Insight 1: Testing & diagnoses

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Diagnosing hepatitis C

If you think you may have been exposed to hepatitis C, taking a test will put your mind at rest or, if the test is positive, allow you to start treatment early GP surgeries, sexual health clinics, GUM (genitourinary medicine) clinics or drug treatment services all offer testing for hepatitis C.


Who should get tested?

You should consider getting tested for hepatitis C if you're worried you could have been infected or you fall into one of the groups at an increased risk of being infected.


Hepatitis C often has no symptoms, so you may still be infected if you feel healthy.

The following groups of people are at an increased risk of hepatitis C:

•Ex-drug users and current drug users, particularly users of injected drugs

•People who received blood transfusions before September 1991

•Recipients of organ or tissue transplants before 1992

•People who have lived or had medical treatment in an area where hepatitis C is common – high risk areas include North Africa, the Middle East and Central and East Asia

•Babies and children whose mothers have hepatitis C

•Anyone accidentally exposed to the virus, such as health workers

•People who have received a tattoo or piercing where equipment may not have been properly sterilized

•Sexual partners of people with hepatitis C


If you continue to engage in high-risk activities, such as injecting drugs frequently, regular testing may be recommended.


Testing for hepatitis C

Hepatitis C is diagnosed using two blood tests: the antibody test and the PCR test. The results usually come back within two weeks.


The antibody test

The antibody blood test determines whether you have ever been exposed to the hepatitis C virus by testing for the presence of antibodies to the virus. Antibodies are produced by your immune system to fight germs.


The test will not show a positive reaction for some months after infection because your body takes time to make these antibodies.


If the test is negative, but you have symptoms or you may have been exposed to hepatitis C, you may be advised to have the test again.


A positive test indicates that you have been infected at some stage. It doesn't necessarily mean you are currently infected, as you may have since cleared the virus from your body.


The only way to tell if you are currently infected is to have a second blood test, called a PCR test.


The PCR test

The PCR blood test checks if the virus is still present by detecting whether it is reproducing inside your body.


A positive test means that your body has not fought off the virus, and the infection has progressed to a chronic (long-term) stage.


Further tests

If you have an active hepatitis C infection, you will be referred to a specialist for further tests to check if your liver has been damaged.


The tests you may have include:

•blood tests – these measure certain enzymes and proteins in your bloodstream that indicate whether your liver is damaged or inflamed

•ultrasound scans – where sound waves are used to test how stiff your liver is (stiffness suggests the liver is scarred)


Hepatitis C and liver damage

The longer you have lived with hep C, the more likely it is that you have some sort of liver damage. Liver damage is more likely if you are: male; over 40 when you contracted hep C; overweight; also living with HIV, hep B or diabetes; a regular or heavy alcohol user.


Liver disease can be advanced by the time hep C symptoms occur. For this reason, it is advisable to be tested and treated early, rather than waiting until symptoms develop.



Approximately one in five people with chronic hepatitis C will develop cirrhosis within 20 years. Liver cirrhosis is a slowly progressing condition in which the healthy liver tissue is replaced with scar tissue, eventually preventing the liver from functioning properly. The scar tissue blocks the flow of blood through the liver and slows the processing of nutrients, hormones, drugs and toxins.

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