Hepatitis C Testing

Hepatitis C is a condition in which an infection with the hepatitis C virus (HCV) causes inflammation and potential damage to the liver.

Hepatitis C tests are a group of blood tests that are performed to detect and diagnose HCV and to guide and monitor treatment of the infection.

Purpose of the test

The purpose of hepatitis C testing is to determine if a person has been infected by the hepatitis C virus, to evaluate a current or past infection, and to guide a patient’s treatment.

Hepatitis C is the most common form of viral hepatitis in the United States. HCV infections are classified as acute or chronic:

• Acute hepatitis C: Acute hepatitis C occurs in the first six months after a person is exposed to the virus. Early in the course of the illness, acute hepatitis C is mild and may cause no symptoms. For this reason, most people with acute hepatitis C do not know they have this infection. In about one quarter of patients, the immune system fights off the HCV infection and the virus is cleared from the body.
• Chronic hepatitis C: If a patient’s body isn’t able to fight off the virus, they will develop chronic hepatitis C. Progression from acute to chronic hepatitis C is common, occurring in about 75% to 85% of patients. Diagnosing chronic hepatitis C as early as possible is important because prompt treatment can prevent complications linked to this condition, including liver disease, liver failure, and liver cancer.

The hepatitis C virus is found in the blood and other body fluids of a person with this infection. In the United States, the most common way of becoming infected with hepatitis C is by sharing needles used to inject drugs.

Less commonly, a person is infected with hepatitis C in other ways, including during birth, through sex with a person infected with HCV, and by coming into contact with infected blood. Currently, there is no vaccine to prevent hepatitis C.

A doctor may order hepatitis C testing for screening, diagnosis, and to guide and monitor treatment:

• Screening: Screening tests look for a disease before a person has symptoms. Because acute hepatitis C often has no symptoms, screening is an important way to diagnose hepatitis C before it causes liver damage.
• Diagnosis: When a patient has signs or symptoms of viral hepatitis, doctors use hepatitis tests to diagnose the cause of hepatitis. Hepatitis C testing can distinguish HCV from other causes of hepatitis, including hepatitis A and hepatitis B.
• Treatment: Once a patient is diagnosed, tests can determine the specific type of hepatitis C. There are several types of hepatitis C and knowing the type helps to determine appropriate treatment. Hepatitis C testing can also measure the amount of virus in the blood. Measuring changes to the amount of HCV over time helps doctors understand if treatment is effective.

What does the test measure?

Hepatitis C testing identifies antibodies to the hepatitis C virus, detects viral RNA, and/or determines the strain of hepatitis C. Hepatitis C testing may involve several different tests:

• Hepatitis C antibody (anti-HCV) test: Antibodies are a part of the body’s response to an infection. Testing for hepatitis C antibodies determines whether or not a patient has been exposed to the hepatitis C virus at some point in their life. If this test is positive, the next step is to test for hepatitis C RNA which can tell you if you have a current infection.
• Hepatitis C RNA test: RNA is a type of genetic material from the hepatitis C virus that can be detected in the blood. If test results are positive after a hepatitis C antibody test, doctors use a hepatitis C RNA test to look for and/or measure the amount of the virus in the blood. Qualitative HCV RNA tests can detect the presence of HCV RNA, while quantitative HCV RNA tests measure the amount of HCV RNA. Understanding the amount of HCV in the blood helps to monitor response to treatment.
• Genotype test: There are at least six types of hepatitis C, which are also called strains or genotypes. Treatment for hepatitis C depends on the strain, so genotype testing to guide treatment is performed in patients who are diagnosed with an HCV infection.

When should I get hepatitis C testing?

When used for early detection in patients without symptoms of hepatitis C, screening is recommended at least once for all adults aged 18 years or older, except in locations with very low prevalence of HCV. Screening is also recommended during pregnancy and for patients of any age with risk factors for HCV infection. In patients with risk factors, periodic screening is recommended for as long as risk factors persist.

