Testing and Liver Monitoring

Testing for Hepatitis C

The initial screening test for hepatitis C is a blood test which checks for antibodies. The human body produces antibodies in response to the virus. It can take up to 12 weeks for sufficient antibodies to be present and detectable in a blood test – this is known as the ‘window period’. A negative antibody test in the first 12 weeks may not be definitive. If a person is found to be antibody positive, another blood test is required to check for the presence of the actual virus. This is done because people who naturally clear the virus will still have the (harmless) antibodies, possibly for life.

A Polymerase Chain Reaction (PCR) test can detect whether the virus (not just the antibodies to the virus) is present in your blood. The hepatitis C virus is usually found in low levels in the blood and the PCR test uses a laboratory technique to amplify the genetic material of the virus. There are three types of PCR tests:

  • A basic PCR viral detection test is used to determine if a person has the virus, formally called qualitative test. It is recommended for anyone who is antibody positive that they have the PCR test performed to see if they still have the virus.
  • A PCR viral load test looks for the virus and estimates the amount of virus circulating in someone’s blood.
  • A PCR genotype test looks for the virus, and determines the particular strain (genotype) of HCV a person has. The genotype testing can help predict a person’s chances of responding to therapy.

Monitoring Hepatitis C

Fibroscan tests use advanced ultrasound technology to assess the stiffness of a person’s liver (the stiffer the liver, the more likely that fibrosis or cirrhosis exists). Fibroscan takes only 15 minutes and does not involve needles or other invasive instruments. A series of annual fibroscan tests will show whether or not a person’s liver stiffness is increasing, decreasing or remaining stable.

Liver biopsies, now used less commonly, can provide helpful information on the current status of the liver injury. A biopsy can also identify features useful in the decision to embark on anti-viral treatment, and it may reveal advanced fibrosis or cirrhosis that necessitates surveillance for liver cancer and other serious complications.

People with hepatitis C who have developed severe liver scarring or cirrhosis are at significant risk of developing complications. Regular monitoring and screening tests are recommended. Six monthly ultrasound scans are recommended to detect any new lumps or nodules that may be early liver cancers. If a concerning nodule is identified, another scan (CT or MRI) will be recommended for further assessment.

Importantly, lifestyle modifications can help an infected person reduce the risk of serious complications.

Click here for more information about living well with viral hepatitis

Testing for Hepatitis B

When people know their hepatitis B status they are able to make lifestyle choices to enhance their health.  This may enable them to protect their liver, prevent serious liver damage, prevent transmission of the virus to others, and to seek treatment. In some cases, a diagnosis of hepatitis B may explain why a person has been feeling ill or fatigued, or why certain foods or alcohol may make them feel unwell.

Hepatitis B infection is complex and a number of tests may need to be carried out. The results of these tests can indicate an acute (recent) infection, resolved infection (immunity) or chronic (long term) infection.  Further tests in chronic hepatitis B infection can indicate whether the virus is actively replicating (active infection) or ‘inactive’ (replicating at a much lower rate). All test results and an explanation of their meaning should be provided by the doctor in person.

To understand the tests, it is helpful to understand two basic medical terms:

  • antigen—a foreign substance in the body, such as the hepatitis B virus, and
  • antibody—a protein that the immune system makes in responses to a foreign substance. Antibodies can be produced in response to a vaccine or a natural infection.

Monitoring Hepatitis B

People with chronic hepatitis B are likely to have a lifelong infection, and although they generally remain in good health, they have an increased risk of developing serious complications, such as cirrhosis (scaring of the liver) and liver cancer. Unfortunately, it is the body’s attempt to kill the virus that causes most of the inflammation and damage to the liver.

People living with hepatitis B who are receiving antiviral therapy should be closely monitored. People who are chronically affected and not receiving antiviral treatment for hepatitis B also require continued monitoring. Not all people living with hepatitis B are at equal risk of serious complications. People who are higher risk should undertake a liver health assessment every six months. People living with hepatitis B who are at higher risk include those with cirrhosis, a family history of liver cancer, active inflammation, African people older than 20 years, Asian people older than 35 years (if infected early in life).

Importantly, lifestyle modifications can help an infected person reduce the risk of serious complications.

Click here for more information about living well with viral hepatitis