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Viral Hepatitis

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Just Diagnosed: Entire Lesson

for Veterans and the Public

Just Diagnosed: Entire Lesson

Your next steps

Finding out that you have hepatitis C can be scary and overwhelming. If you feel overwhelmed, try to remember that you can get help and that these feelings will get better with time.

Remember:
  • Hepatitis C does not mean bad health problems or death. Over half of people with hepatitis C will never have any health problems from it.
  • Learning how to live with hepatitis C and getting in touch with a health care team that knows how to manage it will help you to feel better and get on with your life.
  • You are not alone. Probably between 3 and 5 million people are living with hepatitis C in the United States.

The following are steps to take if you have been diagnosed with hepatitis C:

  • Understand Your Diagnosis
  • Telling Others and Finding Support
  • Working with Your Doctor
  • Treatment Options for Hepatitis C

Understand your diagnosis

When your doctor tells you that you have hepatitis C, it means that you have been infected with the hepatitis C virus (or HCV, for short).

You probably got hepatitis C by coming in contact with the blood of another person who is infected. Some of the ways this might have happened include the following:

  • You had a blood transfusion or organ transplant before 1991.
  • You shared needles or works to inject drugs, even if it was only once or many years ago.
  • You were on long-term kidney dialysis.
  • You were a health care worker and had contact with blood on the job.
  • Your mother had hepatitis C when she gave birth to you.
  • You have had many sexual partners.
  • You have had tattoos and body piercings.

Don't waste too much time and energy trying to figure out how you got infected, or blaming someone or something that happened in the past. It is important that now you focus your energy on dealing with the infection and working with your VA doctor to get better.

Learn about hepatitis C

Your first step is to learn about the disease and how it can affect your life. The more you know about hepatitis C, the less confused and anxious you will be about your diagnosis. The more you learn, the better you will be at making decisions about your health.

Here are some ways to start:

  • Read through the topics in Understanding the Liver and this Hepatitis C website.
  • Check out government or nonprofit educational organizations that deal with hepatitis C issues. You can find a list of them in the Resources at the end of this section.
  • Use your local library. The most current information will be in the library's collection of newspapers and magazines (books about hepatitis C may be out of date by the time they are published).
  • Check with your local VA medical center to see if there is an on-site library where you can find patient materials on hepatitis C.
  • Talk with others who have been diagnosed with hepatitis C. Ask your doctors if they know of any support groups. Or you can go online, where you can find message boards and chat rooms. Always discuss what you learn from these sources with your doctor. The information may not be accurate, and even if it is, it may not be right for your particular situation.
  • See the section on Living with Hepatitis to learn about special diet and nutrition suggestions, complementary therapies, emotional health, and other topics.

Adopt a healthy lifestyle

The symptoms of hepatitis C infection are mild, but over time, the virus can damage your liver. You can help prevent this damage from becoming serious by following your doctor's advice and adopting a healthy lifestyle. Here are some important tips to keep your liver healthy:

  • Do not drink alcohol or take recreational drugs. Alcohol and recreational drugs are hard on your liver even when you are healthy. If you need help to stop drinking alcohol or taking drugs, talk with your VA doctor.
  • Avoid taking medicines, supplements, and natural or herbal remedies that might cause even more damage to your liver. Although Tylenol is safe in low doses, many pain relievers can cause liver problems in some very sensitive people. Check with your doctor or pharmacist before you take any natural or herbal remedy, supplement, prescription, or over-the-counter medicine.
  • Be sure to get plenty of rest, follow a healthy diet, and get moderate exercise. Ask your VA doctor for suggestions about what types of food would be good for you and what forms of exercise would be appropriate. More information is available in the Diet and Nutrition section under Living with Hepatitis.

Protect others

If you have hepatitis C, you can give the virus to other people. This is true even if you are feeling perfectly fine.

To protect others from getting hepatitis C, follow these rules:

  • Do not donate blood, body organs, tissues, or sperm.
  • Do not let anyone else use your razor, toothbrush, or other personal care items.
  • Cover open cuts or sores on your skin with a bandage until they have healed.
  • Don't inject drugs. If you are currently injecting drugs, talk with your VA doctor about trying to stop. If you can't stop, don't ever share your needles or works with anyone else.
  • Practice safer sex. Use a latex barrier, such as a condom (or rubber) every time you have sex. Using condoms also reduces your chances of getting sexually transmitted diseases.

Following the above suggestions also can help protect you from other diseases, such as HIV or AIDS and hepatitis B. Talk with your doctor if you would like more information about these conditions.

Understand long-term effects

More than half of people with hepatitis C will never have any health problems from it. The disease generally progresses slowly, over the course of 10 to 40 years.

Here is a snapshot of the long-term effects of hepatitis C.

Out of 100 people who get hepatitis C:

  • 15 will get rid of the virus without any treatment
  • 85 will develop a chronic infection

Of those 85 who have a chronic infection:

  • About 17 will develop liver cirrhosis in their lifetime
  • About 2 will develop liver cancer

Liver complications

Anything that damages the liver over many years causes the liver to form scar tissue. Fibrosis is the medical term for liver scarring. When scar tissue builds up and takes over most of the liver, this is a more serious problem called cirrhosis (pronounced "sir-o-sis"). Scar tissue cannot perform any of the jobs of normal liver cells, and this causes a person with cirrhosis to slowly become ill.

There is no way of predicting who is going to get cirrhosis. Cirrhosis does not happen overnight. Many people who have cirrhosis for 5 to 10 years or more do not show clear signs of illness. However, having the hepatitis C virus for a long time (such as 20 to 30 years) increases your risk of having cirrhosis.

Over time, you can become ill from cirrhosis. Symptoms that can develop include fatigue, difficulty thinking clearly, fluid in the abdomen, bleeding in the intestines, and poor blood clotting.

It is not clear who will develop cirrhosis or complications from hepatitis C, but how you take care of yourself and your liver plays an important role in how slowly (or how quickly) hepatitis C progresses.

You can help keep your liver healthy by eating well, losing weight if you are overweight, and avoiding substances that can harm your liver, such as alcohol and illegal drugs.

To learn more about these problems, read the Liver Complications section.

