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Health Protocols

Hepatitis C


HCV infection is usually detected during routine blood testing. Elevated levels of the liver enzyme alanine transaminase (ALT) would alert a physician to a possible infection with HCV. If a doctor suspects HCV, hepatitis C testing typically begins with a blood test to detect the presence of antibodies to the hepatitis C virus (Wilkins 2010, CDC 2012a).

The disease can be diagnosed by the presence of HCV antibodies or the direct presence of the virus or viral products in the blood. If the screen is positive, a liver biopsy may also be recommended to assess the severity of the disease and guide treatment decisions (Wilkins 2010).

Baby boomers (people born between 1946 and 1964) in particular are urged to get tested because rates of HCV infection are particularly high in this population (CDC 2012c).

Non-Invasive Tools Are Now Available to Monitor Hepatitis C Progression

In HCV patients, determining the degree of fibrosis progression in the liver is crucial—and new methods may make this possible without the need for an invasive liver biopsy.

One new approach synchronously combines blood tests (FibroMeters) and ultrasound-based transient elastography (Fibroscan), which are then algorithmically analyzed to yield a thorough liver fibrosis assessment (Boursier 2011; Echosens 2012; Cales 2011; Cales 2008).

In a large study of 1,785 patients with chronic hepatitis C, the diagnostic accuracy of this new method did not differ significantly from that of current algorithms, but it provided a more precise diagnosis (Boursier 2012). Also, this new combination method is much more accurate at classifying the fibrosis stage than FibroMeters or Fibroscan alone (Boursier 2011).

Another noninvasive strategy is also now available for assessing liver fibrosis. FibroTest is a patented test that uses the results of five blood tests to generate a score that correlates with the degree of liver damage (Poynard 2011).

In a recent study involving 1,457 patients with chronic HCV, noninvasive liver fibrosis tests helped predict the 5-year survival of people with chronic HCV. Patient outcomes declined with increased liver stiffness and FibroTest values. FibroTest may facilitate an earlier prognosis so certain treatments, such as liver transplant, can be evaluated (Vergniol 2011). FibroTest and ActiTest (an assessment of necroinflammatory activity) are marketed in the U.S. as FibroSure (Poynard 2012; Cales 2011).