Tests to monitor hepatitis C

After tests show you have HCV, your clinic should run a series of other blood tests.

These include HCV genotype, testing forhepatitis A and B, full blood count (FBC) and clotting studies, liver enzyme tests
(including ALT/AST, albumin and GGT), thyroid function test (TFT), serum iron, liver autoantibodies, and liver ultrasound.

Hepatitis C viral load (RNA testing)

The hepatitis C virus replicates at a much greater rate than HIV (trillions vs. millions copies per day) so HCV viral load is often high– sometimes in the tens of millions.

People with HIV usually have higher hepatitis C viral loads than people with HCV alone.

Unlike HIV, hepatitis C viral load is not related to the risk of the disease getting worse. Unlike HIV, the hepatitis C viral load is not used to
decide when to start treatment. This can be confusing, especially if you are used to using HIV viral load results as a guide for when to start HIV treatment.

HCV treatment is more effective for people who start treatment when their HCV viral load is low (less than 400,000/International Units), but most people already have viral loads that are well above this before treatment.

About HCV viral load testing

There are two types of viral load tests.

Qualitative testing

Qualitative testing is usually used to diagnose HCV, and to monitor response to treatment, because it can detect very low levels of HCV RNA. The most sensitive qualitative test can detect a viral load as low as 5 IU/mL (International Units per millilitre of blood). The virus is either found or not, and results are reported as either detectable or undetectable.

Quantitative testing

Quantitative testing measures the amount of HCV in a blood sample. Results are reported as IU/mL. Quantitative testing is usually used to obtain baseline (pre-treatment) viral load. Qualitative testing is often used to monitor response to treatment during HCV therapy.

Glossary

antibody protein that is part of the immune system and which recognises an infection

autoantibody abnormal antibodies produced against the body’s own tissues