Testing for the hepatitis C virus

Certainty
If you are worried that you may have been exposed to hepatitis C, uncertainty can be a lot more stressful than knowing you do have it. If you have been unwell, taking a test will either eliminate hepatitis C as a possible cause or, if you receive a positive result, it can explain your symptoms and knowing why you feel the way you do can be a big relief. And of course once you do know, you have a range of options for addressing the disease.

Taking responsibility for your own health
Although hepatitis C is a serious health issue, treatment is now available that, in a significant number of cases, can clear the virus and can also slow down disease progression. Hepatitis C is a progressive illness therefore the sooner you know you have the disease, the sooner you can take action to help yourself, and the more success you can have in alleviating symptoms, slowing progression and even clearing the virus.

Once you have received a diagnosis you will be referred to a specialist experienced in hepatitis C. Not only will this mean that your condition will be monitored closely and treatment options considered, but it will also enable you to ask important questions, gain further information and enable you to make choices about how you can best manage your condition and any symptoms, physical or mental, you may be experiencing.

Simple lifestyle changes such as reducing your alcohol intake, cutting down on smoking and improving your diet can make a significant difference to your health. See caring for yourself

Knowing about your condition will enable you to take more control over your life in general; this is very important for your psychological health. You may feel more able to make plans for both the short and long term future.

Protecting others
If your test result is positive, you can take appropriate measures to ensure that you do not transmit the virus to others. See transmission prevention.

Getting the timing right
Before you make your decision, consider whether this is the right time for you to take the test: are you prepared, have you considered the implications of your result? This is not to dissuade you from taking the test, but to encourage planning for it. If you do have hepatitis C, postponing taking a test for a short period of time whilst you prepare yourself is unlikely to make a great deal of difference.

Having a pre-test consultation with a professional
The point of having a pre-test consultation is to explore the implications of a positive or negative test result. Its advisable to only go ahead with a test after you have considered these implications and you feel confident that you are prepared. If you are at all unsure, require further information or you feel you need to discuss it with someone else, then make arrangements to return at a later date.

Access to a pre-test discussion will vary according to where you are tested. For example all sexual health clinics and most drug agencies will provide a pre-test discussion to those who request a hepatitis C antibody test. Some GPs will provide the service, although this will largely depend on the resources they have. Whether you receive a pre-test discussion may also depend on the circumstances that have led to considering a test. For example if your doctor is undertaking a series of investigative tests to determine the cause of symptoms you have presented with, then it is likely that a hepatitis C test may be undertaken alongside a series of other tests and pre-test discussion may not be considered.

Emotional impact
You may want to prepare yourself for the impact of a positive diagnosis. The result may cause very strong emotions that can be hard to handle on your own. You may, for example, experience a lot of anger about how you contracted it or remorse about certain actions.

A positive diagnosis is, without doubt, a life-changing experience. Not only may it confirm your worst fears, but it may also place a huge question mark over your future. For example, am I going to die? How ill am I going to get? Will I be able to have children? Will I be able to continue work? Who will care for me? Who will love me? Being faced with these uncertainties on your own can be a tall order. Do you think you could cope without support? If you think you will need supporting, do you have someone to be there for you?

Putting support in place
You may find it easier to arrange to have someone available to talk to after you receive your result. This could be a professional, a family member or a close friend. It is possible you will find the actual impact of a positive diagnosis more distressing than you had imagined, so it is good to have some support arranged in advance just in case.

Impact on your partner
As it is possible, although extremely rare, that hepatitis C can be sexually transmitted, you may need to consider the possibility that a positive diagnosis could mean your partner may also be positive. Another thing to consider is that your partner may be negative and if you receive a positive result in theory there is a small risk you may be able to pass the virus on to them and so you may want to open up the question of how this may effect your relationship.

Financial impact
How will the result affect your access to a mortgage or insurance? If your test result is positive and you apply for a mortgage or insurance, you may be asked about your hepatitis C status. You are required by law to give an honest answer: if you lie and your deception is discovered, your insurance will be invalidated and any claims refused. To address this consideration you may decide to postpone your test until after organising any insurance or mortgage.

If either your mortgage broker or insurance provider wishes to obtain a medical report about you from you doctor, they are required to gain your permission prior to contacting them. However, be very careful: sometimes you sign papers that merely contain quotes or estimates, but they may also include small print that states you are giving them permission to obtain your medical records. Read all the small print very carefully before signing anything. You are entitled to see any requested medical reports prior to them being dispatched. If you wish to see the report you should make any request clear to your doctor.

To conclude
Prior to taking a test you should consider whether you are prepared for the changes it may make to your life. Perhaps you could make some preliminary arrangements or put some plans into place before going for a test. But remember, delaying or postponing testing should be about giving yourself time to prepare for it. The only definite way to know whether you have hepatitis C is by taking the test and on the whole this is a positive step to take.