Telling others and finding support

Finding support means finding people who are willing to help you through the emotional and physical issues you are going to face. If you let the right people in your life know that you have hepatitis C, they can:

  • offer you support and understanding
  • provide you with assistance, such as running errands, helping with child care, or going with you to doctor visits
  • learn from you how hepatitis C is spread and work with you to prevent the virus from spreading

Deciding to tell others that you have hepatitis C is an important personal choice. If you decide to share your diagnosis, it is best to tell people you trust and people who are directly affected, including:

  • past or present sex partner(s)
  • past or present needle-sharing partners
  • roommates or family members
  • people whom you spend a lot of time with, such as good friends

Of course, you also should inform all of your health care providers, such as your doctors, nurses, and dentists.

What you should tell others

You may want to begin with when and how you found out that you have hepatitis C. You may want to give information on how the virus is spread and how the virus is not spread.

Explain that hepatitis C is spread through blood-to-blood contact. Tell them that hepatitis C is not spread through casual contact, such as hugging or shaking hands.

When you should tell others

Many people share their diagnosis as soon as they find out. Others wait for some time to adjust to the news and to learn more about hepatitis C.

You should share your diagnosis as soon as possible with people who may be directly affected by your diagnosis, such as sex partners and needle-sharing partners. It is important that they know so that they can decide whether to get tested. If you need help telling people that they may have been exposed to hepatitis C, most city or county health departments will tell them for you, without using your name. Ask your doctor about this service.

Before telling your partner that you have hepatitis C, take some time alone to think about how you want to bring up the subject.

  • Decide when and where would be the best time and place to have a conversation. Choose a time when you expect that you will both be comfortable, rested, and as relaxed as possible.
  • Think about how your partner may react to stressful situations. If there is a history of violence in your relationship, consider your safety first and plan the situation carefully.

Join a support group

Some VA medical centers have a support group for Veterans with hepatitis C. You may want to ask your provider if your center has one that you can join for support and for more information about living with hepatitis C.

Joining a group of people who are facing the same challenges you are facing can have important benefits. These benefits include feeling better about yourself, making new friends, improving your mood, and better understanding your needs and those of your family. People in support groups often help each other deal with common experiences associated with having hepatitis C.

Support groups are especially helpful if you live alone or don't have family and friends nearby.

There are different types of support groups, from hotlines to face-to-face encounter groups. Here are descriptions of some of the most popular types, and suggestions about how to find them.

  • Hotlines
    Find a hotline in your area by talking to a VA social worker in your hospital. Or look in the telephone book, in the yellow pages under "Social Service Organizations." Ask the hotline to "match" you with another person with a history like yours. He or she can give you practical advice and emotional support over the telephone.
  • Professional help
    Veterans with hepatitis C can get referrals to mental health professionals, such as psychologists, nurse therapists, clinical social workers, or psychiatrists. You will likely have a social worker who is part of the hepatitis C clinic where you will receive care. You can also get help for drug abuse.
  • Self-help organizations
    Self-help groups enable people to share experiences and pool their knowledge to help one another and themselves. They are run by members, not by professionals (although professionals sometimes are involved). Because members face similar challenges, they feel an instant sense of community. These groups are volunteer, nonprofit organizations, with no fees (although sometimes there are small dues).

Move forward with your life

Life does not end with a diagnosis of hepatitis C. In fact, with certain lifestyle changes and proper treatment, hepatitis C can be a mild health problem from which you may never feel ill.

Taking care of your overall health can help you deal with hepatitis C. Here are some things to remember:

  • Get regular medical and dental checkups.
  • Follow your doctor's advice.
  • Eat a healthy diet.
  • Exercise regularly.
  • Avoid smoking and recreational drug use.
  • Limit alcohol intake.
  • Practice safer sex.

For more information on a healthy lifestyle, read the chapters in the Living with Hepatitis section.

Working with your doctor

Hepatitis C, if left untreated, can lead to serious illness and at times even death. This is why it is so important to get medical care if you find out you have hepatitis C.

Your doctor will need to determine how hepatitis C is affecting your health. Soon after your diagnosis, your doctor will run tests to get estimates about your overall health. For descriptions of these tests, go to the Understanding lab tests section.

Treatments for hepatitis C are not perfect, but can be very effective for many people. A doctor or other health care provider can explain the best options for you.

If you work with your health care provider in planning your care, you can deal with the disease in the way that is best for you.

Before appointments

Start with a list or notebook. Prepare for your appointment with your doctor by writing down the following:

  • any questions that you have (you can print out Questions to Ask Your Doctor about Your Diagnosis and take it to your appointment)
  • any symptoms or problems you want to tell the doctor about (include symptoms such as poor sleep, trouble concentrating, feeling tired)
  • medications that you are taking (include herbs and vitamins)
  • upcoming tests or new information you've heard about
  • changes in your living situation, such as a job change

That way you won't forget anything during the appointment.

You may want to ask a friend or family member to go with you and take notes. It can be difficult for you to take notes and pay attention to what your doctor is saying at the same time.

During appointments

Go over your lab work, and keep track of your results.

If your doctor wants you to have some medical tests, make sure you understand what the tests are for and what your doctor will do with the results. If you don't understand what your doctor is saying, ask the doctor to explain it in everyday terms.

If you feel your doctor has forgotten something during the appointment, it is better to ask about it than to leave wondering whether something was supposed to happen that didn't. It's your right to ask questions of your doctor. You also have a legal right to see your medical records. After all, it's your body.

Be honest. Your doctor isn't there to judge you, but to help you make decisions about your health based on your particular circumstances. Tell your doctor about your sexual or drug-use history.

Monitor your health

Once you have been diagnosed with hepatitis C, you need to pay closer attention to your health than you did before.

You can keep track of your health in two ways. First, listen to what your body is telling you, and be on the alert for signs that something isn't right. Note any change in your health--good or bad. Know when you should contact your doctor.

Second, have regular lab tests done. Lab tests often can detect signs of illness before you have any noticeable symptoms.

Know when to call a doctor

You don't need to panic every time you have a headache or feel tired. But if a symptom is concerning you or is not going away, it is always best to have your doctor check it out, even if it doesn't feel like a big deal. The earlier you see a doctor when you have unusual symptoms, the better off you are likely to be.

