Everything About Hepatitis C and HCV Testing

The hepatitis C virus (HCV) is a contagious infection that affects the liver. “Hepatitis” means inflammation of the liver, and is a condition that can stem from a variety of sources. It is most often caused by viruses, especially hepatitis A, hepatitis B, and hepatitis C. The liver is a vital organ and its key roles include filtering the body’s blood, fighting infections and processing nutrients. When the liver is infected, inflamed or damaged, it can severely affect these important functions.

Hepatitis C is most frequently spread when blood from a person infected with the hepatitis C virus enters the body of someone who is not infected. Hepatitis C is spread by contact with blood or bodily fluids from a person infected with the virus, shared needles/drug equipment, or from mother to baby at birth. It can also be contracted from infected tattooing/piercing equipment, or straws or similar devices used to snort drugs like cocaine.

According to the CDC, approximately 2.7 million people in the United States have chronic HCV infection. The hepatitis C virus was not identified until 1989, and widespread screening of the blood supply for hepatitis C began in 1992.

Since there are multiple strains of HCV, an individual can be infected with more than one strain. This is very rare and is likely linked to intravenous drug use.

Hepatitis C Phases

There are two phases of hepatitis C: acute and chronic. Acute hepatitis C occurs within the first six months of infection. For unknown reasons, one out of five individuals infected with the virus will clear (or get rid of) it on their own within these months. It is not uncommon for individuals with acute hepatitis C do not experience any symptoms.

Acute hepatitis C can display the following symptoms: Flu-like symptoms including fever, fatigue, nausea, loss of appetite, and vomiting, as well as joint pain, jaundice, stomach/abdominal pain, dark urine and/or gray-colored stool.  

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Chronic hepatitis C is the second phase and begins after the first six months of contracting the virus. The same aforementioned symptoms can occur anytime in life after the acute phase, sometimes even decades later. Often, this is a sign of advanced liver disease caused by the virus.

According to the CDC, of every 100 persons infected with HCV, approximately:

  • 75–85 will go on to develop chronic infection.
  • 60–70 will go on to develop chronic liver disease.
  • 5–20 will go on to develop cirrhosis over a period of 20–30 years.
  • 1–5 will die from the consequences of chronic infection (liver cancer or cirrhosis).

Hepatitis C is more common in individuals born between 1945-1965. This is believed to be caused by a few reasons: Many baby boomers experimented with drugs at least once (even one infected drug needle or straw could transmit the virus); during the hippie era unprotected sex and drugs were popular; and hepatitis C was not yet screened for in blood, so any transfusions or whole organ donations received at this time could have resulted in contracting the virus. Chronic hepatitis C can result in liver damage, liver cancer, cirrhosis, and even liver failure.

Avoid contact with personal items that may come in contact with blood infected with hepatitis C, like razor blades, toothbrushes (bleeding gums), nail clippers, tweezers, and glucose monitors.

Hepatitis C and Pregnancy

Hepatitis C can be transmitted from an infected mother to her baby during delivery. The rate of hepatitis C transmission from mother to child is 1 in 20. Currently, there is no vaccine or another way to help prevent the baby from contracting hepatitis C at birth. If a child gets hepatitis C at birth, their health (especially liver health) will need to be monitored. One in four children will clear the virus on their own; the remaining will become carriers of the virus.

Whether or not hepatitis C can be transmitted via breast milk is not 100 percent certain. Doctors do, however, recommend that women with hepatitis C breastfeed.

The testing methods for hepatitis C include:

Antibody Tests

 1. Enzyme Immunoassay (EIA) 

  • Blood test; The 3rd generation HCV EIA has a sensitivity of approximately 98%.
  • Tells whether a person has been infected with the hepatitis C virus at some point in their life.
  • A positive antibody test does not necessarily mean a person still has hepatitis C.
  • An additional test (RNA test) is needed to determine if a person is currently infected with hepatitis C.
  • Antibodies are also called immunoglobulins (Ig). Antibodies are always present, whether you are having an active infection or not.

2. Chemiluminescence Immunoassay (CIA)

  • Blood test; CIA has similar sensitivity and specificity as the 3rd generation EIA.
  • Tells whether a person has been infected with the hepatitis C virus at some point in their life.
  • A positive antibody test does not necessarily mean a person still has hepatitis C.
  • An additional test (RNA test) is needed to determine if a person is currently infected with hepatitis C.
  • Antibodies are also called immunoglobulins (Ig). Antibodies are always present, whether you are having an active infection or not.

3. Point-of-Care Rapid Immunoassays:

  • Blood sample
  • OraQuick® HCV Rapid Antibody Test was FDA-approved in 2010 as a point-of-care test for use with whole blood samples obtained either by venipuncture or fingerstick.
  • OraQuick® HCV Rapid Antibody Test is the only point-of-care rapid immunoassay test that is FDA-approved at this time.

