Articles

Hepatitis C is a viral disease that primarily affects the liver. In its chronic (or long-lasting) form, the hepatitis C (HCV) can cause liver damage, cirrhosis (scarring of the liver), and liver cancer. These complications can lead to the need for transplant, and even death. And although it is estimated that between 3.2 and 5.2 million Americans are living with chronic hepatitis C, most are not aware of their HCV status, and so do not seek treatment until symptoms begin, sometimes decades after they became infected. New HCV therapies hold the promise of more efficient, successful treatment, with fewer side effects than current treatment regimens. But, as John Ward, Director of the Centers for Disease Control and Prevention (CDC), recently stated, “The benefits of such improved treatment…cannot be realized if infected persons are not brought in to care. Testing is the link…”

The fact that rapid antibody screening tests are available for both HIV and HCV is only one of many reasons that it makes sense to encourage clients to test for HIV and HCV at the same time. Both are widespread, infectious, damaging, sometimes fatal diseases that may take years to show symptoms.

The key route of transmission for hepatitis C is blood, and HCV is more easily transmitted through blood contact than HIV. This is because there is a greater quantity of HCV in blood than HIV, and because HCV can live longer than HIV outside the body. Some of the common ways that people come into contact with HCV in blood include sharing injection equipment and accidental needle sticks among healthcare professionals. It is uncommon for a person who has injected drugs for many years to not have been exposed to HCV. Some studies suggest that as many as 70 to 96 percent of people who have injected drugs have been infected with HCV at some point. Sexual contact plays a bigger role in HIV transmission than in HCV transmission, but sex is a way that HCV infection can occur, particularly among people living with HIV, those who have had “rough sex” (that could include skin tearing or other exposure to blood), and people with “multiple sexual partners.”

Some of the same populations are disproportionately affected by HCV and HIV. This shared disparity is particularly stark among Black Americans, who have rates of HIV that are four times higher than the general population, who are twice as likely to have ever been infected with the hepatitis C virus than the U.S. population as a whole.

The new OraQuick Rapid HCV test, like the OraQuick HIV-1/2 test, is an antibody test. That means that it is looking for antibodies to the hepatitis C virus, rather than the hepatitis C virus itself. As with HIV, it takes a person’s body a while to develop these antibodies, a span of time called the “window period.” See the figure labeled “Understanding the HCV Window Period” to compare the HCV and HIV window periods. If a person had an exposure to HCV that was less than six months ago, and their HCV test result was nonreactive, they would need to come back for more antibody testing after the end of the window period to be sure that the exposure had not resulted in infection.

When the rapid HCV test does find antibodies, the meaning is different from what it is for a preliminary positive HIV antibody test. On an HIV test, a preliminary positive result means that it is highly likely that the client is infected with HIV, and that a confirmatory test must be done. There is only a tiny chance that the confirmatory HIV test will reveal that the person is not actually infected. Once people get HIV, they always have it, even though treatment can greatly reduce HIV’s harmful effects.

Watch for Part 2 of this article tomorrow.