for Veterans and the Public
Getting Tested for Hepatitis C: Entire Lesson
What is hepatitis C?
Hepatitis means inflammation (or swelling) of the liver. When the liver is inflamed, it can have a harder time doing some of its jobs. (See Understanding the Liver.)A hepatitis virus is one that lives in liver cells and causes inflammation. Different hepatitis viruses have been given different names, such as A, B, and C.
Hepatitis C is a disease that affects your liver. It is caused by a virus, called the hepatitis C virus, or HCV for short. Approximately 4 million people in the United States are thought to have chronic hepatitis C, making it the most common infection of the blood in the United States. Veterans using VA facilities have higher rates of hepatitis C than the general population.
What are the symptoms of hepatitis C?
The symptoms of hepatitis C infection are often very mild. Most people can carry the virus for years and not notice any symptoms. The most common symptoms are vague abdominal discomfort, fatigue, and joint pains. Even if you do not have any symptoms, hepatitis C can be a serious illness. Over time, it can cause other health problems, such as cirrhosis and liver cancer.
Finally, because it stays in your body, you can give hepatitis C to someone else.
What happens to people with hepatitis C?
Hepatitis C, or HCV, replicates in the liver. During this process, parts of the virus trigger your immune system into action. In the process of trying to rid your body of the HCV infection, the immune system actually kills infected liver cells. Over a slow process of many years, the interaction between the immune system and your liver can result in scarring of the liver and loss of liver function.
Most people who are infected with hepatitis C develop a chronic infection with the virus. But for some people, their body gets rid of the virus on its own very early after they are first infected. 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.
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
Should I get tested?
Talk with your VA healthcare provider about being tested if any of the following are true for you.
- Wish to be tested
- Were born between 1945 and 1965
- Have ever used a needle to inject drugs, even if once and long ago
- Had a blood transfusion or organ transplant before 1992
- Are a health care worker who had blood exposure to mucous membranes or to non-intact skin, or a needlestick injury
- Were on long-term kidney dialysis
- Were born of a mother who had hepatitis C at the time
- Are a Vietnam-era Veteran
- Had contact with hepatitis-C-positive blood to non-intact skin or to mucous membranes
- Have tattoos or body piercings in non-regulated settings
- Have ever snorted drugs or shared equipment
- Have liver disease or abnormal liver function test
- Have a history of alcohol abuse
- Have hemophilia and received clotting factor before 1987
- Have had a sexual partner with Hepatitis C, now or in the past
- Have had 10 or more lifetime sexual partners
- Have HIV infection
If you are at risk for hepatitis C, you should consider getting tested. You have to get blood tests to find out if you have HCV because the symptoms of hepatitis C infection often are very mild. In fact, you may not have any symptoms at all.
If you are diagnosed with hepatitis C, you can begin to get the health care and support you need. You will need to learn how to take care of your liver and yourself. You will also need to learn how to avoid giving the virus to others. Because it stays in your body, you can give the hepatitis C virus to others (such as family members and sexual partners).
What Tests Do I Need?
There are usually only two blood tests that need to be done to determine if you have chronic hepatitis C.
The first test your doctor will perform is called an "antibody" test, to see if your body has developed antibodies to HCV. (Antibodies are particles your body makes to fight off infections.) This test is sometimes called an anti-HCV test. A positive antibody result means that, at some point in your life, you were exposed to the hepatitis C virus, and you developed antibodies to fight off the virus. (Another name for this antibody test is EIA.) But just having a positive antibody test does not mean you have chronic hepatitis C infection.
If your hepatitis C antibody test is positive, then your doctor will perform a second test to see if you still have the hepatitis C virus in your body. This test is called a hepatitis C viral load test (or RNA test). If this test is positive, you have chronic hepatitis C, and you may eventually have health problems from the virus.
You do not need a liver biopsy to determine if you have hepatitis C.
For more details about these tests, go to Understanding Lab Tests.
Where can I get tested?
