. The six major strains, or genotypes, of HCV considered in the United States respond differently to different treatments, so your doctor will conduct another blood test that determines your HCV genotype. You can be infected with more than one genotype at a time. Genotypes 1, 2, and 3 are the most common in the United States. ( 9 )
How Is Liver Damage Assessed? Assessing Liver Damage If you have hepatitis C, doctors can gauge the level of liver damage you’ve experienced. One useful diagnostic tool is called a hepatic function panel, a group of blood tests performed together that examine the levels of certain liver enzymes, bilirubin (a fluid the body produces when red blood cells break down), and proteins circulating in the blood. ( 11 ) Higher-than-normal levels of the liver enzymes, indicate that your liver is damaged, possibly from cirrhosis or liver cancer. Albumin may be low, and your total bilirubin levels may also be elevated. (11) Along with the hepatic function panel, your doctor may also order two other tests: one test to determine the levels of the liver enzyme gamma-glutamyl transpeptidase in your blood, and a prothrombin time test that measures how well your blood clots. ( 12 )
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A liver biopsy, in which a liver tissue sample is removed with a thin needle inserted through your skin and into your liver, can provide more details about the amount of scarring and damage HCV has caused. Your doctor may also order an imaging test, such as a computerized tomography (CT) scan, magnetic resonance imaging (MRI), or ultrasound, to see if your hepatitis C has caused liver cancer, a possible complication of hepatitis C. Various imaging tests and liver biopsies are also used to determine if you have cirrhosis. Transient elastography is an imaging modality that maps the elastic properties and stiffness of the liver. (5) It’s a noninvasive method for assessing liver fibrosis, the first stage of liver scarring. Cirrhosis develops when the scarring becomes widespread. ( 13 ) For people with liver failure from HCV-related cirrhosis, a liver transplant may be the only real treatment option. ( 14 ) Liver transplants are also the standard treatment for early liver cancer. Other therapies, including chemotherapy and hepatectomy (removing the diseased parts of the liver), may also work depending on the cancer stage and the patient’s performance status. ( 15 ) Additional reporting by Deborah Shapiro.
