C - Frequently Asked Questions
Centers for Disease Control, Prevention Diagnosis and Testing & NATAP
What is hepatitis C?
Hepatitis C is a liver disease caused by the hepatitis C virus (HCV), which is found in the blood of persons who have this disease. HCV is spread by contact with the blood of an infected person.
What is Co-Infection?
When a person has HIV and Hepatitis C it's called co-infection. It's estimated that 60-90% of everyone who got HIV through IV drug use also has HCV. If you have HIV you should be tested for HCV. A co-infected person should also be tested for hepatitis A and B. If negative for hepatitis A one should consider getting the hepatitis A vaccine, because getting hepatitis A can be very harmful if you have HIV.
What blood tests are available to check for hepatitis C?
There are several blood tests that can be done to determine if you have been infected with HCV. Your doctor may order just one or a combination of these tests. The following are the types of tests your doctor may order and the purpose for each:
Anti-HCV (antibody to HCV):
EIA (enzyme immunoassay) - This test is usually done first. If positive, it should be confirmed
RIBA (recombinant immunoblot assay) - A supplemental test used to confirm a positive EIA test
Anti-HCV does not tell whether the infection is new (acute), chronic (long-term) or is no longer present.
Qualitative tests to detect presence or absence of virus (HCV RNA. The Food and Drug Administration (FDA) just approved the Roche qualitative PCR test):
Generic polymerase chain reaction (PCR)
Quantitative tests to detect amount (titer) of virus (HCV RNA). Roche is submitting its quantitative PCR test to the FDA for approval:
Amplicor HCV MonitorTM
Quantiplex HCV RNA (bDNA)
A single positive PCR test indicates infection with HCV. A single negative test does not prove that a person is not infected. Virus may be present in the blood and just not found by PCR. Also, a person infected in the past who has recovered may have a negative test. When hepatitis C is suspected, such when a person got HIV by IVDU, and PCR is negative, PCR should be repeated.
Can you have a "false positive" anti-HCV test result?
Yes. A false positive test means the test looks as if it is positive, but it is really negative. This happens more often in persons who have a low risk for the disease for which they are being tested. For example, false positive anti-HCV tests happen more often in persons such as blood donors who are at low risk for hepatitis C. Therefore, it is important to confirm a positive anti-HCV test with a supplemental test as most false positive anti-HCV tests are reported as negative on supplemental testing.
Can you have a "false negative" anti-HCV test result?
Yes. Persons with early infection may not as yet have developed antibody levels high enough that the test can measure. In addition, some persons may lack the (immune) response necessary for the test to work well. In these persons, research-based tests such as PCR may be considered. Persons with HIV may test false-positive. So you should re-test if you have HIV and get a false-positive.
How long after exposure to HCV does it take to test positive for anti-HCV?
Anti-HCV can be found in 7 out of 10 persons when symptoms begin and in about 9 out of 10 persons within 3 months after symptoms begin. However, it is important to note that many persons who have hepatitis C have no symptoms.
It is possible to find HCV within 1 to 2 weeks after being infected with the virus.
Who should get tested for hepatitis C?
persons who ever injected illegal drugs, including those who injected once or a few times many years ago
who were treated for clotting problems with a blood product made before 1987
when more advanced methods for manufacturing the products were developed
who were notified that they received blood from a donor who later tested
positive for hepatitis C
who received a blood transfusion or solid organ transplant before July 1992
when better testing of blood donors became available
who have signs or symptoms of liver disease (e.g., abnormal liver enzyme
workers after exposures (e.g., needle sticks or splashes to the eye ) to HCV-positive
blood on the job
born to HCV-positive women
is the next step If you have a confirmed positive anti-HCV test?
the level of ALT ( alanine aminotransferase, a liver enzyme) in the blood. An
elevated ALT indicates inflammation of the liver and you should be checked
further for chronic (long-term) liver disease and possible treatment. The
evaluation should be done by a healthcare professional familiar with chronic
you have a normal liver enzyme (e.g., ALT) level and still have chronic
It is common for persons with chronic hepatitis C to have a liver enzyme level
that goes up and down, with periodic returns to normal or near normal. Some
persons have a liver enzyme level that is normal for over a year but they still
have chronic liver disease. If the liver enzyme level is normal, persons should
have their enzyme level re-checked several times over a 6 to 12 month period. If
the liver enzyme level remains normal, your doctor may check it less frequently,
such as once a year.
