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Thank you all for reading our first Hep C U Later blog. In this blog (written by our southern coordinator Louise Hansford) we will be looking at how we test for Hep C, and the different tests that we use.
How We Test for Hepatitis C (HCV)
HCV is diagnosed through two tests; the first one will test for the presence of HCV antibodies. Having these does not mean a person has HCV. A second test known as PCR (Polymerase chain reaction) or (RNA Ribonucleic acid) is required to check if someone has an active HCV, which will require treatment to clear. Around 20% of people who are exposed to HCV will spontaneously clear the virus without treatment; we are still unsure however how or why this happens.
It is worth noting that unlike other antibodies, HCV ones do not protect you from getting the virus again if someone puts themselves at risk. A further blood test will identify which genotype of HCV someone has, the only relevance now is which treatment you may be given. I use the analogy of tomatoes to explain this, in that we have cherry tomatoes, plum tomatoes, beef tomatoes and vine ripened ones, they are all tomatoes just slightly different. It is important when giving results not to use terminology such as “I’m sorry to tell you….” As this may compound stigma and shame, instead try saying, “Your tests show… and the good news is there is well tolerated treatment available with over 95% cure rates and minimal side effects”
All of the above can be confusing for our patients and indeed many healthcare professionals. To take this a step further there are now a variety of ways to test for hepatitis C
HCV Antibody tests
These can be done at point of care and generally give a result in 20-40 minutes. The tests can be done with oral fluid taken by swabbing the gums, or through finger prick bloods. The sample is taken and then allowed to develop through activating fluid.
The advantages of this test are being able to give someone an indication of their status whilst you have them engaged, meaning less chance for them to drop out of the care pathways. It is best practice to be able to do the RNA/PCR test immediately for this reason but also to alleviate any anxieties and ensure linkage to care.
Antibody tests can also be done through whole blood samples taken through venepuncture; the advantages of this are mostly pathology laboratories can then do the RNA/PCR from the same sample. However sometimes they cannot due to needing different types of bottles for the sample. Again, it is good practice to ensure if testing this way the sample can be reflexed tested for active virus.
Capillary blood testing (CBT) is an option if your patients have poor venous access, this uses finger prick blood into an adapted blood tube and it is processed by the laboratory
Another way, popular within drug and alcohol service is the use of dried blood spot tests (DBST), where droplets of blood are captured on a specialist card and once allowed to dry sent to a laboratory for analysis. The advantage of this is that anyone can be trained and they are straightforward to use. However, results can take up to 14 days so it is important to ensure you can contact your patients to give them their results and if needed link them into care
There is now a new way to test for the presence of a active virus that can also be done by venous, DBST and CBT as above. This is done using a Cepheid machine and you may have seen our social media posts about our machines, fondly called and Cyril and Cindy. These machines utilise a droplet of fingerpick blood and will give a PCR/RNA result after one hour. Obviously, the main advantage is being able to give a complete diagnosis and link patients straight into treatment. They are also changing the landscape for monitoring for reinfections and treatment compliance, and we look forward to continue using them.