While you are being treated for hepatitis C, call your health care provider if you:

  • are extremely short of breath or are dizzy
  • have discomfort in your chest area
  • notice changes in your vision
  • have swelling in your legs, feet, or ankles
  • have diarrhea for more than 48 hours, or have blood in the stool
  • have a skin rash or unusual skin reaction around the injection sites
  • have a fever or other sign of infection that lasts more than 48 hours
  • are extremely tired (fatigued)

Have regular lab tests

Your doctor will use laboratory tests to check your health. Some of these tests will be done soon after you learn you have hepatitis C.

The lab tests look at several things:

  • how well your liver is functioning
  • how much hepatitis C is in your blood
  • other basic body functions (tests look at your kidneys, cholesterol, and blood cells)

For information on specific tests, go to Understanding lab tests.

Treatment options

Treatments for hepatitis C are aimed at doing the following:

  • remove (or clear) all the hepatitis C virus from your body permanently
  • stop or slow down the damage to your liver
  • reduce the risk of developing cirrhosis
  • reduce the risk of developing hepatocellular carcinoma (HCC)
  • reduce the risk of decompensating if you already have cirrhosis

The regimens that exist currently for hepatitis C include the following:

  • Pegylated interferon and ribavirin
  • Pegylated interferon and ribavirin PLUS either boceprevir or telaprevir
  • Sofosbuvir plus pegylated interferon plus ribavirin
  • Sofosbuvir plus ribavirin
  • Simeprevir plus pegylated interferon plus ribavirin
  • Sosofbuvir plus simeprevir--with or without ribavirin

One of the most important decisions you and your doctor will make is whether to begin drug treatment, and, if so, when to start it. Treatment does not have to start right away. The disease usually progresses slowly, with slowly increasing scarring to the liver over many years, from 10 to 40 years or more.

Reasons to Wait for Treatment

There are several reasons that your doctor may recommend treatment be in the future but not right now. One reason is that the new drugs for hepatitis C are newly being used--and although they have been used in clinical trials and scientific studies, in the real world and in real patients, these drugs can sometimes have slightly different outcomes. So, in patients who are not urgently needing treatment, it may be wise to wait and see how well these drugs are working in the real world before starting the treatment yourself. Another reason that your doctor may recommend waiting is that not all types of patients are getting the same results in clinical trials--and if your type of hepatitis C did not have the strongest results in the studies, then it may be wise to wait until one of the new regimens demonstrates the strongest possible outcomes in your type of hepatitis C.

Here's what you should be doing if you are waiting to be treated in the future

  • having liver enzyme blood tests once or twice a year
  • going to regular doctor appointments
  • following your doctor's lifestyle recommendations such as avoidance of alcohol or tobacco, because reducing further damage to your liver is crucial
  • attaining or maintaining a healthy BMI
  • minimizing risk of steatosis with good control of diabetes and lipids

Deciding to start treatment

Only patients with hepatitis C in their blood (chronic hepatitis C infection) are considered for therapy. In general, doctors suggest treatment if you:

  • have significant damage (fibrosis, scarring) in the liver, including cirrhosis
  • are motivated to undergo treatment
  • are able to take your medicine exactly as prescribed, every day
  • are willing to comply with thenecessary steps and blood tests and visits
  • were very recently (acutely) infected with hepatitis C, within the past 6 months
  • are coinfected with HIV or hepatitis B
  • have hepatitis C affected the kidney or organs other than the liver

If you want to start treatment for hepatitis C, speak with your VA doctor. It is a good idea to talk about any concerns you have before you start treatment. You and your doctor will decide if treatment is right for you and which medicines might work.

Laboratory tests: Overview

Once you've been diagnosed with hepatitis C, your VA doctor probably will order a number of tests to learn about your overall health, to decide whether drug therapy is appropriate, and to learn about your body's internal functioning (including how well your liver is working).

Some tests will be done very soon after you've been diagnosed with hepatitis C, while other tests will continue to be done on a regular basis. These tests will monitor your health and help you and your doctor decide when treatment is appropriate (or, if you've already begun treatment, whether it's working).

In the following sections, you can learn about the tests, why your doctor may have ordered them, and what the results mean.

Note:

Normal values for laboratory tests can vary from one lab to another. Check with your doctor on the normal range for your lab tests.

Tests of the liver

If you have hepatitis C, most likely, your doctor will check blood tests of your liver. There's a handful of liver tests and it is helpful to know what each of them means. Here, we explain common liver blood tests and how to understand your results:

Liver panel

A "liver panel" usually refers to several lab tests performed as a group. Depending on the physician or the laboratory, a liver panel usually includes tests for AST, ALT, bilirubin, and alkaline phosphatase.

Liver enzymes

Usually, the term "liver enzymes" refers to the AST and the ALT.

Liver function tests (LFTs)

The phrase "liver function tests" or "LFTs" is commonly used by patients and physicians. Many patients and physicians use the term to describe the AST and ALT. However, this is not correct--the AST and ALT do not measure the function of the liver.

The true function of the liver is actually best measured by the PT, INR and albumin. Therefore, if you are getting a PT, INR or albumin, these tests can determine how the liver is "functioning."

ALT (SGPT)

ALT, or alanine aminotransferase, is 1 of the 2 "liver enzymes." It is sometimes known as serum glutamic-pyruvic transaminase, or SGPT. It is a protein made only by liver cells. When liver cells are damaged, ALT leaks out into the bloodstream and the level of ALT in the blood is higher than normal.

signs of an unhealthy liver

Scroll over image to see an animation of liver enzymes leaking into the blood.

Explanation of test results:

A high ALT level often means there is some liver damage, but it may not be related to hepatitis C. It is important to realize the ALT level goes up and down in most patients with hepatitis C. The ALT level does not tell you exactly how much liver damage there is, and small changes should be expected. Changes in the ALT level do not mean the liver is doing any better or any worse. The ALT level does not tell you how much scarring (fibrosis) is in the liver and it does not predict how much liver damage will develop.

Other things to know:

  • Many patients with hepatitis C will have a normal ALT level.
  • Patients can have very severe liver disease and cirrhosis and still have a normal ALT level.
  • When a patient takes treatment for hepatitis C, it is helpful to see if the ALT level goes down.