Risk factors for HCV include:

• Current or past injectable drug use
• Having a blood transfusion or organ transplant before July 1992
• Receiving kidney dialysis
• Having contact with needles, including at work and while getting tattoos or piercings
• Working or living in a prison
• Being born to a mother with hepatitis C
• Having an HIV infection
• Engaging in unprotected sex

Hepatitis C testing may be recommended for patients with symptoms of hepatitis or a known exposure to hepatitis C. If a patient develops symptoms of hepatitis without a known exposure to HCV, doctors typically order an acute viral hepatitis panel that looks for evidence of hepatitis A, B, and C in one sample of blood.

Although hepatitis C often causes no symptoms, patients may develop symptoms within one to three months after contracting the virus. Symptoms may include:

• Dark yellow urine
• Fatigue or tiredness
• Fever
• Clay- or gray-colored stools
• Pain in the abdomen or joints
• Nausea, vomiting, or loss of appetite
• Jaundice or yellowish skin and eyes

Hepatitis C testing may also be performed when liver tests are abnormal or when diagnosing the cause of existing liver damage.

How to get tested

Hepatitis C testing is performed by a doctor. Testing requires a blood sample, which can be collected in a hospital, lab, or other medical setting. Blood is often drawn from a vein in the arm or, in children, taken by pricking the skin. After blood is collected, the sample is sent to a laboratory for analysis.

Can I take the test at home?

At-home hepatitis C tests are available that allow patients to collect a blood sample at home and mail it to a laboratory for testing. Test samples are collected through pricking a finger with a sharp object, called a lancet, that’s included in the test kit.

At-home HCV testing is a form of hepatitis C antibody testing and does not test for hepatitis C RNA or the strain’s genotype. Testing for hepatitis C at home is not a substitute for testing performed by a health care professional, and positive test results may need to be confirmed by laboratory-based testing.

How much does the test cost?

The cost of hepatitis C testing depends on the tests that are performed, where the test is conducted, and a patient’s health insurance coverage. When testing is ordered by a doctor, patients with health insurance may find it helpful to discuss the cost of hepatitis C testing with their insurance company. In addition to the cost of testing, there may be other out-of-pocket costs such as copays and deductibles.

For patients without health insurance, or for whom insurance doesn’t cover the cost of testing, it may be helpful to discuss the cost of hepatitis C testing with a doctor or hospital administrator.

At-home hepatitis C testing starts around $49. Some at-home kits test for multiple types of viral hepatitis at once, with the cost of these panels starting around $80.

Hepatitis C testing is conducted on a sample of blood. Blood samples can be collected by a doctor, nurse, technician, or other health care provider from an adult patient’s vein using a small needle or a skin prick on a child’s heel.

For an at-home hepatitis C test, patients collect a blood sample according to the manufacturer’s directions. Instructions provided in the test kit detail the steps to obtain a small sample of blood and mail it for testing.

Before the test

No preparation is needed prior to hepatitis A testing. Before the test, though, patients should tell their doctor about any medications they’re taking for hepatitis or other medical conditions.

During the test

For adults, collecting a blood sample for laboratory-based testing involves several steps. First, an appropriate vein is located, usually on the arm or the back of the hand. Next, the health care provider may tie a tourniquet around a patient’s arm to increase blood flow. The provider then cleans the site with an antiseptic to kill germs on the skin. After the site is prepared, a small needle attached to a vial is inserted into the vein, allowing blood to be collected.

Drawing blood usually lasts less than five minutes. While side effects are typically minimal, there may be some bruising and throbbing around the puncture site as well as discomfort when the needle is inserted and withdrawn.

When an infant or child is tested for hepatitis C, blood is obtained through a skin prick. In this method of collecting blood, a small tool called a lancet is used to puncture the skin. After creating a small puncture, a few drops of blood are collected into a glass tube or vial. This process takes less than a minute, causing only a small sting when the skin is punctured.

Taking an at-home hepatitis C test also involves using a lancet to puncture the skin and then collecting a small sample of blood. Test kit instructions vary, so it’s important for patients to read all instructions before obtaining their blood sample.

After the test

After a blood draw or skin puncture is completed, a health care provider may apply a bandage to reduce additional bleeding. Patients may experience some light bruising and tenderness at the puncture site. There are no restrictions on activities once the blood sample is collected.

