At a Glance
Why Get Tested?
To screen for and diagnose a hepatitis C virus (HCV) infection and to monitor treatment of the infection
When to Get Tested?
For screening: when you have risk factors for HCV infection or were born between 1945 and 1965, per 2012 CDC recommendations
For diagnosis: when you may have been exposed to the hepatitis C virus, such as through contact with infected blood, or have symptoms associated with liver disease
A blood sample drawn from a vein in your arm
Test Preparation Needed?
The Test Sample
What is being tested?
Hepatitis C (HCV) is a virus that causes an infection of the liver that is characterized by liver inflammation and damage. Hepatitis C tests are a group of tests that are performed to detect, diagnose, and monitor the treatment of a hepatitis C viral infection. The most common test for HCV looks for antibodies in the blood that are produced in response to an HCV infection. Other tests detect the presence of viral RNA, the amount of viral RNA present, or determine the specific subtype of the virus.
Hepatitis C is one of six hepatitis viruses identified so far, including A, B, D, E, and G, that are known to cause the disease. HCV is spread by exposure to contaminated blood, primarily though the sharing of needles by intravenous drug users, but also by sharing personal items contaminated by blood such as razors, through sex with an infected person, via health care occupational exposure, and, less commonly, from mother to baby during childbirth. Before tests for HCV became available in the 1990s, HCV was often transmitted by blood transfusions.
While HCV is not as contagious as Hepatitis B, there is currently no vaccine to prevent infection. Hepatitis C infection is a common cause of chronic liver disease in North America. An estimated 4.1 million people in the United States have been exposed to the virus, and 3.2 million people are living with a current infection. Up to 85% of those who have it will become chronically infected after their acute infection resolves.
Many of those who are infected have no symptoms and are not aware of the condition. The acute HCV infection may cause few to mild nonspecific symptoms, and the chronic infection may simmer quietly for a decade or two before causing sufficient liver damage to affect liver function.
Hepatitis C infections cause increased risk of developing some other serious conditions:
- About 60-70% of those infected will develop chronic liver disease.
- About 5-20% will develop cirrhosis over 20 years; recent projections suggest that almost 45% will eventually develop cirrhosis.
- HCV causes death in about 1-5% of those chronically infected who develop cirrhosis or liver cancer.
Hepatitis C antibody tests are used to screen individuals for the infection, including, for example, people with no signs or symptoms but with risk factors, people who have symptoms associated with hepatitis or liver disease, or those who have been exposed to the virus. Since the antibody test can remain positive in most people even if they have cleared the infection, a positive antibody test is followed by a hepatitis C RNA test, which detects genetic material of the virus. A positive result on the RNA test means the virus is present, the infection has not resolved, and the person may require treatment. The hepatitis C genotype test determines which type of virus is present to help guide treatment.
How is the sample collected for testing?
A blood sample is taken by needle from a vein in the arm.
NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.
Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.
Is any test preparation needed to ensure the quality of the sample?
No test preparation is needed.
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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.
Sources Used in Current Review
(© 2009) Ghany M, et al. Diagnosis, Management and Treatment of Hepatitis C, An Update. Hepatology, the American Association for the Study of Liver Diseases Practice Guidelines. Available online through http://www.aasld.org. Accessed July 2013.
(May 10, 2013) Centers for Disease Control and Prevention. Testing for HCV Infection: An Update of Guidance for Clinicians and Laboratorians. MMWR May 10, 2013 / 62(18);362-365. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6218a5.htm through http://www.cdc.gov. Accessed June 2013.
(2013) Centers for Disease Control and Prevention. Interpretation of Results of Tests for Hepatitis C Virus (HCV) Infection and Further Actions. PDF available for download at http://www.cdc.gov/hepatitis/HCV/PDFs/hcv_graph.pdf through http://www.cdc.gov. Accessed June 2013.
(1999) U.S. Food and Drug Administration. Device Approvals and Clearances. Home Access Hepatitis C Checksm and Hepatitis C Checksm Express. Available online at http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfTopic/pma/pma.cfm?num=P980046 through http://www.fda.gov. Accessed June 2013.
Fischbach, F.T. (2004). A Manual of Laboratory & Diagnostic Tests. 7th Edition., Lippincott Williams & Wilkins, Philadelphia.
(July 8, 2008) Centers for Disease Control and Prevention. Hepatitis C Information for Professionals. Available online at http://www.cdc.gov/hepatitis/HCV/index.htm through http://www.cdc.gov. Accessed July 2013.
(July 21, 2008) Centers for Disease Control and Prevention. Hepatitus C FAQs for Professionals. Available online at http://www.cdc.gov/hepatitis/HCV/HCVfaq.htm through http://www.cdc.gov. Accessed July 2013.
(May 10, 2013) Centers for Disease Control and Prevention. Vital Signs: Evaluation of Hepatitis C Virus Infection Testing and Reporting — Eight U.S. Sites, 2005–2011. MMWR 62(18);357-361. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm62e0507a1.htm?s_cid=mm62e0507a1_w through http://www.cdc.gov. Accessed May 14, 2013.
Ly K, et al. The Increasing Burden of Mortality From Viral Hepatitis in the United States Between 1999 and 2007. Ann Intern Med, February 21, 2012 vol. 156 no. 4 271-278. Available online http://www.annals.org/content/156/4/271.full through http://www.annals.org through http://www.annals.org. Accessed July 2013.