AST (SGOT)

AST, or aspartate aminotransferase, is 1 of the 2 "liver enzymes." It is also known as serum glutamic-oxaloacetic transaminase, or SGOT. AST is a protein made by liver cells. When liver cells are damaged, AST leaks out into the bloodstream and the level of AST in the blood becomes higher than normal. AST is different from ALT because AST is found in parts of the body other than the liver--including the heart, kidneys, muscles, and brain. When cells in any of those parts of the body are damaged, AST can be elevated.

Explanation of test results:

A high AST level often means there is some liver damage, but it is not necessarily caused by hepatitis C. A high AST with a normal ALT may mean that the AST is coming from a different part of the body. It is important to realize that the AST level in most patients with hepatitis C goes up and down. The exact AST level does not tell you how much liver damage there is, or whether the liver is getting better or worse, and small changes should be expected. However, for patients receiving treatment for hepatitis C, it is helpful to see if the AST level goes down.

Other things to know:

  • The AST level is not as helpful as the ALT level for checking the liver.
  • Many patients with hepatitis C will have a normal AST level.
  • Patients can have very severe liver disease or cirrhosis and still have a normal AST level.

Bilirubin

Bilirubin is a yellowish substance that is created by the breakdown (destruction) of hemoglobin, a major component of red blood cells.

Explanation of test results:

As red blood cells age, they are broken down naturally in the body. Bilirubin is released from the destroyed red blood cells and passed on to the liver. The liver excretes the bilirubin in fluid called bile. If the liver is not functioning correctly, the bilirubin will not be properly excreted. Therefore, if the bilirubin level is higher than normal, it may mean that the liver is not functioning correctly.

Other things to know:

  • Levels of bilirubin in the blood go up and down in patients with hepatitis C.
  • When bilirubin levels remain high for prolonged periods, it usually means there is severe liver disease and possibly cirrhosis.
  • High levels of bilirubin can cause jaundice (yellowing of the skin and eyes, darker urine, and lighter-colored bowel movements).
  • Elevated bilirubin levels can be caused by reasons other than liver disease.
  • Total bilirubin is made up of 2 components: direct bilirubin and indirect bilirubin.
  • Direct bilirubin + indirect bilirubin = total bilirubin.

Albumin

Albumin is a protein made by the liver. Albumin prevents fluid from leaking out of blood vessels into tissues.

Explanation of test results:

A low albumin level in patients with hepatitis C can be a sign of cirrhosis (advanced liver disease). Albumin levels can go up and down slightly. Very low albumin levels can cause symptoms of edema, or fluid accumulation, in the abdomen (called ascites) or in the leg.

Other things to know:

  • A low albumin level can also come from kidney disease or malnutrition or acute illness.
  • A low albumin level causing fluid overload is often treated with diuretic medications, or "water pills."

Prothrombin time

Prothrombin is a protein made by the liver. Prothrombin helps blood to make normal clots. The "prothrombin time" (PT) is one way of measuring how long it takes blood to form a clot, and it is measured in seconds (such as 13.2 seconds). A normal PT indicates that a normal amount of blood-clotting protein is available.

Explanation of test results:

When the PT is high, it takes longer for the blood to clot (17 seconds, for example). This usually happens because the liver is not making the right amount of blood clotting proteins, so the clotting process takes longer. A high PT usually means that there is serious liver damage or cirrhosis.

Other things to know:

  • Some patients take a drug called Coumadin (warfarin), which elevates the PT for the purpose of "thinning" the blood. This is not related to having liver disease because it is the Coumadin causing the PT to be high.
  • The test called INR measures the same factors as PT and is used instead of PT by many doctors. See "INR."

Alkaline phosphatase

Alkaline phosphatase (often shortened to alk phos) is an enzyme made in liver cells and bile ducts. The alk phos level is a common test that is usually included when liver tests are performed as a group.

Explanation of test results:

A high alk phos level does not reflect liver damage or inflammation. A high alk phos level occurs when there is a blockage of flow in the biliary tract or a buildup of pressure in the liver--often caused by a gallstone or scarring in the bile ducts.

Other things to know:

  • Many patients with hepatitis C have normal alk phos levels.
  • Hepatitis C treatment usually does not affect alk phos levels.
  • Alk phos is produced in other organs besides the liver--it is also found in the bones and the kidneys.
  • If your alk phos level is high, your doctor will probably order additional tests to determine why.

INR (international normalized ratio)

International normalized ratio (INR) is blood-clotting test. It is a test used to measure how quickly your blood forms a clot, compared with normal clotting time.

Explanation of test results:

A normal INR is 1.0. Each increase of 0.1 means the blood is slightly thinner (it takes longer to clot). INR is related to the prothrombin time (PT). If there is serious liver disease and cirrhosis, the liver may not produce the normal amount of proteins and then the blood is not able to clot normally. When your doctor is evaluating the function of your liver, a high INR usually means that the liver is not working as well as it could because it is not making the blood clot normally.

Other things to know:

  • Some patients take a drug called Coumadin (warfarin), which elevates the INR, for the purpose of "thinning" the blood.
  • The INR is another way of measuring the blood-clotting time and it is easier to determine than the PT.

Platelets

Platelets are cells that help the blood to form clots. The platelet number or "platelet count" in the blood is measured as part of the complete blood count (CBC).

Explanation of test results:

Platelet counts in a patient who has cirrhosis are often low. But low platelet counts can also come from other causes, including certain medications. Interferon treatment can reduce platelet counts. When the platelet count is extremely reduced, this condition is known as "thrombocytopenia." If a platelet count is too low, the patient cannot make normal clots and may bruise more easily.

Other things to know:

  • If the platelet count drops too low (below 50,000, for example) when a patient is receiving interferon, doctors may recommend that the interferon dosage be reduced.

Total protein

Total protein level is a measure of a number of different proteins in the blood. Total protein can be divided into the albumin and globulin fractions.

Explanation of test results:

Low levels of total protein in the blood can occur because of impaired function of the liver.

Tests of hepatitis C

If you have hepatitis C virus, you are likely to have a doctor recommend a few different hepatitis C blood tests, not just one. It is helpful to understand what each of these blood tests mean. Here we explain the common blood tests of hepatitis C and the meaning of test results.

