Testing
FINDING OUT IF YOU HAVE HEPATITIS C
Who should get tested?
Anyone who has ever been exposed to the hep C virus or been in a situation where they may have been exposed to the hep C virus (see Prevention) should be tested for hep C.
Many people don’t have symptoms, or the symptoms are so general (tiredness, flu-like symptoms, ‘brain fog’), they wouldn’t make someone think to get their liver checked or get tested for hep C. If there has been any risk of exposure, a person should consider getting tested for hepatitis C.
A person could also have ongoing symptoms (like very severe fatigue) that haven’t been explained by other tests or diagnoses. If that is true for you or someone you know, consider getting tested for hep C.
What is an antibody?
Antibodies are what our immune systems make to fight infections like hep C.
What is a virus?
A virus is a tiny microbe that gets into cells in the body. The hepatitis C virus gets into liver cells. When there are too many viruses in a cell, the cell bursts and many more viruses then get out and get into other liver cells and repeat the cycle.
Some people’s immune systems can overcome the hep C virus before too many viruses are made. Their systems ‘clear the virus’. Most people end up having the virus for life.
Window Period
From the time of exposure to the time that HCV antibodies show up in a blood test is called the “window period”
It usually takes up to three months for people to develop antibodies to HCV. In the case of a single known exposure (a needle stick injury, for instance) testing would usually be done three to six months after the needle stick injury.
If there are any risks or exposures in the three-month window period then another HCV antibody test would be needed 3 months after that exposure.
There is often a lot of virus present during the window period. Hepatitis C can be passed on to others in the window period.
What are the tests?
There are two blood tests used to find out if someone has hepatitis C infection:
1. The HCV antibody test finds out if the immune system has made HCV antibodies to fight the hep C virus. This is the first test done to see if someone has hep C. A person who has been exposed to the hep C virus – the virus was or still is in their bloodstream – will always have the hep C antibodies. This doesn’t mean they still have the virus.
2. The PCR or HCV-RNA test looks to see if the virus is actually still in a person’s system. This is the only way to know for sure if the virus is there.
The HCV Antibody Test
Doctors and nurses can order the HCV antibody test. Sometimes nurses can also do the test in their office.
Where the test is done depends on the office and whether there is someone there (nurse or lab tech) who can draw the blood. Someone can go to ask for an HCV antibody test at:
- a public health unit
- a First Nations health centre
- urban and outreach health centres and services
- doctor’s office
- other health care settings
If the blood test isn’t done in the doctors or nurses office, the doctor or nurse will send the patient to a lab. In that case, the doctor or nurse will give the patient a lab requisition to take with them to the lab. The lab requisition tells the lab staff who the person is getting the test, what blood test or tests they are having done and who ordered the test.
Some doctors offices have labs and sometimes a person will go somewhere else, often to a hospital lab. Public health nurses often are able to do the blood test right in their office.
Check Resources section for contact information in your area.
Getting the HCV antibody test results
The test results will always be sent to the person who ordered the blood test - if the test was done at a lab – or to the person who drew the blood.
The patient will go back to whoever gave them their lab requisition or to the office where the blood was drawn.
The time it takes to get results back depends on where (in the province) the test is done (usually 2 – 3 weeks, but this could be longer.)
What does a positive HCV antibody test result mean?
If the HCV antibody is present the doctor or nurse will tell the person they ‘tested positive’ for hep C. This lets the person know that their immune system has noticed the virus and is fighting back.
The HCV-RNA or PCR test (looking for the virus)
To find out if they actually have the virus in their system, a patient can ask for the HCV-RNA test or PCR test.
This test tells a person and their doctor…
- if the virus is present or has been cleared, and
- confirms the diagnosis of hepatitis C infection
The PCR test will also tell a person and their doctor…
- How much virus is present (viral load);
- and maybe, depending on the type of PCR test the doctor ordered, the genotype ( strain) of hep C a person has.
There are 6 genotypes. Genotypes 1, 2 and 3 are most common in Canada.
The PCR or HCV-RNA test does not say anything about how the person’s liver is doing. There are different tests for that (see Treatment and Care).
A person can become infected with more than one genotype, so prevention (following the basic rules for staying healthy) and harm reduction are always important!
THINGS TO KNOW
A low immune system (from HIV or from cancer treatment, for instance) can allow the hepatitis C antibodies to hide. If someone:
- has a low immune system
- was exposed, or could have been exposed, to the hepatitis C virus but tested negative for hep C
their doctor can order a PCR test to find out if the HCV virus is present in their blood.
And again:
- Having HCV antibodies doesn’t protect from getting the virus again.
- A person will always have the HCV antibodies – even if they clear the virus.