Receiving test results

It can take up to several business days before patients receive results of laboratory-based hepatitis C testing. Results may be communicated by the patient’s doctor during a follow-up appointment. Patients may also receive results by phone, mail, or electronically.

In some medical offices, patients may receive a rapid test for HCV antibodies. This test provides results in 20 to 30 minutes, so patients may be told their results during that appointment.

At-home hepatitis C test results may be shared through the testing company’s website or smartphone application. Results are often available several days after the laboratory receives the test sample.

Interpreting test results

Interpreting hepatitis C test results requires evaluating the results of several tests at the same time and is best done under the guidance of a doctor or specialist.

In general, an HCV antibody test is reported as positive or negative, but it may also be reported as reactive or non-reactive. The results of quantitative HCV RNA testing are reported as a number of virus copies present, also called the viral load. If no virus is present or if the amount of viral load is too low to detect, the result is often reported as negative or not detected. Potential interpretations of hepatitis C test results include:

When used to determine the best treatment for HCV, a genotype test result identifies the strain of hepatitis C detected in the test sample. Doctors consider the virus’s strain as well as the health of the patient’s liver and other factors when determining treatment.

Diagnosing chronic hepatitis C involves testing positive for both anti-HCV and HCV RNA six months or more after initial infection.

Are test results accurate?

Although no test is perfect, hepatitis C testing is an important and accepted method of testing for HCV. In order to reduce the risk of inaccurate results, doctors take steps to verify a patient’s diagnosis. For example, a positive test result for hepatitis C antibody requires confirmation with HCV RNA testing.

Do I need follow-up tests?

After hepatitis C testing, the need for follow-up tests depends on initial test results. For patients who are diagnosed with hepatitis C, follow-up tests may be used to monitor the health of the liver and guide treatment choices. Doctors may also test for other infections that are spread in the same way as HCV, including HIV and hepatitis B.

During treatment for HCV, the amount of virus in the blood is monitored using quantitative HCV RNA tests. A high or increasing viral load may mean that treatment is not working. A low, decreasing, or undetectable viral load usually means that the treatment is working.

Questions for your doctor about test results

Patients receiving hepatitis C testing may find it helpful to ask questions about their test results. Questions to consider include:

• What type of hepatitis C test(s) did I receive?
• What was my test result?
• How do you interpret the results of the hepatitis C tests that I had?
• Do I need any follow-up tests based on my test result?

Sources

A.D.A.M. Medical Encyclopedia. Venipuncture. Updated April 26, 2019. Accessed July 18, 2021. https://medlineplus.gov/ency/article/003423.htm

A.D.A.M. Medical Encyclopedia. Hepatitis virus panel. Updated October 29, 2020. Accessed July 18, 2021. https://medlineplus.gov/ency/article/003558.htm

A.D.A.M. Medical Encyclopedia. Antigen. Updated July 2, 2020. Accessed July 18, 2021. https://medlineplus.gov/ency/article/002224.htm

A.D.A.M. Medical Encyclopedia. Antibody. Updated July 2, 2020. Accessed July 18, 2021. https://medlineplus.gov/ency/article/002223.htm

ARUP Consult. Acute viral hepatitis. Updated April 2021. Accessed July 18, 2021. https://arupconsult.com/content/hepatitis-acute

ARUP Consult. Hepatitis C Virus: HCV. Updated April 2021. Accessed July 18, 2021. https://arupconsult.com/content/hepatitis-c-virus

Centers for Disease Control and Prevention. Interpretation of results of tests for hepatitis C virus (HCV) infection and further actions. Published 2013. Accessed July 18, 2021. https://www.cdc.gov/hepatitis/HCV/PDFs/hcv_graph.pdf

Centers for Disease Control and Prevention. Hepatitis C testing: What to expect when getting tested. Published April 2020. Accessed July 18, 2021. https://www.cdc.gov/hepatitis/HCV/PDFs/HepCGettingTested.pdf