Some GPs are reluctant to undertake, or make a referral for hepatitis C testing. This may be for a number of reasons. They may consider that other tests should be performed prior to a hepatitis C test or they may, with the information they have on you and your health, not perceive that you have been exposed to any risk of a hepatitis C infection. They may actually not know much about hepatitis C. However, if you are at all concerned that you may have been exposed to hepatitis C or have symptoms that may be attributed to hepatitis C and you feel a hepatitis C antibody test is necessary, do not be swayed. Explain your concerns and, if necessary, ask for a second opinion. If you are experiencing real resistance from your GP and deem it necessary to make a complaint or change your GP, you can exercise your right to do so. See Dealing with doctors.

Alternatively, if you are generally happy with the care your GP is providing you but you are unable to obtain a hepatitis C antibody test via them, you could consider approaching your local Sexual Health Centre or GUM Clinic at your local hospital.

Some GUM or Sexual Health clinics may also be unwilling to test for hepatitis C as it is not strictly speaking a sexually transmitted disease. It may help if they think that you could have been exposed to HIV at the same time.

If you have already received a negative antibody test result in the past and you are concerned about a subsequent exposure you are entitled to a further test. You do not have to return to the same testing site, neither do you have to reveal that you have previously been tested. All information you provide should be treated with respect and confidence.

The process of getting a diagnosis involves 2 blood tests.

1. A hepatitis C antibody test is the first test undertaken. This is to determine whether you have ever been exposed to the hepatitis C virus by testing for the presence of antibodies to the virus generated by your immune system.

If you receive a negative hepatitis C antibody test but you have experienced symptoms or have been recently exposed to hepatitis C then you are likely to be advised to receive a second test. It is important to remember that what is called a 'window period' exists when your immune system may not have had time to produce antibodies. It usually takes between six to twelve weeks for antibodies to HCV to develop however in a few people it can take up to six months. So if you have the test within this window period of six months and the result is negative, it does not neccesarily mean that you don't have the virus.

If you receive a positive hepatitis C antibody test, this does not necessarily mean you are currently infected. Up to 20% of people clear the virus from their bodies yet they still have hepatitis C antibodies - this is called spontaneous clearance. There is a chance that you may have been infected with hepatitis C in the past but you are no longer infected.

2. If an antibody test is positive the next test is to check if the virus is still present by having a ‘qualitative’ PCR test (polymerase chain reaction). The PCR test determines whether you are currently infected by detecting active hepatitis C virus replication in the blood.

Test results are reported as either ‘undetectable’ or ‘detectable’. A positive (detectable) PCR result means your immune system did not clear the infection during the acute phase of infection and has progressed to the chronic phase.

The PCR test will usually be undertaken by the hepatology unit of your local hospital, although some GPs, GUM and Sexual Health Clinics will perform this test as well. Regardless of where your blood test is initiated all blood samples will be sent to a laboratory for analysis. Test results are usually returned within two weeks, sometimes sooner.

If you have decided to go ahead with a test there are a number of people you can approach to arrange a test. There will be regional variations. Some areas, especially urban and metropolitan areas, have more testing sites than others. Nevertheless, across the whole country most Sexual Health Clinics or GUM Clinics are able to provide hepatitis C antibody testing. (in Scotland all GUM clinics provide testing).

GPs
Some GPs are able to undertake hepatitis C antibody testing. Depending on their facilities this may involve a blood test, taken at the surgery which is then sent for laboratory analysis or a referral to a local hospital for a blood test and a return to the doctors surgery for the result.

Sexual Health clinics or GUM departments
Most sexual health clinics or GUM departments provide hepatitis C antibody testing. However, it would be wise to call and check whether you require an appointment for a test, some units have a walk-in facility; others operate an appointment system. Sexual Health Clinics and GUM Clinics operate an anonymous clinic number system and it is therefore possible to undertake the test and obtain your result anonymously. If you decide to provide the clinic with a name other than your real name, you should retain your clinic number and make a note of your recorded details as you will need these to obtain your test results.

Drug Dependency Units and Commnity Drug Teams
If you are accessing the services of a Drug Dependency Unit or Community Drug Team, then they are usually able to undertake hepatitis C antibody testing, although once again you are advised to call and check whether you need to book an appointment.

One Stop Health Shops
Some areas have walk in one-stop health shops, often located in town or city centres. These facilities offer a number of health-related services, often including hepatitis C testing. Once again you may be required to make an appointment for a future test.

Antenatal Clinics
Finally, if you are a pregnant woman you may be offered a hepatitis C antibody test while attending an antenatal appointment. If you are pregnant and concerned about hepatitis C and would like to undertake a hepatitis C test, you should discuss this with your midwife.