Some people live with hepatitis C for many years without knowing it. Unfortunately they will only become aware of hepatitis C when they develop serious liver problems. When people know their hepatitis C status they are able to make lifestyle choices to enhance their health. This may enable them to protect their liver and prevent serious liver damage, and prevent further transmission of the hepatitis C virus to others. In some cases, it may explain why people have been feeling unwell or fatigued or why certain foods or alcohol may make them feel unwell.
People should consider being tested if they:
- Have ever shared injecting drug equipment (sharing any equipment involved in injecting drug use is a risk of hepatitis C transmission).
- Have been in prison or detained – new, sterile equipment for injecting, tattooing or piercing is rarely available in prisons or detention centres which greatly increases the risk of hepatitis C transmission for people engaging in these practices. Violence, including sexual assault and rape, can and does occur in these settings and increases the risk of hepatitis C transmission in prison or detention settings.
- Have received a blood transfusion or blood products before February 1990 (in Australia). Up to ten percent of people in Australia with hepatitis C contracted it through the receipt of blood or blood products prior to this time. Since February 1990, all blood in Australia has been screened for hepatitis C and the blood supply is considered safe.
- Have received blood transfusions or blood products overseas.
- Have had a needlestick or other sharps injury.
- Are a healthcare worker who has engaged in exposure prone procedures.
- Have abnormal liver function tests.
- Have had renal dialysis.
- Have had unprotected sex (ie. didn't use condoms, dams or gloves) where there is blood present.
Preparing for Testing
Receiving as much information as possible about hepatitis C before getting tested may reduce any anxiety or fear about the process and the results. Talking with a GP or the Support Officer at the Hepatitis Council can be helpful and may allay any fears or anxiety a person may have.
Informed Consent
Doctors must obtain a persons consent before taking a blood test for hepatitis C. It is a doctor's responsibility to explain the test in terms people can understand. A doctor should explain the purpose of the test; the possible implications of a positive or negative result, and follow-up care and support options. This is referred to as pre and post-test discussion(s) and provides an opportunity for a patient and their doctor to discuss the behaviours and circumstances that present a risk of hepatitis C transmission. It is up to each individual to decide whether or not they wish to be tested, or whether they feel they can deal with a diagnosis of hepatitis C at this time in their life.
Antibody Testing for Hepatitis C
Testing for hepatitis C requires a blood sample to be taken. The sample is tested for antibodies to the hepatitis C virus (known as anti-HCV). Antibodies for hepatitis C will be produced by the immune system if a person has come in contact with the virus. It may take three to six months from the time of infection for antibodies to be produced in sufficient quantities to be detected in the blood. The six month period is known as the ‘window period’. During this time, it is possible for people who have been infected with hepatitis C virus to show a negative test result. Antibodies to hepatitis C do not protect a person from reinfection. People who clear the virus naturally or through treatment, will continue to carry antibodies.
A positive antibody test result shows there has been exposure to the hepatitis C virus. It does not show whether this is an acute (<6 months duration), chronic (>6 months duration), or resolved (past) infection. Nor does a positive antibody test indicate whether or not a person is still infectious. In the event of a positive antibody test result a second antibody test is done to confirm the result.
When a test result is confirmed positive the doctor should inform the patient in person, not by telephone. The doctor should also provide basic information about hepatitis C including: how the virus affects the body; preventing transmission to others; the long term impact of living with hepatitis C and available treatments. The doctor should also discuss healthy lifestyle information including: reducing alcohol consumption; information around disclosure, rights and confidentiality. Information is also available at the Hepatitis Council.
PCR (Polymerase Chain Reaction) Test
A PCR test will confirm whether or not the virus is still present. PCR testing involves looking for the genetic material of the hepatitis C virus in the blood and can confirm hepatitis C infection earlier than the antibody test. While the PCR test is more sensitive than the antibody test, it is expensive. Only limited access to Medicare covered PCR tests is available, and there are strict guidelines applying to its use. This test is sometimes done as a confirmatory test if the antibody test result is inconclusive. It can also be used to ascertain the viral load (level of virus in the blood), and the genotype of the virus which are useful in making treatment decisions. PCR testing is also approved for monitoring the effectiveness of hepatitis C treatment.
