From the Guidelines
After a patient is found to be reactive for Hepatitis C, the next step is to perform a Hepatitis C Virus (HCV) RNA test to confirm the diagnosis and determine if the patient has an active infection requiring treatment. This recommendation is based on the most recent and highest quality study, which emphasizes the importance of HCV RNA testing in confirming the diagnosis of HCV infection 1. The HCV RNA test directly detects the presence of the virus in the bloodstream, whereas antibody tests can remain positive even after the infection has cleared.
According to the guidelines, HCV RNA testing is recommended in patients with a positive anti-HCV test to confirm the diagnosis (A1) 1. Additionally, even if anti-HCV is negative, HCV RNA testing is required when acute HCV infection is suspected or in the presence of unexplained liver disease in immunosuppressed patients (B1) 1.
The following steps are recommended after a patient is found to be reactive for Hepatitis C:
- Perform an HCV RNA test to confirm the diagnosis
- If the HCV RNA test is positive, perform HCV genotyping to determine the specific strain (genotypes 1-6)
- Conduct a comprehensive assessment of liver health through liver function tests, fibrosis assessment (FibroScan or other non-invasive methods), and possibly liver imaging
- Use these results to determine the appropriate direct-acting antiviral (DAA) treatment regimen and duration, which typically ranges from 8-12 weeks depending on genotype, prior treatment history, and degree of liver damage.
It is essential to note that approximately 15-25% of people who contract HCV will spontaneously clear the virus without treatment while still maintaining antibodies, highlighting the importance of HCV RNA testing in determining the need for treatment 1.
From the Research
Hepatitis C Testing
After a patient is found to be reactive for Hep C, the following tests are typically run:
- HCV RNA testing to confirm the diagnosis and determine the viral load 2, 3
- Genotype testing to determine the specific strain of the virus, which can affect treatment options 4, 5
- Liver function tests to assess the level of liver damage 3
- Other tests may be ordered to rule out other liver diseases or to assess the patient's overall health
Treatment and Follow-up
Treatment for Hep C typically involves direct-acting antivirals (DAAs), which can cure the infection in most cases 4, 5
- The choice of treatment regimen depends on the patient's HCV genotype, liver disease stage, and other factors 4, 5
- Follow-up testing is typically done to monitor the patient's response to treatment and to check for any signs of relapse 2, 3, 6
- Patients who do not respond to initial treatment or who experience relapse may be eligible for retreatment with a different regimen 6