a co-infected person may have normal ALT but still have moderate to severe liver
damage (fibrosis). It may be necessary to do a biopsy to properly assess liver
condition. Biopsy ought to be considered as soon as HCV diagnosis is known in
order to assess liver damage, because HCV may progress more quickly when a
person also has HIV. Rapid HCV progression, within 2 years, has been seen in
coinfection. One small study suggests HCV may progress the same as if a person
had HCV without HIV if they are receiving HIV therapy with HAART (CD4s above
200). But, liver damage, progression, and silent progression to cirrhosis may
occur prior to being treated for HIV even with CD4s above200. In another study,
21% of HCV/HIV coinfected persons had minimal liver damage.
Is HCV Spread from One Person to Another?
could a person have gotten hepatitis C?
is spread primarily by direct contact with human blood. For example, you may
have gotten infected with HCV if:
ever injected street drugs, as the needles and/or other drug "works"
used to prepare or inject the drug(s) may have had someone else's blood that
contained HCV on them
received blood, blood products, or solid organs from a donor whose blood
were ever on long-term kidney dialysis as you may have unknowingly shared
supplies/equipment that had someone else's blood on them
were ever a healthcare worker and had frequent contact with blood on the job,
especially accidental needlesticks
mother had hepatitis C at the time she gave birth to you. During the birth her
blood may have gotten into your body
ever had sex with a person infected with HCV
lived with someone who was infected with HCV and shared items such as razors or
toothbrushes that might have had his/her blood on them
there any evidence that HCV has been spread during medical or dental procedures
done in the United States?
and dental procedures done in most settings in the United States do not pose a
risk for the spread of HCV. There have, however, been some reports that HCV has
been spread between patients in hemodialysis units where supplies or equipment
may have been shared between patients.
HCV be spread by sexual activity?
but this does not occur very often. See section on counseling for more
information on hepatitis C and sexual activity.
HCV be spread by oral sex?
is no evidence that HCV has been spread by oral sex. See section on counseling
for more information on hepatitis C and sexual activity.
HCV be spread within a household?
but this does not occur very often. If HCV is spread within a household, it is
most likely due to direct exposure to the blood of an infected household member.
more advanced tests have been developed for use in blood banks, what is the
chance now that a person can get HCV infection from transfused blood or blood
chance out of 100,000, per each transfused unit.
Pregnancy and Breast Feeding
pregnant women be routinely tested for anti-HCV?
women have no greater risk of being infected with HCV then non-pregnant women.
If pregnant women have risk factors (HIV) for hepatitis C, they should be tested
is the risk that HCV infected women will spread HCV to their newborn infants?
5 out of every 100 infants born to HCV infected women become infected. This
occurs at the time of birth, and there is no treatment that can prevent this
from happening. Most infants infected with HCV at the time of birth have no
symptoms and do well during childhood. More studies are needed to find out if
these children will have problems from the infection as they grow older. There
are no licensed treatments or guidelines for the treatment of infants or
children infected with HCV. Children with elevated ALT (liver enzyme) levels
should be referred for evaluation to a specialist familiar with the management
of children with HCV-related disease.
risk may be greater if a person has
HIV. One study conducted in Italy found that 17 out of every 100 infants born to
HCV infected women with HIV became infected
a woman with hepatitis C be advised against breast-feeding?
is no evidence that breast-feeding spreads HCV. HCV-positive mothers should
consider abstaining from breast-feeding if their nipples are cracked or
bleeding. But one study found HCV in breastmilk. However, it's uncertain if its
should babies born to mothers with hepatitis C be tested to see if they were
infected at birth?
should not be tested for anti-HCV before 12 months of age as anti-HCV from the
mother may last until this age. If testing is desired prior to 12 months of age,
PCR could be performed at or after an infant's first well-child visit at age 1-2
can persons infected with HCV prevent spreading HCV to others?
not donate blood, body organs, other tissue, or semen.
not share personal items that might have your blood on them, such as
toothbrushes, dental appliances, nail-grooming equipment or razors.
your cuts and skin sores to keep from spreading HCV.
can a person protect themselves from getting hepatitis C and other diseases
spread by contact with human blood?