Hepatitis C antibody (HCV Ab, anti-HCV)

This is the first test for determining whether you have been infected with hepatitis C. The results will come back as either positive or negative.

Explanation of test results:

If this test result is positive, it means your body was exposed to the hepatitis C virus and made antibodies (for more information, see "Antibody" section under Associated Lab Tests). However, it does not tell you whether you are still infected with hepatitis C. If the antibody test result is positive, you should be tested for hepatitis C RNA (see "Hepatitis C RNA"), which determines whether you are chronically infected. The lab might perform this RNA test automatically if your hepatitis C antibody test is positive or your doctor might need to order the Hepatitis C RNA test separately.

If the antibody test result is negative, it means you have not been infected with the hepatitis C virus, and further testing for hepatitis C usually is not needed.

Other things to know:

  • After a successful course of treatment for hepatitis C, the hepatitis C antibody remains detectable, but the hepatitis C RNA will be undetectable.
  • Any patient with a positive test result for the hepatitis C antibody should have additional tests to determine whether or not the virus is still active.

Hepatitis C RNA qualitative testing

The qualitative HCV RNA tests use either a process called polymerase chain reaction (PCR) or a process called transcription-mediated amplification (TMA). Either type of qualitative test will report whether the hepatitis C virus is present in the bloodstream or not. The result is reported as either "detected" or "not detected."

Explanation of test results:

If a qualitative RNA test is positive (detected), then it is confirmed that the patient has chronic hepatitis C. The "qualitative" test is more accurate than the "quantitative" test because qualitative tests are able to detect very low levels of the virus.

Other things to know:

  • If a patient has a quantitative test that shows no detectable virus, but has a positive result with the qualitative test, it means there is a very low level of virus that can be detected only with the qualitative test.
  • The qualitative test will show a negative result when patients have a successful response to interferon treatment.
  • The qualitative test result also will be negative when patients clear the hepatitis C virus on their own, soon after infection, or "spontaneously."

Hepatitis C RNA quantitative testing

The quantitative HCV RNA tests measure the amount of hepatitis C virus in the blood. The result will be an exact number, such as "1,215,422 IU/L." Many people refer to the quantitative measurement as the hepatitis C "viral load."

Explanation of test results:

There are 2 situations in which a quantitative test is useful:

The quantitative HCV RNA test is checked before a patient starts treatment.

For each patient, the result can be described as either a "high" viral load, which is usually >800,000 IU/L, or a "low" viral load, which is usually <800,000 IU/L. Knowing the viral load before starting treatment is useful because patients with "high" viral loads can have a difficult time getting the virus to become completely undetectable on treatment. Patients with "low" viral loads have a better chance of getting their virus to become completely undetectable on treatment.

The quantitative HCV RNA test is used to monitor a patient who is currently on treatment.

The response to treatment is considered good when the quantitative HCV RNA measurement drops and the virus eventually becomes completely undetectable.

Other things to know:

  • The viral load measurement does not tell us anything about the severity of a patient's liver disease or the degree of fibrosis (scarring). For that information, the patient would need a liver biopsy.
  • It is not necessary to check the viral load repeatedly unless a patient is on treatment or is considering treatment.
  • If a quantitative HCV RNA result is reported as "<615 IU/L," this means that the quantitative test cannot measure the hepatitis C virus. It may mean that there is no detectable HCV RNA at all, but it may mean that the level of virus is just too low for the test to pick it up. A qualitative test should then be performed to see if there is any detectable hepatitis C virus at all (see previous screen: "Hepatitis C RNA Qualitative Testing").
  • If a quantitative HCV RNA results is "<615 IU/L" but the qualitative test is "detected" then the hepatitis C virus is present in the bloodstream, but at a very very low level, too low to be measured by a quantitative test.

Hepatitis C RIBA

The hepatitis C recombinant immunoblot assay (RIBA) is the confirmation test for the hepatitis C antibody.

Explanation of test results:

If the result of the HCV RIBA is positive, this confirms that the detection of a hepatitis C antibody (anti-HCV) was a true positive, meaning that there has been infection with hepatitis C in the past.

If the HCV RIBA result is negative, it means there has not been infection with hepatitis C. If an earlier hepatitis C antibody (anti-HCV) test had been positive, then this was a false positive.

Other things to know:

  • Even if the HCV RIBA result is positive, only the test of HCV RNA (viral load) can detect whether the hepatitis C virus is still present in the body.
  • HCV RIBA is not a test that is needed for most patients. Usually, it is performed by blood banks to check for hepatitis C in people who donate blood.

Hepatitis C genotype

The hepatitis C genotype is a type or "strain" of hepatitis C virus. There are 6 genotypes of hepatitis C around the world. In the United States, 3 genotypes are common:

  • Genotype 1
  • Genotype 2
  • Genotype 3

These can be further specified as:

  • Genotype 1a or 1b
  • Genotype 2a or 2b
  • Genotype 3a or 3b

The genotype of hepatitis C does not change over time. It needs to be tested only once. If you are treated for hepatitis C, your genotype will determine your treatment plan, such as which medications are prescribed and how long the treatment will be.

Viral load

The viral load of hepatitis C refers to the amount of virus present in the bloodstream.

A viral load test is usually measured with the hepatitis C RNA quantitative test; a blood sample will be taken by needle from a vein in your arm.

Viral load tests are often used with hepatitis C treatment to help determine response to treatment by comparing the amount of virus in your blood before, during, and after treatment.

If you have lower levels of virus in your blood when you start treatment, you may have a better chance of getting rid of the virus.

Associated lab tests

Patients with hepatitis C often have a wide variety of blood tests requested by their doctor. In addition to tests of hepatits C and tests of the liver, you may have tests of your kidney, blood counts, thyroid and others.

It is especially important to understand these tests if you are taking hepatitis C treatments. Here we explain the meaning of some of the most common blood tests you may want to understand.

White blood cells (WBCs)

This test measures the total number of white blood cells (WBCs). There are 5 main types of WBCs: neutrophils, eosinophils, basophils, monocytes, and lymphocytes. Each type does a slightly different job. All of them help fight infection.

