Sunday, May 20, 2012

Hepatitis C Testing- the Fine Print

Yesterday's blog focused on the CDC's new recommendation for ALL BABY BOOMERS to be tested for Hepatitis C, regardless of their other risk factors. The rational is to diagnose this often silent disease early, while treatment can make the most impact saving lives and improving quality of lives. While hepatitis C is largely transmitted via IV drug abuse (which obviously people can identify as a risk factor), there is a significant chunk- usually quoted around 10%- of people who have NO KNOWN risk factors.

So what's the fine print about the testing? First of all, the Hep C test is a blood test (just a heads up for the needle-phobics out there.) Mainly, however, the issues about testing surround the results.

A negative result is wonderful- there is extremely low chance that you have the disease and the test missed it, because this is a very sensitive test.

A positive result, however, leads to a much longer discussion. A positive Hep C Antibody test (the screening test) cannot tell you how long you have been infected. More testing is now required. The next step will be to have a different blood test that measures "viral load"- actually looking for the amount of Hep C virus present in your system. Other blood tests will measure your liver "function" to see if it looks inflamed.  Your doctor may also test to determine the subtype of Hep C in order to better advise you regarding the potential response to therapy. By the way, All positive tests for Hep C will be reported to the health department. This should not to make you paranoid, as your insurance company will obviously know as well, but simply something to note.

If your screening test was positive but your viral load does NOT show any current presence of Hep C, and your liver enzymes are normal- you will be considered to have recovered from a prior Hep C infection, and part of the lucky 15-25% who do not progress to chronic disease.

 If your screening test is positive, your viral load is elevated, but your liver enzymes are normal and you feel fine- you may be a Hep C Carrier, and most people in this category do not require immediate treatment. Carriers are followed closely to be sure they are not having silent worsening of disease (as measured by deteriorating blood tests or symptoms), holding off on treatment until there has been a change.

If your screening test is positive, your viral load is high, and your liver enzymes are abnormal or you have significant symptoms, then you will be heading to a liver specialist to discuss treatments. Though the treatment for Hep C can be challenging, between 50-80% of patients have sustained (successful) responses to treatment, depending on their subtype and how long the disease has been present.

BOTTOM LINE: Baby Boomers should talk with their doctors about getting tested for Hepatitis C, but recognize the results may initially create more additional questions than answers. 


shahidul islam said...

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Sandy S said...

How would you interpret a reactive Hep C, high LFT's (AST- 700, and AST- 900) and a viral load of 5 when <5 is considered undetectable?