Friday, May 19, 2006
I Have HCV, So What's Next
If your doctor suspects you may have it, he or she will most likely perform a variety of tests to diagnose and monitor your condition. Four main types of tests are used to diagnose and monitor hepatitis C: Serologic Assays, Two types of tests are often used to screen for hepatitis C: enzyme linked immunosorbent assay (ELISA) and recombinant immunoblot assay (RIBA*). Both of these tests check for hepatitis C antibodies in the blood, which are produced by the body's immune system in response to the hepatitis C virus. ELISAs are suitable tests for screening patients who are at risk of infection, and are recommended as initial tests for patients who are showing symptoms of liver disease. In the past, doctors would often use RIBA tests to confirm a positive ELISA test. This was because ELISAs had a relatively high rate of false-positive results. However, new advances in ELISA tests have greatly reduced the need to confirm the results with additional tests. Therefore, RIBA tests are used less frequently today.The outcome of an antibody detection test (ELISA or RIBA) will be either positive or negative. A positive antibody detection test tells the doctor that the person has been exposed to the hepatitis C virus, but it does not reveal how much (if any) virus is currently in the blood.
Qualitative HCV Assays-If an ELISA test shows that you have been exposed to the hepatitis C virus, your doctor may perform a qualitative HCV Polymerase Chain Reaction (PCR) test.
This new technique specifically checks for hepatitis C viral RNA and is helpful in situations where the ELISA test is unreliable. The PCR is considered more definitive than the serologic assay tests, although the qualitative PCR test does not indicate how much virus is in the blood, just that the virus is present. Genotype Tests-Genotype testing finds out the type of hepatitis C virus a person has. At least 6 different genotypes, or varieties, of HCV have been identified. The major genotypes (1, 2, and 3) are found in most countries of the world, while the other three (4, 5, and 6) are found mainly in certain geographic areas. In the United States, approximately 72% of people infected with hepatitis C have genotype 1, and most others are types 2 or 3 (genotypes 4, 5, and 6 are not common in the United States). For details on the distribution of these genotypes, see The Question of Genotype. Genotyping may be important in determining treatment options, and also predicting how the virus will respond to therapy. For example, genotype 1 infections require therapy for 48 weeks, whereas shorter treatment may be possible for genotypes 2 and 3. In fact, in PEGASYS clinical studies, doctors found that patients who took PEGASYS along with COPEGUS responded to therapy just as well after 24 weeks as they did after 48 weeks. However, there is no conclusive evidence that the genotype influences the severity or outcome of the disease, or your risk of transmitting it.If you have been tested for HCV genotype, it may be important for you to know which genotype you have when discussing treatment options with your physician. Liver Health Tests, If you are diagnosed with hepatitis C, your healthcare provider may continue to perform a variety of tests to see how well your liver is functioning using one of the following methods. Many doctors now feel that doing treatment 72 weeks gives you better odds at beating the virus and I agree.
ALT (Alanine Aminotransferase)—A blood test is used to measure alanine aminotransferase (ALT), an enzyme that is normally found in the liver cells and in the blood. An increase in ALT levels indicates acute liver damage. Monitoring ALT levels is considered to be an inexpensive way of following the progression of HCV. However, a single ALT test will not reveal the severity of liver damage. Many individuals with chronic hepatitis C have normal ALT levels, so this test is not considered a completely accurate marker of progression. Liver biopsy—The best way to measure the extent of liver damage is with a liver biopsy. This is a procedure in which a tiny sample of tissue from the liver is removed and examined in a laboratory. Liver biopsies are also important in ruling out any other forms of liver disease.
Today, liver biopsies are performed as outpatient procedures. General anesthesia is not necessary. Patients receive local anesthesia at the area where the needle will be inserted. Although the test itself only takes a few seconds, you may be monitored at the testing facility for several hours. Patients often describe the sensation they experience during the test as a feeling of strong pressure on the spot where the tissue is removed. Patients may feel tired after the test, so it is a good idea to schedule some rest time after having a biopsy.
Qualitative HCV Assays-If an ELISA test shows that you have been exposed to the hepatitis C virus, your doctor may perform a qualitative HCV Polymerase Chain Reaction (PCR) test.
This new technique specifically checks for hepatitis C viral RNA and is helpful in situations where the ELISA test is unreliable. The PCR is considered more definitive than the serologic assay tests, although the qualitative PCR test does not indicate how much virus is in the blood, just that the virus is present. Genotype Tests-Genotype testing finds out the type of hepatitis C virus a person has. At least 6 different genotypes, or varieties, of HCV have been identified. The major genotypes (1, 2, and 3) are found in most countries of the world, while the other three (4, 5, and 6) are found mainly in certain geographic areas. In the United States, approximately 72% of people infected with hepatitis C have genotype 1, and most others are types 2 or 3 (genotypes 4, 5, and 6 are not common in the United States). For details on the distribution of these genotypes, see The Question of Genotype. Genotyping may be important in determining treatment options, and also predicting how the virus will respond to therapy. For example, genotype 1 infections require therapy for 48 weeks, whereas shorter treatment may be possible for genotypes 2 and 3. In fact, in PEGASYS clinical studies, doctors found that patients who took PEGASYS along with COPEGUS responded to therapy just as well after 24 weeks as they did after 48 weeks. However, there is no conclusive evidence that the genotype influences the severity or outcome of the disease, or your risk of transmitting it.If you have been tested for HCV genotype, it may be important for you to know which genotype you have when discussing treatment options with your physician. Liver Health Tests, If you are diagnosed with hepatitis C, your healthcare provider may continue to perform a variety of tests to see how well your liver is functioning using one of the following methods. Many doctors now feel that doing treatment 72 weeks gives you better odds at beating the virus and I agree.
ALT (Alanine Aminotransferase)—A blood test is used to measure alanine aminotransferase (ALT), an enzyme that is normally found in the liver cells and in the blood. An increase in ALT levels indicates acute liver damage. Monitoring ALT levels is considered to be an inexpensive way of following the progression of HCV. However, a single ALT test will not reveal the severity of liver damage. Many individuals with chronic hepatitis C have normal ALT levels, so this test is not considered a completely accurate marker of progression. Liver biopsy—The best way to measure the extent of liver damage is with a liver biopsy. This is a procedure in which a tiny sample of tissue from the liver is removed and examined in a laboratory. Liver biopsies are also important in ruling out any other forms of liver disease.
Today, liver biopsies are performed as outpatient procedures. General anesthesia is not necessary. Patients receive local anesthesia at the area where the needle will be inserted. Although the test itself only takes a few seconds, you may be monitored at the testing facility for several hours. Patients often describe the sensation they experience during the test as a feeling of strong pressure on the spot where the tissue is removed. Patients may feel tired after the test, so it is a good idea to schedule some rest time after having a biopsy.
# posted by Joyfulstill @ 5:38 PM 
