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Hepatitis C Follow-Up Testing Recommended for All Positive Screening Tests

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June 13, 2013

Hepatitis C (HCV), a virus that infects the liver and can slowly damage it, has been in the news again recently. Significant advances in the development of antiviral drugs to treat hepatitis C infections along with the development of new HCV testing technologies has led the Centers for Disease Control and Prevention (CDC) to issue new guidelines for HCV testing. These guidelines recommend that testing for HCV infection begin with either a rapid or a laboratory-conducted test for HCV antibodies in blood. If antibodies are detected, a follow-up test to detect the presence of the virus should be performed.

Since antibodies remain in the blood long after an infection has resolved, the HCV screening test indicates only that a person was infected at some point in time. It cannot indicate whether that person is currently infected. To identify a current infection, a blood test that detects the genetic material (RNA) of the virus is needed. If the RNA test is positive, the virus is present in the person's body and the infection is an active one. This result indicates that the person should be evaluated for treatment. Viral testing will usually be done again during and after treatment to verify that the virus has been eradicated.

According to the CDC, about three million Americans are infected with hepatitis C, but too many of those infected are not aware that they harbor the virus. Hepatitis C is a leading cause of liver cancer and the most common indication for liver transplants. Liver cancer is the fastest-rising cause of cancer-related death in the U.S. Data from the U.S. Department of Health and Human Services show that hepatitis C deaths have nearly doubled over the past 10 years and currently account for over 15,000 deaths annually.

Only half of all Americans identified as having hepatitis C antibodies on screening tests have had a follow-up test to determine if active virus is present. CDC Director Tom Frieden, MD, MPH said, "…complete testing is critical to ensure that those who are infected receive the care and treatment for hepatitis C that they need in order to prevent liver cancer and other serious and potentially deadly health consequences."

Hepatitis C is usually spread when blood from a person infected with the HCV enters the body of someone who is not infected. The most common form of transmission is sharing needles or other equipment to inject drugs. Before 1992, when widespread screening of the blood supply began in the U.S., HCV was also commonly spread through blood transfusions and organ transplants. There are other, less common routes of exposure, such as sharing personal items like razors or tooth brushes.

"Hepatitis C has few noticeable symptoms, and left undiagnosed it threatens the health of far too many Americans – especially baby boomers," said John Ward, MD, Director of CDC's Division of Viral Hepatitis. "Identifying those who are currently infected is important because new effective treatments can cure the infection better than ever before, as well as eliminate the risk of transmission to others."

For these reasons, the CDC recommends that everyone in the United States born from 1945 through 1965 be screened for hepatitis C. Other groups at risk and who should be tested include people who received blood transfusions or organ transplants before 1992 and anyone who has ever injected drugs. (See the article New CDC Reports Urge Age-Based Screening to Reduce Rising Tide of Hepatitis C Deaths among Baby-Boomer Generation).

Those with a positive screening test will want to get follow-up testing to determine if they have active infection that will require treatment. While in a small number of cases people are cured of hepatitis C with no treatment, the majority (75-85%) can harbor the infection and go on to develop chronic HCV with significant health problems unless they receive effective treatment. Newer, more effective options for treating hepatitis C can help those with chronic infections.

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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. To access online sources, copy and paste the URL into your browser.

(May 10, 2013) Centers for Disease Control and Prevention. Testing for HCV Infection: An Update of Guidance for Clinicians and Laboratorians. MMWR 62(18);362-365. Available online at through Accessed May 14, 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 through Accessed May 14, 2013.

(May 8, 2013) Young, Kelly. Hepatitis C RNA Testing Recommended for All Positive HCV Antibody Tests. JournalWatch. Available online at through Accessed May 14, 2013.

(May 19, 2013) Smith, Michael. Incomplete HCV Testing Common, CDC Says. Medpage Today. Available online at through Accessed May 14, 2013.

(May 7, 2013) CDC Features. Hepatitis C: Testing Baby Boomers Saves Lives. Available online at through Accessed May 14, 2013.