Genotype
Viruses can have a number of genotypes or strains. This means they have some differences in their genetic structure, but are similar enough to be considered the same type of virus. Genotype along with liver health, affects both the duration and the outcome of treatment for hepatitis C. Hepatitis C is generally considered to have six major genotypes, with each genotype having a number of sub-types. The most common genotypes found in Australia are 1 and 3 with the most common sub-types being 1a, 1b and 3a.
A Negative Test Result
A negative result could mean one of a number of things including:
- there has been no exposure to hepatitis C.
- the test was conducted during the `window period' (which can last up to six months) before the immune system has produced enough antibodies to be detected.
- insufficient quantities of antibodies have been produced to be detected even though the person has been infected.
The doctor will advise if a person should be tested again.
An Inconclusive Test Result
This means that a clear positive or negative result was not obtained. If this is the case the doctor may decide to wait a short time and then retest using a new blood sample, or may request the laboratory to perform a PCR test which is more sensitive than an antibody test.
Notification of Results
Hepatitis C is one of the many communicable or infectious diseases notified to the Health Department of WA. This allows the Department to allocate health care resources for affected people in WA, and to plan prevention strategies to further reduce spread of the virus in the future.
If a person tests positive for hepatitis C the doctor and the laboratory are required by law to inform the Health Department. While some personal details will be provided in this notification, the law requires that the Health Department ensures that the persons details remain confidential.
Receiving Results
It may take 7 – 14 days for the test results for antibodies to hepatitis C to be returned from a laboratory. When a test result is confirmed positive the doctor should inform the patient in person, not by telephone. The doctor should provide basic information about hepatitis C including: how the virus affects the body; preventing transmission to others; the long term impact of living with hepatitis C and available treatments. The doctor should also discuss healthy lifestyle information including: reducing alcohol consumption; information around disclosure, rights and confidentiality. The doctor may also discuss follow-up care and referral to a liver clinic or liver specialist. Information is also available at the Hepatitis Council.
Further tests for people with hepatitis C
While some people with hepatitis C are able to eliminate the virus from the body naturally (but can be still reinfected). Others will live with what is known as chronic (long-term) hepatitis C. People with chronic hepatitis C need to have their liver health monitored on a regular basis. The most common test (LFTs) used to ascertain liver health is explained below. A PCR test may be performed to check on the viral load (virus level) and, if there are causes for concern, an ultrasound or a liver biopsy may be performed. An ultrasound is also performed if someone is preparing to undertake hepatitis C treatment as it gives an accurate indication of the health of the liver.
Liver function tests (LFTs)
This test measures the level of enzymes normally produced by the liver and circulating in the blood in low levels. When the enzymes are found in the blood in higher levels it indicates that inflammation of the liver is present and damage may be occurring.
Alanine aminotransferase (ALT) is the enzyme most relevant in monitoring liver health. High ALT levels in the blood occur when liver cells are inflamed. High levels over a period of time can indicate that damage to the liver is occurring on a continuous basis. If this is the case the doctor will most likely refer a patient to a liver specialist for further tests.
Privacy and Confidentiality
Most professions are guided by a code of ethics that include mechanisms for preserving confidentiality. This means that health professionals like doctors and others (such as staff in doctors rooms and testing laboratories) are expected to keep a patient’s personal information private. Workers who disregard this can be held answerable to disciplinary procedures of the relevant professional body.
Research suggests that most people do not complain about breaches of confidence by professionals. It is in a patient’s and the profession's interest that legitimate complaints are made and investigated. Otherwise nothing changes. In rare instances professionals may have a duty to disclose or make known information to an appropriate third party if serious danger is likely to another person.
Support
It can take time to adjust to receiving a positive diagnosis for hepatitis C. Some people will manage this adjustment better than others. For information about hepatitis C, support in dealing with a diagnosis, or the diagnosis of a partner or family member, and treatment options, contact the Hepatitis Council on (08) 9227 9800 or 1800 800 070 (free call for country callers) and ask to speak to the Support Officer. Support may be provided over the telephone or face-to-face at the Council.
A free coffee morning (for people living with or affected by hepatitis) is held on the third Tuesday of each month at:
Hepatitis Council of WA
Level 4
102 James Street
NORTHBRIDGE