Centers for Disease Control and Prevention. CDC recommendations for hepatitis C screening among adults: United States, 2020. Published April 10, 2020. Accessed July 18, 2021. https://www.cdc.gov/mmwr/volumes/69/rr/rr6902a1.htm

Centers for Disease Control and Prevention. Hepatitis C questions and answers for health professionals. Updated August 7, 2020. Accessed July 18, 2021. https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm

Chopra S, Pockros PJ. Overview of the management of chronic hepatitis C virus infection. In: Bisceglie AMD, ed. UpToDate. Updated June 12, 2020. Accessed July 18, 2021. https://www.uptodate.com/contents/overview-of-the-management-of-chronic-hepatitis-c-virus-infection

Chopra S, Arora S. Screening and diagnosis of chronic hepatitis C virus infection. In: Bisceglie AMD, ed. UpToDate. Updated July 15, 2020. Accessed July 18, 2021. https://www.uptodate.com/contents/screening-and-diagnosis-of-chronic-hepatitis-c-virus-infection

Feld JJ. Clinical manifestations, diagnosis, and treatment of acute hepatitis C virus infection in adults. In: Bisceglie AMD, ed. UpToDate. Updated August 13, 2020. Accessed July 18, 2021. https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-treatment-of-acute-hepatitis-c-virus-infection-in-adults

Kumar S. Overview of hepatitis. Merck Manual Consumer Edition. Updated January 2021. Accessed July 18, 2021. https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/hepatitis/overview-of-hepatitis

Kumar S. Overview of acute viral hepatitis. Merck Manual Consumer Edition. Updated January 2021. Accessed July 18, 2021. https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/hepatitis/overview-of-acute-viral-hepatitis

Kumar S. Overview of chronic hepatitis. Merck Manual Consumer Edition. Updated January 2021. Accessed July 18, 2021. https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/hepatitis/overview-of-chronic-hepatitis

Kumar S. Hepatitis C, acute. Merck Manual Consumer Edition. Updated January 2021. Accessed July 18, 2021. https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/hepatitis/hepatitis-c-acute

Kumar S. Hepatitis C, acute. Merck Manual Professional Edition. Updated January 2021. Accessed July 18, 2021. https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/hepatitis/hepatitis-c-acute

Kumar S. Hepatitis C, chronic. Merck Manual Professional Edition. Updated January 2021. Accessed July 18, 2021. https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/hepatitis/hepatitis-c-chronic

Kumar S. Hepatitis C, chronic. Merck Manual Consumer Edition. Updated January 2021. Accessed July 18, 2021. https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/hepatitis/hepatitis-c-chronic

MedlinePlus: National Library of Medicine. Hepatitis testing. Updated July 6, 2016. Accessed July 16, 2021. https://medlineplus.gov/hepatitistesting.html

MedlinePlus: National Library of Medicine. Health screening. Updated April 23, 2020. Accessed July 16, 2021. https://medlineplus.gov/healthscreening.html

MedlinePlus: National Library of Medicine. Hepatitis panel. Updated July 31, 2020. Accessed July 16, 2021. https://medlineplus.gov/lab-tests/hepatitis-panel/

MedlinePlus: National Library of Medicine. What you need to know about blood testing. Updated March 9, 2021. Accessed July 16, 2021. https://medlineplus.gov/lab-tests/what-you-need-to-know-about-blood-testing/

Samji NS. Viral hepatitis. Anand BS, ed. Medscape. Updated June 16, 2017. Accessed July 16, 2021. https://emedicine.medscape.com/article/775507-overview

National Heart, Lung, and Blood Institute. Blood tests. Date unknown. Accessed July 16, 2021. https://www.nhlbi.nih.gov/health-topics/blood-tests

National Institute of Diabetes and Digestive and Kidney Diseases. What Is viral hepatitis?. Updated May 2017. Accessed July 12, 2021. https://www.niddk.nih.gov/health-information/liver-disease/viral-hepatitis/what-is-viral-hepatitis

National Institute of Diabetes and Digestive and Kidney Diseases. Hepatitis C. Updated March 2020. Accessed July 12, 2021. https://www.niddk.nih.gov/health-information/liver-disease/viral-hepatitis/hepatitis-c