Explanation of test results:

WBCs are produced in the bone marrow, an area in the middle of many bones. Low WBC "counts"may develop as a side effect of interferon treatment. A low WBC count may be caused by cirrhosis of the liver, alcohol use, medications, or other medical conditions.

Neutrophils

Neutrophils are a type of white blood cell. Your neutrophil level is also known as the absolute neutrophil count (ANC).

Explanation of test results:

Neutrophils play a key role in inflammation, formation of pus, and destruction of bacteria. Your doctor will check your ANC regularly if you are taking interferon treatment. If the ANC falls too low, your doctor may reduce the dosage of interferon treatment. Additionally, if the ANC falls too low, your doctor may prescribe additional medication to try to boost the ANC back up.

Other things to know:

  • The ANC is more important than the total WBC count in terms of determining interferon dosages.
  • Even if the ANC falls during interferon treatment, it will return to its normal level once treatment is stopped.
  • Your total WBC count includes neutrophils plus the 4 other types of WBCs (eosinophils, basophils, monocytes, and lymphocytes).
  • Laboratories will report both the total WBC count and the ANC.

Hemoglobin

Hemoglobin is a protein within red blood cells. Hemoglobin allows red blood cells to carry oxygen to the rest of the body.

Explanation of test results:

Measuring hemoglobin levels helps to estimate the number of red blood cells in the body. A low hemoglobin level is referred to as "anemia." If hemoglobin levels are very low, patients may feel tired easily.

Other things to know:

  • The hemoglobin level is related to the hematocrit (see next screen: "Hematocrit").
  • Low hemoglobin levels can develop during treatment with interferon and ribavirin.
  • Often, lowering the dosage of ribavirin will help bring the hemoglobin level back up.
  • Often, a medication called Epogen can be used by patients receiving treatment to bring the hemoglobin level back up.

Hematocrit

The hematocrit is sometimes known as "red blood cell count." The hematocrit is the percentage of red blood cells in the total contents of your blood.

Explanation of test results:

A low hematocrit is referred to as "anemia." If the hematocrit is very low, patients may feel tired easily.

Other things to know:

  • The hematocrit is directly related to the hemoglobin level (see previous screen: "Hemoglobin").
  • Low hematocrits can develop during treatment with interferon and ribavirin.
  • Often, lowering the dosage of ribavirin will help bring the hematocrit back up.
  • Often, a medication called Epogen can be used by patients receiving treatment to bring the hematocrit back up.

Creatinine

The level of creatinine in your body is a marker of kidney function. Creatinine comes from the breakdown of creatine, a muscle protein. Properly functioning kidneys remove creatinine from the blood.

Explanation of test results:

High levels of creatinine mean that the kidneys are not functioning normally. When creatinine levels rise gradually, there are not usually any symptoms, and the higher levels can be detected only with blood tests.

Other things to know:

  • Certain medications can cause high levels of creatinine.
  • A high creatinine level is sometimes referred to as "renal insufficiency."
  • If your creatinine level is too high, you may not be able to receive hepatitis C treatments.

TSH (thyroid-stimulating hormone)

TSH is a hormone produced by the pituitary gland in the brain. TSH causes the thyroid gland (located in the neck) to produce thyroid (T4 and T3).

Explanation of test results:

Having a high TSH level means you are "hypothyroid." Symptoms can include fatigue, constipation, and weight gain. When there are low levels of thyroid hormone (hypothyroidism), the TSH becomes elevated as the body tries to increase thyroid production.

Having a low TSH level means you are "hyperthyroid." Symptoms can include weight loss and nervousness. When there are high levels of thyroid hormone (hyperthyroidism), the TSH falls as the body tries to slow thyroid production.

Other things to know:

  • Interferon treatment can cause thyroid changes, so you could see a TSH level rise or fall when you are receiving interferon.
  • Occasionally, patients on interferon need to take medication to correct their TSH levels.
  • Hepatitis C itself also can cause thyroid changes, even without the interferon treatment.
  • In general, thyroid problems are common and occur without hepatitis C.

Glucose

Glucose is also called "blood sugar." It comes from the breakdown of foods and from production of glucose by the liver.

Explanation of test results:

When the glucose (or blood sugar) level is higher than normal, this is known as "hyperglycemia." Patients whose fasting glucose levels are higher than 126 mg/dL are considered to have diabetes mellitus. Patients who have hepatitis C and have diabetes mellitus may have a more difficult time controlling their glucose while receiving interferon treatment.

Other things to know:

  • Most people who have a family history of diabetes, are overweight, or are older than 50 should have a fasting glucose level checked by their doctor.
  • If you develop diabetes, it is not necessarily related to your hepatitis C.
  • If you already have diabetes, it is very important to work to get your glucose levels well controlled. Poorly controlled diabetes can lead to "fatty liver" in addition to the hepatitis C infection of the liver.
  • Fatty liver and hepatitis C together can make liver disease much worse.

Hepatitis B virus testing

HBsAg (hepatitis B surface antigen)

A positive test result means you are infected with hepatitis B.

HBsAb (hepatitis B surface antibody)

A positive test result means you have antibodies to hepatitis B. If you also test positive for HBcAb, then you were infected or exposed to hepatitis B virus in the past, cleared the virus, and are now "immune" (protected) against another infection with hepatitis B. If you test positive for HBsAb but negative for HBcAb, then you were vaccinated against hepatitis B and are protected by the vaccination.

HBcAb (hepatitis B core antibody)

A positive test result means you once were infected with hepatitis B.

HBV DNA (hepatitis B DNA)

A positive test result means you have the hepatitis B virus in the bloodstream and this is called "chronic hepatitis B." You may be right for hepatitis B drug treatments. A negative result means you do not have hepatitis B replicating or circulating in the bloodstream and you do not need hepatitis B drug treatments.

HBeAg (hepatitis B e antigen)

A positive test result means you have the hepatitis B virus in the bloodstream. If you are HBV DNA positive but this HBeAg test result is negative, then you still have the hepatitis B virus in your bloodstream.

Hepatitis A antibody total

A positive test result means you have been infected with hepatitis A in the past or were vaccinated against hepatitis A in the past but are now immune (protected) against being infected with hepatitis A virus in the future.

