Hepatitis C Virus Quantity: Assessing Levels, Measuring Methods, and Further Details
Article: The Importance of HCV RNA Testing in Diagnosing and Monitoring Hepatitis C
The HCV RNA test plays a crucial role in determining the presence of an active hepatitis C infection and distinguishing it from a prior, resolved infection.
Diagnosis
After an initial positive anti-HCV antibody test indicating prior exposure, a nucleic acid test (NAT) for HCV RNA is needed to confirm ongoing infection. The HCV RNA becomes detectable in blood as early as 1 to 2 weeks post-infection, preceding antibody formation and elevations in liver enzymes like ALT.
Monitoring and Progression
Quantitative HCV RNA testing measures viral load, guiding assessment of disease activity and response to treatment. A high viral load is associated with active disease, and decreases during effective therapy. Undetectable HCV RNA 12 weeks after completing treatment indicates a sustained virologic response, effectively a cure.
Acute vs Chronic Infection
Fluctuations in HCV RNA levels during acute infection mean tests must be interpreted carefully; however, early detection of RNA helps identify acute infection before antibody tests turn positive.
Clinical Implications
Persistently positive HCV RNA means chronic hepatitis C infection, requiring treatment consideration. Negative RNA despite positive antibody suggests resolved infection or a false positive antibody test.
The HCV RNA test is the gold standard for confirming active hepatitis C infection, monitoring disease progression, and evaluating treatment success. It provides direct evidence of viral replication, which antibody tests alone cannot.
The Department of Veterans Affairs defines a low viral load as less than 800,000 IU/L and a high viral load as more than 800,000 IU/L. A decreasing viral load may indicate that the treatment is working, while an increasing viral load may indicate the treatment is not effective.
People who inject and share needles, have ongoing risk of contracting HCV, or receive maintenance hemodialysis will need regular testing. If a result comes back as undetected, it means no HCV is present. Treatment for hepatitis C is effective for both low and high viral loads.
The Centers for Disease Control and Prevention (CDC) recommends one-time testing for people with HIV, those who have ever injected drugs, individuals with atypical alanine aminotransferase levels, people who have received a transfusion or organ transplant, any child from a biological mother with an HCV infection, and healthcare workers who experienced a needle-stick injury or exposure to HCV-positive blood. The CDC also recommends HCV testing in all adults over the age of 18 years at least once during their lifetime, and testing for each pregnancy.
Any person with concerns about acquiring HCV infection may speak to their doctor about taking an HCV test. If a result is inconclusive, another test is needed. If individuals have an undetected viral load 12 weeks after completing treatment for hepatitis C, they no longer have the infection.
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