ever shoot drugs. If you shoot drugs, stop and get into a treatment program. If
you can't stop, never reuse or share syringes, water, or drug works, and get
vaccinated against hepatitis A and hepatitis B.
not share toothbrushes, razors, or other personal care articles. They might have
blood on them.
you are a healthcare worker, always follow routine barrier precautions and
safely handle needles and other sharps. Get vaccinated against hepatitis B
the health risks if you are thinking about getting a tattoo or body piercing:
You can get infected if:
tools that are used have someone else's blood on them.
artist or piercer doesn't follow good health practices, such as washing hands
and using disposable gloves.
can be spread by sex, but this does not occur very often. HOWEVER, if a person is co-infected with HIV and HCV, the
risk for transmitting HCV may increase. If you are having sex, but not with one
and your partners can get other diseases spread by having sex (e.g., AIDS,
hepatitis B, gonorrhea or chlamydia).
should use latex condoms correctly and every time.
should get vaccinated against hepatitis B.
patients with hepatitis C change their sexual practices if they have only one
long-term steady sex partner?
is a very low chance of spreading HCV to that partner through sexual activity.
But, if a person has HIV and HCV, they risk of spreading HCV through sex
increases. If you want to lower the small chance of spreading HCV to your sex
partner, you may decide to use barrier precautions such as latex condoms. Ask
your doctor about having your sex partner tested.
sexual practices may increase the risk of sexually spreading HCV. Any type of
sex where blood may be exchanged increases the risk. Men who have sex with men may have an increased risk for
spreading HCV if they use risky sexual practices such as fisting.
can persons with HCV infection do to protect their liver?
your doctor regularly.
start any new medicines or use over-the-counter, herbal, and other medicines
without a physician's knowledge.
vaccinated against hepatitis A if liver damage is present.
other information should patients with hepatitis C be aware of?
is not spread by sneezing, hugging, coughing, food or water, sharing eating
utensils or drinking glasses, or casual contact.
should not be excluded from work, school, play, child-care or other settings on
the basis of their HCV infection status.
with a support group may help patients cope with hepatitis C.
about if a person also has HIV?
treatment options and strategies with a doctor knowledgeable about both HIV and
to begin HCV therapy is a key question. It may be beneficial to start therapy
when CD4s are high. It may be preferable to treat HCV before treating HIV,, in
part because HIV therapy may be tougher on the liver if a person has HCV. Also,
HCV therapy may be more successful if started earlier. But the decision on when
to begin therapy varies by individual circumstances, and should be discussed
thoroughly with a knowledgeable doctor
ALT is normal, moderate to severe liver damage may still be present and biopsy
may be needed to properly assess
persons with chronic hepatitis C be vaccinated against hepatitis B?
with your doctor. For some people getting the HBV vaccine is recommended. If
persons are in risk groups for whom hepatitis B vaccine is recommended, they
should be vaccinated.
Consequences of HCV Infection
are the chances of persons with HCV infection developing long term infection,
chronic liver disease, cirrhosis liver cancer, or dying as a result of hepatitis
every 100 persons infected with HCV about:
persons may develop long-term infection
persons may develop chronic liver disease
persons may develop cirrhosis over a period of 20 to 30 years
persons may die from the consequences of long term infection (liver cancer
If a person has HIV and HCV, this may accelerate the progression of HCV. One
small study suggests HCV may progress the same as if a person had HCV without
HIV if they are receiving successful HIV therapy with HAART.
medical conditions outside the liver occur in persons with chronic hepatitis C?
small percentage of persons with chronic hepatitis C develop medical conditions
outside the liver (this is called extrahepatic). These conditions are thought to
occur due to the body's natural immune system fighting against itself. Such
conditions include: glomerulonephritis, essential mixed cryoglobulinemia, and
porphyria cutanea tarda.
and Treatment of Chronic Hepatitis C
might a specialist (gastroenterologist or hepatologist) be consulted in the
management of HCV-infected persons?
referral to or consultation with a specialist for further evaluation and
possible treatment should be considered if a person is antibody-HCV positive and
has elevated liver enzyme levels, or if a person also has HIV. Any physician who
manages a person with hepatitis C should be knowledgeable and current on all
aspects of the care of a person with hepatitis C.
is the treatment for chronic hepatitis C?
drugs such as interferon used alone or in combination with ribavirin, are
approved for the treatment of persons with chronic hepatitis C. Interferon works
in 15 to 20 persons out of 100 treated (undetectable viral load). Interferon
combined with ribavirin works (on the viral strain that is mostly found in the
U.S.) in about 40 persons out of 100. Ribavirin, when used alone, does not work.