AFP (Alfa-fetoprotein)

AFP is a protein that is present in patients with liver disease. AFP is also a "tumor marker" and may be used to see if a patient has liver cancer. (Liver cancer is also called hepatocellular carcinoma).

Explanation of test results:

A high level of AFP might mean that a patient has liver cancer. However, sometimes the AFP is high when there is active liver disease but no cancer. Usually, the AFP test needs to be interpreted by a doctor in combination with pictures of the liver taken with ultrasound or CT scan.

Other things to know:

  • An elevated AFP level needs to be interpreted by your doctor. A high AFP level may just mean you have an active liver.
  • AFP can be elevated in other types of cancers and in a normal pregnancy.

Antibody

Antibodies are part of the immune system's response to infection. Once an infection has taken place, the body makes antibodies, which become detectable in the bloodstream. Different antibodies fight different infections.

Explanation of test results:

If you have a positive test result for a specific antibody, it means that your body has had an immune response to that specific infection. It does not necessarily mean you are still infected--it does mean that you were infected at some point in the past.

The hepatitis C antibody test is explained under Hepatitis C tests.

Hepatitis A antibody total

Explanation of test results:

A positive test result means you have been infected with hepatitis A in the past or were vaccinated against hepatitis A in the past but are now immune (protected) against being infected with hepatitis A virus in the future.

Understanding liver biopsy

Liver biopsy is a medical procedure in which a doctor uses a special needle to remove a small piece of tissue from your liver to check for signs of damage. A liver biopsy will help you and your doctor find out more about the health of your liver.

This is important if you have hepatitis C or another liver disease and you are trying to decide about treatment. A liver biopsy also can be helpful if your doctor is not sure what is causing your liver problem. Not everyone, however, will need a liver biopsy.

Liver biopsy--the procedure

A liver biopsy is a medical procedure done in a hospital. You will need to lie flat on your back during the procedure. First, the doctor will find the space between your ribs on your right side where a liver biopsy can be performed most safely.

Then, the doctor will clean the skin above this location and give you an injection (or shot) of local anesthetic to numb the area. After the area is numb, the doctor will insert a biopsy needle to take out a small piece of liver. This part of the procedure is done quickly.

Most people who have a liver biopsy say that it only hurts a little. One generally feels a sting when the doctor administers the shot of anesthetic. Many people also have a feeling of pressure when the doctor inserts the biopsy needle. Some people say that they feel this pressure in their right shoulder, as well.

Liver biopsy--after the procedure

After the biopsy is done, your doctor will ask you to roll onto your side and lie still for 1 or 2 hours. This is to put pressure on the area where the biopsy was performed, so that you do not have bleeding or other problems caused by getting up too soon. After a while, your doctor may order blood tests to make sure that you are not bleeding. Before long, you will be told that you can go home. Follow your doctor's advice not to lift heavy weights or exercise too hard for about 2 weeks, so that your body has enough time to heal.

Liver biopsy risks

A liver biopsy generally is very safe. But, as is true for any medical procedure, there are some risks. These risks include:

  • pain at the site of the biopsy
  • bleeding from the liver
  • puncturing of other organs, if something goes wrong when the needle is inserted
  • very rarely, death (1 in 10,000 cases)

You should not have a liver biopsy if you have used aspirin or another blood-thinning medicine the week before your procedure. You should not take these medicines in the week after your biopsy either. Make sure that you tell your doctor about all the medicines you have been taking or that you plan to take. You also should not have a liver biopsy if your doctor thinks that your liver disease has progressed to the point that your blood does not clot normally.

What is HIV coinfection?

Coinfection is a medical term meaning that you have two or more infections in your body at the same time. If you have both HIV and hepatitis C, then you have HIV and hepatitis C coinfection. These two illnesses are very different, so it is important that you learn about both of them.

  • HIV stands for the human immunodeficiency virus. The virus attacks the body's immune system and, over time, can lead to AIDS.
  • Hepatitis C is a virus that can damage your liver slowly over time.

Why is HIV-hepatitis C coinfection an issue?

Many people who have HIV also have been exposed to other infections, such as hepatitis C. Over half of people who become HIV infected through injecting drugs also become infected with hepatitis C. Overall, more than one third of all Americans infected with HIV have hepatitis C, too. So HIV-hepatitis C coinfection is common.

Having both viruses also makes it a little harder to deal with either one. There are specific medical issues that are unique to coinfected patients.

What do coinfected people need to be concerned about?

Doctors and patients always should try to bear in mind that there are two infections to deal with. Hepatitis C can mean that a person's liver is more sensitive to the effects of HIV medications. Likewise, if coinfected persons are taking hepatitis C medications (interferon shots and ribavirin pills), their doctors need to be extra careful in monitoring them, because their bodies are more sensitive to the effects of these medications. Being coinfected is not a terrible situation, but it requires more attention.

How can HIV affect me?

HIV is the virus that causes AIDS. It is spread mainly through blood and sexual contact. You can have HIV and feel healthy. Over many years, however, the virus can wear down your body's immune system, making it hard for your body to fight off dangerous infections. Having HIV also can increase your risk of getting certain cancers.

Even though there is no cure for HIV infection, there are many medications that can help people with HIV live longer and healthier lives.

You will want to learn much more about HIV, so that you can do everything possible to stay healthy. You also will need to learn how to avoid giving HIV to others. You can find information on the VA HIV/AIDS websiteLink will take you to our HIV/AIDS internet site.

How can hepatitis C affect me?

Hepatitis C is a disease of your liver. It is caused by infection with the hepatitis C virus. The virus is spread mainly through contact with infected blood.

Many people don't know that they have hepatitis C, because the symptoms of the infection often are very mild. Some people with hepatitis C feel tired or have an upset stomach. Others may not have any symptoms at all.

Even if you do not have any symptoms, hepatitis C is still a serious illness. There are medications, called interferon and ribavirin, that can make the hepatitis C virus go away in some people, and even better medications are being developed. It is important to get care for hepatitis C because it stays in your body. You can give hepatitis C to someone else and can develop other health problems yourself.

Hepatitis C is the main cause of cirrhosis of the liver in the United States in 2006. In cirrhosis, healthy liver tissue is replaced by scar tissue. Over time, with cirrhosis, the liver can stop functioning well, and a person even may need to be considered for a liver transplant.

