Testing for HCV in New York
Many tests are available to detect Hepatitis C virus in the blood. The first test done to screen an individual for the presence of HCV is called Anti-HCV antibody test that is done with enzyme immunoassay or ELISA. Once an individual is infected with HCV, the immune system of that individual will make antibodies against the virus. Detection of these antibodies in the blood shows the individual is infected with HCV. This is very important to know here that once the Anti-HCV antibody tests get positive, it will remain positive during the lifetime of an individual even if the virus is cleared from the body.
There is a considerable probability of anti-HCV antibody being false positive or false negative, so another test called HCV RIBA (recombinant immunoblot assay) is done to confirm the result of a positive anti-HCV antibody test.
Once Anti-HCV antibody test is found positive, second test to confirm the presence of HCV is RNA PCR (polymerase chain reaction). This test detects the presence of HCV RNA in the blood. PCR can be qualitative to detect the presence of the HCV in blood sample or quantitative to detect the viral load in the blood sample.
What is HCV?
The term Hepatitis comprises of two words i.e. “hepat” meaning liver and “itis” meaning inflammation. Therefore, hepatitis refers to a disease in which there is inflammation of the liver cells. There are many types of hepatitis; some are caused by infections and some are due to other pathologic conditions in the body. The hepatitis C is a disease that is caused by viral infection of the liver cells and this virus is commonly known as hepatitis C virus or HCV.
The infection of HCV spread through blood-to-blood contact i.e. blood transfusion from an infection individual to a healthy individual or unsterilized medical/dental equipment use. The people involved in intravenous drug use are the most at risk to be infected with HCV. There is still no concrete evidence whether HCV is transmitted through sexual activity, but it is seen that people indulging in high-risk sexual activities and having multiple sex partners are at high risk. Tattooing is also associated with high risk of transmission of HCV, as well as sharing of personal items like razors and toothbrushes
What are the symptoms of HCV?
Hepatitis C infection can be acute or chronic. An acute infection is very often asymptomatic or exhibits very mild symptoms like fatigue, nausea, decreased appetite, weight loss and pain in muscles or joints. There is no appearance of jaundice in an acute infection in most cases and acute infection very rarely causes acute liver failure. The acute infection is very common in young females, and it resolves spontaneously 10-50% of the time.
More than 80% of the HCV infected individuals develop chronic infection. If the viral RNA is detected in an individual’s blood for more than 6 months, it is known as a chronic infection of HCV. The symptoms with chronic HCV infection are mild fatigue and difficulty in processing information also known has cognitive dysfunction.
The liver function remains close to normal that is indicated by normal levels of enzymes produced by liver. Chronic infection of HCV if remains untreated for several years can cause liver cancer and liver cirrhosis. Cirrhosis is a condition of the liver in which the normal liver tissue is replaced by dead and scar tissue. An estimated 10-30% of the individuals infected with chronic HCV infection develop liver cirrhosis over a period of 30 years and the incidence of developing cirrhosis is noted more in male gender, alcoholics and the individuals who are also infected with hepatitis B virus and HIV (AIDS) virus in addition to HCV. Fatty liver changes are also noted in most of the individuals with chronic HCV infection before development of liver cirrhosis.
Chronic HCV infections may cause other diseases in a human body that does not involve the liver. Most common of these non-liver diseases due to HCV are diabetes mellitus, diabetic nephropathy, cryoglobulinemia, inflammation of small blood vessels and inflammation of the thyroid. Different cardiac problems like cardiomyopathy and cardiac arrhythmias are also reported associated with chronic HCV infection.
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Dr. Gafanovich is performing STD testing as a part of her annual check up .
Treatment of HBV
Treating hepatitis C within first six months of the infection has proven to be more effective than once the disease gets to a chronic stage. As it is a viral infection, treatment is usually done with antiviral drugs like ribavirin, boceprevir and telaprevir. Over a period of time, treatment with a combination of pegylated interferon alpha and antiviral drug like ribavirin for 24-48 months has become a standard treatment for hepatitis C. The treatment strategy of combining different types of antiviral drugs and pegylated interferon alpha depends on the genotype of the HCV. For example, a combination of ribavirin with pegylated interferon alpha cures 70-80% of individuals infected with genotype 2 or 3 of HCV and 45-70% of other types. In addition, results that are more effective are seen when ribavirin is combined with pegylated interferon alpha-2a rather than pegylated interferon alpha-2b. Genotype 1 is most common type in United States and usually treated with a combination of either boceprevir or telaprevir with ribavirin and pegylated interferon alpha. Combination of another drug named sofosbuvir with ribavirin and pegylated interferon has proven to cure 90% of genotype 1, 4, 5 and 6.
Liver transplant surgery is also a common practice in individuals with chronic HCV infection who have developed liver cirrhosis, but rate of recurrence of HCV infection is still very high around 80-90% post-surgery. Treatment with ribavirin and pegylated interferon after liver transplant surgery decreases the chances of recurrence of HCV infection to 70%.
An estimated 3% population of the world is infected with HCV and the virus infects about 3-4 million new people every year; out of which, around 350,000 people die every year from hepatitis C and it is related diseases.
Different alternative medicines have also shown to be helpful like milk thistle and ginseng, but their effect against controlling the HCV infection or eradicating the virus is still questionable.
More emphasis is put on prevention strategies to control the spread of disease including educating the population about HCV, use of disposable needles and syringes, prevention of intravenous drug use, screening of blood donors for HCV, as well as HCV screening before blood transfusions etc.
Scientists are putting in a lot of efforts in developing vaccine for HCV, and some have shown very encouraging results, but these are still on the experimental level and no standard HCV vaccine available as of now.