From the Guidelines
Prior to initiating hepatitis C treatment, the most essential serological tests to be performed are HCV RNA viral load to confirm active infection and assessment of the presence or absence of cirrhosis by a non-invasive method, as recommended by the most recent and highest quality study 1.
Key Tests
- HCV RNA viral load to confirm active infection
- Assessment of the presence or absence of cirrhosis by a non-invasive method, such as FIB-4 or APRI score
Additional Considerations
- Possible drug-drug interactions should be carefully checked and dose modifications implemented when necessary 1
- Hepatitis B serology (HBsAg, anti-HBc, anti-HBs) to rule out co-infection, although not explicitly mentioned in the most recent study, is still an important consideration in clinical practice to prevent reactivation of latent HBV infection
- Pregnancy testing for women of childbearing age, as some HCV medications are teratogenic
Rationale
These tests are essential because they help determine the appropriate treatment regimen, identify potential contraindications, assess liver disease severity, and establish baseline values for monitoring treatment response and adverse effects. The viral load testing directly influences the decision to start treatment, while the assessment of cirrhosis determines the duration of treatment and the need for post-treatment surveillance for hepatocellular carcinoma (HCC) 1.
From the FDA Drug Label
Test all patients for evidence of current or prior HBV infection by measuring HBsAg and anti-HBc before initiating HCV treatment with ledipasvir and sofosbuvir Test all patients for evidence of current or prior HBV infection by measuring HBsAg and anti-HBc before initiating HCV treatment with SOVALDI
The serology tests that need to be checked prior to initiation of treatment for Hepatitis C (Hep C) are:
From the Research
Serology Tests for Hepatitis C
The following serology tests are recommended to be checked prior to initiation of treatment for Hepatitis C:
- Anti-HCV antibody test to screen for HCV infection 4, 5, 6, 7
- Qualitative HCV RNA test to confirm current infection if the anti-HCV antibody test result is positive 4, 5, 6
- Quantitative HCV RNA testing to assess the viral load 4, 6, 7
- HCV genotype testing to determine the genotype of the virus, which guides treatment decisions 4, 5, 6
Additional Tests
Additional tests that may be necessary prior to initiation of treatment include:
- Assessment of the degree of liver fibrosis using liver biopsy or noninvasive testing, such as Fibrosis-4 index (FIB-4) or aspartate aminotransferase to platelet ratio index (APRI) 4, 5
- Testing for comorbidities, such as HIV or Hepatitis B Virus (HBV) coinfection 5
- Ultrasound surveillance for hepatocellular carcinoma in persons with chronic Hepatitis C virus infection and cirrhosis 7