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Steps to Diagnosing and Getting Treatment for Hep C

What to expect during and after hep C screening and how to decide on a treatment plan.

A man's blood is drawn for hep-C testing. A positive hep-C diagnosis means the lab will run an RNA test to guide treatment.

Medically reviewed in January 2022

Hepatitis C is a viral infection with the hepatitis C virus (HCV) that causes inflammation of the liver. An estimated 3.5 million people in the United States have hepatitis C, and it's estimated that there are more than 30,000 new hep C diagnoses each year. HCV is most often transmitted through direct contact with the blood of a person who is infected with the virus. Because hep C infections are often asymptomatic, patients can have a chronic hep C infection for years without knowing it. A chronic hep C infection can lead to life-threatening complications like cirrhosis of the liver, liver cancer and liver failure. 

The good news is that there are effective methods for diagnosing hep C, as well as a number of effective treatments—currently, more than 90 percent of people who are treated for hep C are cured of the infection. 

Here, we’ll look at the tests that a healthcare provider will use when diagnosing the virus—and how this hep C testing helps patients and healthcare providers find the best course of treatment. 

Initial hep C screening 
The initial screening test for hepatitis C is an antibody test that looks for the presence for HCV antibodies (anti-HCV) in the blood. If this test comes back positive, it means that the person has been infected with hepatitis C at some point in their life. 

Hep C RNA test 
If the initial screening test is positive, your next step is a follow-up test to determine whether the hepatitis C infection is active. As many as 20 to 40 percent of hepatitis C cases resolve on their own without treatment and without becoming a chronic infection. Your healthcare provider will order a test that checks for the presence of hepatitis C virus RNA (the genetic material of the virus). If the RNA test is positive, it means the hep C infection is active. 

Before you can begin treatment, there are several key pieces of information that your healthcare provider will need to know about the infection. These include the virus’s genotype, the viral load and the health of your liver. 

Genotype 
Hep C genotypes are different versions of the hepatitis C virus—just like any living organism, HCV has evolved over time, and these evolutions have resulted in seven major hepatitis C genotypes, as well as numerous subtypes within the genotypes. The most common hep C genotype in the United States is genotype 1. Different treatment regimens are tailored to each genotype, which is why this is a crucial piece of information. 

Viral load 
Before treatment, your healthcare provider will also test for viral load, which is the amount of the virus that is present in the blood. Viral load can be useful in predicting how an infection will respond to treatment. It will also be monitored while a patient is on a treatment to determine how well a treatment is working. The goal of treatment is to get the viral load to zero, or undetectable in the blood, which means the body has cleared the infection. 

While it is usually easier to clear a low viral load, viral load is not an indication of the severity of the inflammation and/or damage to the liver—a low viral load can cause as much (or more) inflammation as a high viral load. 

Liver damage 
Prior to treatment, your healthcare provider will need to know how much damage the hep C infection has caused to the liver. This is accomplished with blood tests and imaging tests, though biopsies may be used in some cases. The guidelines for treatment are sometimes different for patients with cirrhosis of the liver, and patients with cirrhosis may require treatment from a different specialist. 

Deciding on a treatment 
When deciding on a treatment plan for hepatitis C, your healthcare provider will also take into account other important factors about your health, including whether you have been treated for hep C before, whether you have had a liver transplant, whether you have any other health conditions (there is overlap between hepatitis C and other blood-borne viruses, including HIV and hepatitis B), and your overall health. If you have been diagnosed with hepatitis C, it is important to work closely with your healthcare provider, get the tests you need and follow your treatment plan.

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