Symptoms and Testing:

Testing for Hepatitis C:

Doctors can tell if you're infected with the Hepatitis C virus by performing different blood tests. They look at several different things such as:

Liver Enzymes- When the liver is being attacked and cells are being destroyed, liver enzymes becomes elevated. Doctors use a blood test that measures the level of the liver enzyme called ALT (alanine aminotransferase). An elevated ALT test may indicate liver damage.

Antibodies- Doctors use the Elisa (enzyme-linked immunosorbent assay) and the Riba (recombinant immunoblot assay) tests to detect the presence of antibodies that the body produces against the Hepatitis c virus. A positive HCV antibody test indicates exposure but does not tell if it is a current or past infection.

HCV-RNA By PCR- (Polymerase Chain Reaction)- It is the most sensitive test available. This test assesses the presence or absence of the Hepatitis C virus itself in the blood, or in other body tissues. It can detect minute traces of the virus in any given medium. It works by taking a sample of the blood and amplifying the nucleic acid associated with the virus many millions of times. It brings the nucleic acid up to detectable levels. Testing for HCV RNA by PCR is particularly useful when aminotransferases (ALT and AST) are normal or only slightly elevated, when anti-HCV is not present, or when several causes of liver disease are possible. This method also helps diagnose hepatitis C in people who are immunosuppressed, have recently had an organ transplant, or have chronic renal failure. At present, however, there are no PCR assays approved by the Food and Drug Administration for general use, although commercial test systems are available. Many commercial laboratories offer their own PCR assays, which are not subject to strict independent quality controls. Thus, the reliability and specificity of the PCR technique are not standardized. In addition, it is expensive and prone to technical or laboratory error. When ordering HCV RNA testing by PCR, the physician should use a high-quality laboratory willing to document standardization of the test.
 

Quantification of HCV RNA in Serum:

Several methods are available for measuring the titer or level of the virus in serum, which is an indirect assessment of viral load. These methods include a quantitative PCR and a branched DNA (bDNA) test. Unfortunately, these assays are not standardized, and different methods from different laboratories can provide different results on the same specimen. In addition, serum levels of HCV RNA can vary spontaneously by 3- to 10 fold over time. Nevertheless, when performed carefully, quantitative assays provide important insights into the nature of hepatitis C
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Viral load does not correlate with the severity of the hepatitis or with a poor prognosis (as it seems to in HIV infection): but viral load does correlate with the likelihood of a response to anti viral therapy. Rates of response to a course of alpha interferon and ribavirin are higher in patients with low levels of HCV RNA. There are several definitions of a "low level" of HCV RNA, but the usual definition is below 2 million copies per milliliter (mL).

In addition, monitoring viral load during the early phases of treatment may provide early information on the likelihood of a response. Yet because of the shortcomings of the current assays for HCV RNA level, these tests are not reliable guides to therapy. More sensitive and reliable methods of quantitating HCV RNA in serum are needed. Until that time, these tests should not be routinely used in practice.

Genotyping and Serotyping of HCV:

There are 6 known genotypes and more than 50 subtypes of  hepatitis C. The genotype of infection is helpful in defining the epidemiology of hepatitis C. Knowing the genotype or serotype (genotype specific antibodies) of HCV is helpful  in making recommendations and counseling regarding therapy. Patients with genotype 2 and 3 are almost three times more likely to respond to therapy with alpha interferon and ribavirin. Furthermore, when using combination therapy, the recommended duration of treatment depends on the genotype. For patients with genotype 2 and 3, a 24-week course of combination treatment is adequate, whereas for patients with genotype 1, a 48-week course is recommended. For these reasons, testing for HCV genotype is often clinically helpful. Once the genotype is identified, it need not be tested again; genotypes do not change during the course of infection. A genotype test can not be performed once the patient is "undetectable" with the virus.

Once you start getting all the blood tests involved with the treatment, here is a really good website to explain the interpretation of the lab tests. If your blood tests are under the normal range, or above the normal range, this page is for you to read and to learn by.  Blood tests online is another great source.

Normal Serum ALT Levels:

Some patients with chronic hepatitis C have normal serum alanine aminotransferase (ALT) levels, even when tested on multiple occasions. In this and other situations in which the diagnosis of chronic hepatitis C may be questioned, the diagnosis should be confirmed by testing for HCV RNA. The presence of HCV RNA indicates that the patient has ongoing viral infection despite normal ALT levels. A large population of people with normal ALT can have cirrhosis.

Liver Biopsy:

Liver biopsy is not necessary for diagnosis but is helpful for grading the severity of disease and staging the degree of fibrosis and permanent architectural damage. Hematoxylin and eosin stains and Masson's trichrome stain are used to grade the amount of necrosis and inflammation and to stage the degree of fibrosis. Specific immunohistochemical stains for HCV have not been developed for routine use. Liver biopsy is also helpful in ruling out other causes of liver disease, such as alcoholic liver injury or iron load.

 HCV causes the following changes in liver tissue:

*Necrosis and inflammation around the portal areas, so-called "piecemeal necrosis" or "interface hepatitis."

*Necrosis of hepatocytes and focal inflammation in the liver parenchyma.

*Inflammation cells in the portal area ("portal inflammation").

*Fibrosis, with early stages being confined to the portal tracks, intermediate stages being expansion of the portal tracks and bridging between portal areas or to the central area, and late stages being frank cirrhosis characterized by architectural disruption of the liver with fibrosis and regeneration.

Grading and staging of hepatitis by assigning scores for severity are helpful in managing patients with chronic hepatitis. The degree of inflammation and necrosis can be assessed as none, minimal, mild, moderate, or severe. The degree of fibrosis can be similarly assessed. Scoring systems are particularly helpful in clinical studies on chronic hepatitis.

Knowledge is power with the Hepatitis C virus!

 

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