GGTP, rise only slightly. Liver function tests are not diagnostic tests for hepatitis C, but they do indicate that more specific tests to evaluate for hepatitis C might be necessary. The fastest initial screening test, a lab test to detect antibodies to the HCV virus, is also the most easily obtained. To confirm this viral infection, a test that measures the actual hepatitis C genome (HCV RNA) is performed.
Several types of tests—known by abbreviations such as PCR, TMA, bDNA—measure the actual amount of hepatitis C RNA virus in the blood. The HCV RNA test, commonly called a viral load test, is more expensive than the antibody test, but it is the best test to determine the presence and quantity of the virus in the bloodstream. This information is important because the body sometimes rids itself of the virus on its own. The doctor will want to retest the patient to confirm whether the hepatitis C virus persists in the blood.
If follow-up tests are performed in six months, and the HCV RNA has become nondetectable, then patient and doctor will know that the infection was indeed acute HCV and that the body was able to eliminate the virus on its own. If the immune system has failed to eliminate the HCV, then the hepatitis will have progressed to the stage of chronic infection, and treatment options can be explored.
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Most acute hepatitis C infections are not identified early because the patients do not display symptoms and, therefore, do not seek medical care. The good news is that once a patient is identified as having acute hepatitis C, treatment, if it is required, is extremely effective. In a number of small studies, treatments for acute hepatitis C have shown a viral eradication rate of up to or greater than 80 percent.
In extremely rare instances, acute HCV develops into a severe form known as fulminant hepatitis C. In fulminant HCV, liver failure, jaundice, and encephalopathy strike suddenly, and the patient must undergo a liver transplant immediately in order to survive.
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Hepatitis C is a much more stubborn virus than HBV, and as many as 85 percent of acute HCV patients may develop chronic hepatitis C. One reason for the resiliency is that the hepatitis C virus found in any one person is actually made up of many genetic variations of HCV, a phenomenon described as a quasispecies. ‘When the immune system begins to fight the HCV virus, the virus it encounters may alter its genetic features in subtle ways, thereby evading the body’s defenses.
People may be infected with chronic HCV for years and not knowit. Onlyabout25 percent ofpeople infected with HCV notice any symptoms, and those that they do notice are likely to be mild and nonspecific, such as weakness, weight loss, some depression, and possibly discomfort in the abdomen. Because many people have no troublesome symptoms, the diagnosis of hepatitis C may be made incidentally, for example when a life-insurance physical calls for lab tests or in the wake of a blood donation.
Chronic HCV sometimes causes disorders outside the liver. These are called extrahepatic manifestations. Skin diseases, such as vasculitis (inflammation of blood vessels), blisters, and pruritus (extreme itching), are some of these rarer features. Blood-related disorders, such as non-Hodgkin’s B-cell lymphoma, may also be seen. Thyroid disease, diabetes, corneal ulcers, kidney disorders, and joint pain are other disorders possibly associated with chronic HCV.
When chronic HCV is suspected, the doctor will order several tests to determine the best course of treatment. The first test is hepatitis C viral RNA (HCV RNA), which confirms the presence of the virus in the blood (viremia). Next, the doctor selects from a
number of tests to assess the actual viral load, or amount of HCV RNA in 1 milliliter of blood. These quantitative tests include the polymerase chain reaction (PCR), target-mediated amplification (TMA), and branched DNA (bDNA). As a rule, test results are reported in international units per milliliter of blood, or IU/ml.
Another term often associated with HCV is genotype, which is used to describe the genetic makeup of the specific strain of HCV that is infecting a patient. Researchers recognize six clear HCV genotypes, and the genotype that is infecting a given individual is identified with a simple blood test. Genotypes are reported as 1 through 6, with subgroups indicated by lowercase letters a, b, c. In rare instances, people may be infected, by more than one genotype.
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