Last Updated on June 4, 2020 by Shuvani Sanyal, MD
Hepatitis testing is a two-stage process: first diagnosing the illness, and then evaluating liver damage and treatment prospects. The first stage tests, antibody screening and confirmation, tell you if you’ve been infected by hep-C, and whether the virus is still present and active.
Once you know that you have hep-C, the tests in the evaluative stage – liver biopsies and ultrasound, genotype, and viral load and liver function tests – will tell you more about the virus, and whether it’s causing any damage to your liver.
Diagnostic Hepatitis Testing
Screening
Hep-C antibody screenings look for antibodies to the hep-C virus in your blood, and show if you’ve been infected by the virus. Because antibodies are created during the first six months when your body tried to fight off initial infection by hep-C, and are left in your blood even if you later clear the virus, these screenings do not tell whether you are currently infected. Hep-C antibody screenings only let you know that at one time you had hep-C. If you test positive for hep-C, it is necessary for you to take a confirmation test to see if you are currently infected.
The most common and the cheapest hep-C antibody screening is the ELISA III, followed by the RIBA, which costs more but is also more accurate.
False positive and false negative results happen:
- Some people test positive to the hep-C antibody screening, but later clear the virus – part of the 15% of people who rid the virus on their own.
- Some people test too soon after initial exposure, before their body has developed antibodies to the virus, resulting in a false negative. If you get a negative result but think you may have hep-C, take the antibody screening again in six months.
- Antibodies are created by your immune system. Weakened immune systems may not make enough antibodies for a screening test to detect. False negatives happen more frequently with people who have HIV/AIDS, or other immune weakening conditions (for example: diabetes, transplant and dialysis patients). As a result, knowing your HIV status before you screen for hep-C is very important.
Confirmation
Confirmation tests determine whether hep-C is present and active, indicating a current hep-C infection. These are sensitive hepatitis C-PCR tests that look for HCV RNA (genetic material) in your blood.
There are two kinds of PCR tests: qualitative and quantitative. The qualitative test is most commonly used to confirm whether you have a current hep-C infection. The results are reported as positive or negative. The quantitative test actually counts the amount of virus in a given blood sample. This is mainly used as a tool to help make decisions about hep-C treatment.
Evaluative Hepatitis Tests
These are the tests that are given once you know you are infected with hep-C. They will let you know how much damage, if any, there is to your liver.
Liver Biopsy
- A small piece of liver is removed by a needle. That piece of liver can be examined for signs of scarring.
Ultrasound
- Similar to an x-ray, ultrasound shows a ‘live’ image of your liver, and is mostly used to find liver cancer, and, sometimes, cirrhosis.
Genotype
- There is more than one genotype – or strain – of hep-C. This test tells you which one you’re infected with. Knowing your genotype helps you make treatment choices.
Viral Load Tests
- Measures how much virus is present in a given sample of blood.
Liver Function Tests
- These tests measure the levels of different chemicals (enzymes) your liver produces. Liver enzyme levels can help tell you if your liver is stressed or working too hard.
Overall
While the testing process can be confusing, and, at times, feel overwhelming, don’t let this keep you from getting tested. Knowing your hep-C status helps you make informed decisions about your health, treatment, and other aspects of your life – like drug and alcohol use and diet – that affect your liver’s health.
Ask questions. Take time to learn as much as possible about hep-C and hep-C testing before you get tested. And don’t be afraid to ask questions at the testing center. After all, you are the person who will be living with the test results, whatever those results may be.
Don’t be afraid to speak out if you don’t understand or agree with the tests you’ve been given. Consider bringing a treatment advocate with you.
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Did the information above help you? Have you recently been tested for Hep-C and would like to share your perspective? Share your thoughts in the comments section below!