The most effective and most often used treatment is ribavirin plus interferon.
is the goal of therapy?
primary goal of HCV therapy is undetectable viral load. The secondary goal is to
improve the condition of the liver (fibrosis).
is a new form of interferon that is injected only once a week, but it has not
yet been approved by the Food and Drug Administration (FDA). The current
approved dose of interferon is an injection 3 times per week on 3 separate days.
Pegylated interferon is made by a new chemical process that permits the
interferon to remain in the blood for one week. Pegylation delays the body from
eliminating interferon. With pegylation, interferon stays in the blood
continuously compared to 3 times per week injections, and it appears to be more
potent. The side effects appear to be about the same as regular interferon, or
maybe a little better. The FDA is reviewing two pegylated interferons and should
be approving them around December-January 2000/2001.
are the side effects of interferon therapy?
persons have flu-like symptoms (fever, chills, headache, muscle and joint aches,
fast heart rate) early in treatment, but these lessen with continued treatment.
Later side effects may include tiredness, hair loss, low blood count, trouble
with thinking, moodiness, and depression. Severe side effects are rare (seen in
less than 2 out of 100 persons). These include thyroid disease, depression with
suicidal thoughts, seizures, acute heart or kidney failure, eye and lung
problems, hearing loss, and blood infection. Although rare, deaths have occurred
due to liver failure or blood infection, mostly in persons with cirrhosis. An
important side effect of interferon is worsening of liver disease with
treatment, which can be severe and even fatal. Interferon dosage must be reduced
in up to 40 out of 100 persons because of severity of side effects, and
treatment must be stopped in up to 15 out of 100 persons. Pregnant women should
not be treated with interferon.
are the side effects of combination (ribavirin + interferon) treatment?
addition to the side effects due to interferon described above, ribavirin can
cause serious anemia (low red blood cell count) and can be a serious problem for
persons with conditions that cause anemia, such as kidney failure. In these
persons, combination therapy should be avoided or attempts should be made to
correct the anemia. Anemia from ribavirin can be treated while remaining on HCV
therapy. Anemia may go away after treatment is stopped. Anemia caused by
ribavirin can be life-threatening for persons with certain types of heart or
blood vessel disease. Ribavirin causes birth defects and pregnancy should be
avoided during treatment. Patients and their healthcare providers should
carefully review the product manufacturer information prior to treatment.
anything be done to reduce symptoms or side effects due to antiviral treatment?
should report what you are feeling to your doctor. Some side effects may be
reduced by giving interferon at night or lowering the dosage of the drug. In
addition, flu-like symptoms can be reduced by taking acetaminophen before
children receive interferon therapy for chronic hepatitis C?
drugs are not licensed for persons under 18 years of age. Children with
hepatitis C should be referred to a children's specialist in liver diseases. You
may want to ask your doctor about clinical trials that may be on-going for
new drugs in development?
and development for HCV treatments are receiving much attention because of the
need. Antivirals and immune based therapies are being researched and so there
should be additional treatments becoming available within several years.
does the term genotype mean?
refers to the genetic make-up of an organism or a virus. There are at least six
distinct HCV genotypes identified. Genotype 1 is the most common genotype seen
in the U.S.
it necessary to do genotyping when managing a person with chronic hepatitis C?
Although persons with genotype 1 respond less often to treatment, genotype
should not be a deciding factor on whether or not to treat. With newer
therapies, however, treatment regimens might differ on the basis of genotypes.
But, genotype 1 may need longer treatment, so it helps to know your genotype to
about HCV viral load?
person with a high viral load (>2 million) may not respond as well to
therapy. Such a person also may need longer therapy.
do most persons remain infected?
infected with HCV mount an antibody response to parts of the virus, but changes
in the virus during infection result in changes that are not recognized by
preexisting antibodies. This appears to be how the virus establishes and
maintains long-lasting infection.
persons become infected with different genotypes?
Because of the ineffective immune response described above, prior infection does
not protect against reinfection with the same or different genotypes of the
virus. For the same reason, there is no effective pre- or postexposure
prophylaxis (i.e, immune globulin) available.