Any veteran can get a test for hepatitis C. You may or may not need an appointment to get tested at your local VA medical center, as different sites have different practices. Your provider will give you basic information about the testing process and to answer any questions that you have about hepatitis C or the test itself.
For more information, call your local VA medical center. (Click here to locate a VA health care facility near you.)
Must I answer personal questions?
Your health care provider may want to discuss your sexual or drug-use history with you. This can help better assess your risk for hepatitis C. Your provider also can give you some recommendations on how to reduce your risk for getting hepatitis C or for transmitting it to others.
If these questions make you feel uncomfortable, you can say that you'd rather not answer them.
Things to remember about getting tested for hepatitis C in the VA system:
- Testing is voluntary. It is a decision that you and your doctor can make together.
- If you don't want to have a test for hepatitis C, it will not keep you from receiving other medical care from the VA.
- Your test results will go on your medical record.
- The VA is not the military. You won't lose your VA benefits just because you engage in certain drug or sexual behaviors.
Is there counseling?
It's important to get counseling when you are tested for hepatitis C. As part of the procedure in the VA, a health care provider will talk with you and explain the testing process, answer your questions, and address your concerns. The provider also can offer advice about reducing your risk for hepatitis C.
After your results come in, your health care provider will tell you what the results were and answer your questions. If your test result is positive, the provider will refer you for a medical evaluation and treatment in a VA facility. If your result is negative, you will learn about ways to protect yourself against hepatitis C.
How long does it take to test positive?
If a person exposed to hepatitis C becomes infected, virus particles (called HCV RNA) can be detected within 1-2 weeks. Liver function tests also will tend to rise during this timeframe. Hepatitis C antibodies appear after RNA is detectable and can take 3-12 weeks to appear.
Can test results be wrong?
Yes. But this is rare.
A "false-positive" test means your antibody test shows that you have been exposed to hepatitis C, when in fact you haven't been. For this reason, your doctor will perform other tests to double- or triple-check your results.
A "false-negative" test means your results suggest that you have not been exposed to hepatitis C, when in fact you have been. One reason someone could have a false-negative result is that they have been infected with hepatitis C recently and haven't developed enough antibodies for the test to detect them. Or sometimes people with other conditions, such as HIV, will have hepatitis C but their antibody test is falsely negative.
What should I do if I test positive?
Hepatitis C does not mean bad health problems or liver cancer or death. Over half of people with hepatitis C will never have any health problems from it.
The most important things you can do right now are:
- Stay in close contact with your health care provider. Explain how you feel and what you're going through.
- Make sure you show up at your medical appointments.
- Follow your doctor's instructions about lifestyle, diet and nutrition, and treatment.
- Learn as much as you can about hepatitis C and how to take care of yourself.
- Ask for help or support when you need it.
Being diagnosed with hepatitis C can be overwhelming, but remember that you are not alone. Your doctor is there to help you, answer your questions, and refer you to sources of support if you need them (such as support groups or counselors).
For details on next steps, go to Just Diagnosed.
What should I do if I test negative?
It's a relief to test negative for hepatitis C. You should remember, though, that just because you tested negative, you are not immune from hepatitis C.
Continue to protect yourself from becoming infected. Here are some ways to reduce your risk of getting hepatitis C:
- Don't inject drugs. If you shoot drugs, talk with your doctor about trying to stop. If you can't stop, don't ever share your needles or works with anyone else.
- Always practice safe sex. Use a latex barrier, such as a condom (or rubber) every time you have sex. Using condoms also reduces your chances of getting some sexually transmitted diseases.
- Do not use anyone else's razor, toothbrush, or other personal care items.
Definitions of terms commonly used with viral hepatitis and related conditions.
- Hepatitis Risk Assessment
5-minute assessment developed by the federal Centers for Disease Control and Prevention that gives you a personalized report of your hepatitis risk
- American Liver Foundation
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 Hepatitis
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.
- NATAP: Hepatitis
Recogizing 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.