Viral RNA Polymerase Chain Reaction (PCR) Test

  • Blood test; Detects the presence or absence of hepatitis C virus circulating in the blood and is among the most sensitive tests available.
  • HCV RNA appears in blood and can be detected as early as 2–3 weeks after infection.
  • Determines if an individual is currently living with an active case of hepatitis C.
  • Quantitative tests to detect amount (titer) of virus (HCV RNA PCR)
  • Quantitative HCV RNA tests are used to evaluate the effect of antiviral therapy. If HCV RNA is undetectable both at the end of a course of treatment and 6 months later, a long-term cure is highly probable.
  • Following antiviral therapy, a repeatedly negative test indicates clearance of the virus and recovery from the infection.

Genotyping

  • Blood test
  • Genotype refers to the genetic structure or makeup of living organisms. The hepatitis C virus has seven different genotypes so far and are named 1 through 7. Each genotype has subtypes, which were lettered in the order that they were discovered. Genotype 1 is the most common strain in the United States.
  • It is important to know which hepatitis C genotype you have because it determines both the type and length of treatment and helps to predict the likelihood of curing HCV

In May 2013, the CDC published a new recommended testing sequence for diagnosing current (active) hepatitis C infection. The new recommended sequence consists of initial testing for HCV antibody (using either a rapid or laboratory-conducted assay), followed by HCV RNA testing for all positive HCV antibody tests. Persons who have a negative screening HCV antibody test are considered not infected with HCV and do not need further diagnostic evaluation, unless they have a known risk factor for a false-negative test, such as suspected acute HCV infection, chronic hemodialysis, or an immunocompromising condition. Individuals who have a positive HCV antibody test and a positive HCV RNA are considered to have current (active) HCV infection. If an individual has a positive HCV antibody test and a negative HCV RNA assay, they are considered to have no evidence of current HCV infection; in this situation, further testing with a different HCV antibody assay can usually help to differentiate past (resolved) infection from a biologic false positive result. The 2013 HCV diagnostic testing sequence recommended by the CDC is not intended for diagnosing acute HCV infection.

Precautions for HCV-positive persons: Avoid alcohol as it can accelerate cirrhosis and end-stage liver disease; viral hepatitis patients should also check with a health professional before taking any new prescription pills, over-the counter drugs (such as non-aspirin pain relievers), or supplements, as these can potentially damage the liver.

Treatment Options:
There is not currently a vaccine or immunization for hepatitis C. That being said, new and improved treatments are available that can clear hepatitis C for many individuals.

There are a few treatment types available for HCV and they depend upon which genotype a patient has of the virus. Some prescription drugs for HCV have a high sustained virologic response (a cure marker) after 24-48 weeks of treatment, others have an even higher response.

Key Takeaways:

  • The hepatitis C virus (HCV) is a contagious infection that affects the liver; the virus was not identified until 1989.
  • The liver is a vital organ and its key roles include filtering the body’s blood, fighting infections and processing nutrients. When the liver is infected, inflamed or damaged, it can severely affect these important functions.
  • Hepatitis C is typically spread when HCV-infected bodily fluids, such as blood, semen and/or menstrual or vaginal fluids enter the body of an individual without the infection.
  • The best initial test is for HCV is the IgM antibody for acute infection, and IgG antibody for chronic HCV.
  • HCV is most commonly spread in the U.S. via shared drug equipment, but can also be transmitted by improperly sterilized tattooing equipment, or from an infected mother to her baby at birth.
  • Hepatitis C is more common in individuals born between 1945-1965.
  • Because there are multiple strains of HCV, an individual can be infected with more than one strain. This is very rare, and is likely linked to intravenous drug use.
  • Acute hepatitis C can display the following symptoms: fever, fatigue, nausea, loss of appetite, and vomiting, as well as joint pain, jaundice, stomach/abdominal pain, dark urine and/or gray-colored stool.
  • For unknown reasons, one out of five individuals infected with the acute hepatitis C will clear (or get rid of) it on their own within the first six months.
  • Chronic hepatitis C can result in liver damage, liver cancer, cirrhosis and even liver failure.
  • There is no 100 percent cure for hepatitis C, but there are treatment options available, some of which have dropped the viral load low enough to be considered inactive.
  • There is no vaccine to prevent against hepatitis C.
  • Get tested for hepatitis C.

Read Section 9 on HIV and HIV Testing.

Medically Reviewed by on February 5, 2024

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Author: Nick Corlis

Nick Corlis is a writer, marketer, and designer. He graduated from Texas State University in San Marcos, Texas, with a degree in Digital Communications. Nick is proud to be able to help eliminate the stigma of STD testing through his writing and is always trying to advocate the importance of your sexual health. Before STDcheck, his favorite way to develop his writing skills was by accepting various writing jobs in college and maintaining multiple blogs. Nick wears many hats here at STDcheck, but specifically enjoys writing accurate, well-researched content that is not only informative and relatable but sometimes also contains memes. When not writing, Nick likes to race cars and go-karts, eat Japanese food, and play games on his computer.