Will having hepatitis C affect my HIV treatments?

No. But some HIV treatments can damage your liver, so your doctor may choose specific drugs for you.

Will having HIV affect my hepatitis C treatment?

No. But being coinfected means medications to treat hepatitis C don't work quite as well in you. Still, the drugs are successful 30-75% of the time. Working closely with your doctor will give you the best chance for successful treatment.

Can I give HIV or hepatitis C to someone else through sex?

HIV is spread by infected blood, semen, and vaginal fluids. Practicing safe sex is the best way to keep other people from getting HIV.

Hepatitis C is spread mainly by the blood and rarely by sex. But you still can give hepatitis C to someone you have sex with if you're not careful.

If you have sex, the best thing to do is practice safer sex all the time. To do so, always use a condom, dental dam, or other latex barrier and avoid "rough sex" or other activities that might cause bleeding. For more information, see tips for using condoms and dental damsLink will take you to our HIV/AIDS internet site on the VA HIV Web site.

Can I give HIV or hepatitis C to someone by using drugs with them?

Sharing needles or works to inject drugs is one of the easiest ways to spread hepatitis C and HIV. By sharing needles or works, you even can spread both of these viruses at the same time.

The best thing to do, especially if you have hepatitis C or HIV, is not use drugs. Talk to your doctor about getting help to stop.

If you use drugs, make sure that your needle and works are clean (or brand new) every time and never share them with anyone else. Snorting drugs such as cocaine also may spread hepatitis C, and possibly HIV.

Is there a cure for HIV or hepatitis C?

There is no cure for HIV, but it often can be controlled. Hepatitis C can be treated successfully. This is like a cure, but in rare cases the virus still causes problems later.

Medications for both diseases keep getting better. Talk with your doctor about these treatments for HIV and hepatitis C. Educate yourself about your treatment choices as much as you can.

How can I slow down my HIV and hepatitis C infections?

Having only HIV or hepatitis C is difficult enough. Finding out that you have both at the same time might seem overwhelming. The best way to keep your coinfection from becoming a serious health problem is to keep yourself and your liver healthy by following these guidelines:

Do not drink alcohol.

Alcohol weakens your immune system and damages your liver even when you are healthy. Drinking alcohol heavily when you have HIV and hepatitis C makes the damage much worse. Remember, there is no "safe" amount of alcohol you can drink when you have HIV and hepatitis C. It doesn't help to switch from "hard" liquor to beer, cider, or wine. If you need help to stop drinking alcohol, talk to your doctor.

Get vaccinated against other hepatitis viruses.

Having hepatitis C does not mean that you can't get other kinds of hepatitis. Talk to your doctor about getting vaccinations (or shots) to protect you from getting hepatitis A and B.

Avoid taking medicines, supplements or natural or herbal remedies that might cause more damage to your liver.

Even ordinary pain relievers in high doses can cause liver problems in some people. Check with your doctor before you take any natural or herbal remedy, supplement, prescription, or nonprescription medicine. And, make sure your doctor knows all the medicines you are taking for HIV and hepatitis C.

Don't use illegal drugs.

Remember that these drugs can make your illness worse. Talk with your doctor if you can't stop taking drugs.

Respect your body.

Eat healthy food, drink plenty of water, and get restful sleep. Try to exercise every day.

Get support.

Ask your doctor where you can get support in your area. If you already get services from an AIDS organization, ask about support groups for people who have HIV and hepatitis C.

Stay informed.

HIV and hepatitis C are two of the most important medical issues today. Try to educate yourself about them. Ask your doctor if you need help making sense of anything you hear on the news or read in a newspaper.

Follow your doctor's advice.

Follow all instructions you get from your doctor. Try to keep all of your appointments. Call your doctor immediately if you have any problems.

Resources

General hepatitis resources

  • Glossary
    Definitions of terms commonly used with viral hepatitis and related conditions.
  • American Liver FoundationLink will take you outside the VA website. VA is not responsible for the content of the linked site.
    A national nonprofit organization dedicated to the prevention, treatment, and cure of hepatitis and other liver diseases through research, education, and advocacy. Web site features a database directory of hepatitis clinical trials, lay-oriented facts sheets, and links to additional resources.
  • Centers for Disease Control and Prevention: Viral HepatitisLink will take you outside the VA website. VA is not responsible for the content of the linked site.
    Information on all types of viral hepatitis from the CDC's National Center for Infectious Diseases. Site features related CDC guidelines and recommendations as well as training materials, slide sets, fact sheets, and key CDC hepatitis documents.
  • HCV AdvocateLink will take you outside the VA website. VA is not responsible for the content of the linked site.
    Web site of the Hepatitis Support Project, whose goal is to offer support to those who are affected by hepatitis C and related coinfections. Information and education is provided, as well as access to support groups.
  • Hepatitis B FoundationLink will take you outside the VA website. VA is not responsible for the content of the linked site.
    A nonprofit organization dedicated to finding a cure and improving the quality of life of those affected by hepatitis B worldwide through research, education, and patient advocacy. Features information in English, Chinese, Korean, and Vietnamese.

HIV/Hepatitis C coinfection resources

  • VA National HIV/AIDS Web SiteLink will take you to our HIV/AIDS internet site
    Information on HIV/AIDS for health care providers and patients from the Department of Veterans Affairs.
  • HIV/AIDS/Hepatitis C Nightline:
    Hotline providing support for people with HIV or hepatitis C and their caregivers during the evening and nightime hours. 1-800-273-AIDS or 415-434-AIDS; 5 pm - 5 am Pacific time. Also offers Spanish-language hotline at: 1-800-303-SIDA or 415-989-5212.
  • NATAP: HepatitisLink will take you outside the VA website. VA is not responsible for the content of the linked site.
    Recognizing that coinfection with viral hepatitis among people with HIV is a growing problem, the National AIDS Treatment Advocacy Project (NATAP) has developed an extensive amount of information on hepatitis, both in the context of HIV coinfection and as a separate illness. NATAP provides coverage of key conferences, maintains a selection of hepatitis articles, and features an ask-the-expert forum on hepatitis C.