Rein D, et al. The Cost-Effectiveness of Birth-Cohort Screening for Hepatitis C Antibody in U.S. Primary Care Settings. Ann Intern Med, February 21, 2012, vol. 156 no. 4, 263-269. Available online at http://www.annals.org/content/156/4/263-270 through http://www.annals.org through http://www.annals.org. Accessed July 2013.
Alter HJ, Liang TJ. Hepatitis C. The End of the Beginning and Possibly the Beginning of the End. Ann Intern Med, February 21, 2012, vol 156 no. 4, 317-318. Available online at http://www.annals.org/content/156/4/317 through http://www.annals.org. Accessed July 2013.
Makiko Kitamura (Mar 14, 2012). Former Merck Unit Works on First Vaccine for Hepatitis C. Bloomberg. Available online at http://www.bloomberg.com/news/2012-03-14/former-merck-unit-works-on-first-vaccine-for-hepatitis-c.html through http://www.bloomberg.com. Accessed July 2013.
Centers for Disease Control and Prevention. Recommendations for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born During 1945–1965. Prepared by Smith, Bryce D. et al. MMWR. August 17, 2012. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6104a1.htm?s_cid=rr6104a1_w through http://www.cdc.gov. Accessed July 2013.
Sources Used in Previous Reviews
Clinical Chemistry: Principles, Procedures, Correlations. Michael L. Bishop, Janet L. Duben-Engelkirk, Edward P. Fody. Lipincott Williams & Wilkins, 4th Edition.
The Hepatitis Information Network. Diagnostic Tests for Hepatitis C. By David Gretch, MD, PhD. Available online at http://www.hepnet.com/nih/gretch.html through http://www.hepnet.com.
(Updated 2009 June 9). Hepatitis C FAQs for the Public. CDC [On-line information]. Available online at http://www.cdc.gov/hepatitis/C/cFAQ.htm#overview through http://www.cdc.gov. Accessed January 2010.
(2009 April). What I need to know about Hepatitis C. National Digestive Diseases Information Clearinghouse [On-line information]. Available online at http://digestive.niddk.nih.gov/ddiseases/pubs/hepc_ez/index.htm through http://digestive.niddk.nih.gov. Accessed January 2010.
(Updated 2009 December 16). Hepatitis C: For Patients and the Public. United States Department of Veterans Affairs [On-line information]. Available online at http://www.hepatitis.va.gov/vahep?page=pt-home through http://www.hepatitis.va.gov. Accessed January 2010.
Hillyard, D. and Slev, P. (Updated 2009 November). Hepatitis C Virus – HCV. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/HCV.html?client_ID=LTD through http://www.arupconsult.com. Accessed January 2010.
Mayo Clinic Staff (2009 September 12). Hepatitis C. MayoClinic.com [On-line information]. Available online at http://www.mayoclinic.com/health/hepatitis-c/DS00097/METHOD=print through http://www.mayoclinic.com. Accessed January 2010.
Ford, A. (2009 April). Singing new tunes for hepatitis testing. CAP Today Feature Story [On-line information]. Available online at http://www.cap.org/apps/portlets/contentViewer/show.do?printFriendly=true&contentReference=cap_today%2F0409%2F0409a_singing_new_tunes.html through http://www.cap.org. Accessed January 2010.
Mukherjee, S. and Dhawan, V. (Updated 2009 June 18). Hepatitis C: Differential Diagnoses & Workup. eMedicine [On-line information]. Available online at http://emedicine.medscape.com/article/177792-diagnosis through http://emedicine.medscape.com. Accessed January 2010.
Pagana, K. D. & Pagana, T. J. (© 2007). Mosby's Diagnostic and Laboratory Test Reference 8th Edition: Mosby, Inc., Saint Louis, MO. Pp 526-530.
Clarke, W. and Dufour, D. R., Editors (© 2006). Contemporary Practice in Clinical Chemistry: AACC Press, Washington, DC. Pp 492-493.
Wu, A. (© 2006). Tietz Clinical Guide to Laboratory Tests, 4th Edition: Saunders Elsevier, St. Louis, MO. Pp 544-547.
(July 8, 2008) Centers for Disease Control and Prevention: Hepatitis C Information for Health Professionals. Available online at http://www.cdc.gov/hepatitis/HCV/index.htm through http://www.cdc.gov. Accessed February 2010.
Davis GL, et al. Aging of Hepatitis C Virus (HCV)-Infected Persons in the United States: A Multiple Cohort Model of HCV Prevalence and Disease Progression. Gastroenterology. 2010 Feb;138(2): 513-521.
Sinnema, J. University of Alberta researchers move closer to hepatitis C vaccine. Postmedia News. February 15, 2012. Available online at http://www.canada.com/health/University+Alberta+researchers+move+closer+hepatitis+vaccine/6159502/story.html?id=6159502 through http://www.canada.com. Accessed February 2012.
Centers for Disease Control and Prevention. Recommendations for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born During 1945–1965. Prepared by Smith, Bryce D. et al. MMWR. August 17, 2012. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6104a1.htm?s_cid=rr6104a1_w through http://www.cdc.gov. Accessed August 2012.