HCV infection usually does not cause symptoms, so diagnosis depends on laboratory blood tests. Baby boomers (people born between 1945 and 1965) and certain other populations with a high risk of infection should undergo HCV screening, which measures HCV antibodies and HCV ribonucleic acid (RNA). Testing positive for HCV antibodies means you have been exposed to HCV in the past but do not necessarily have an active infection at the time of testing. Some people fight off HCV infection, but the antibodies persist to help the immune system respond efficiently if it encounters the virus again.15 The HCV RNA test can determine if you have an active HCV infection.
In the event of positive screening tests, testing for HCV genotype helps guide selection of the most appropriate antiviral regimen.
Non-Invasive Tools 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 approach synchronously combines blood tests (FibroMeters) and ultrasound-based transient elastography (Fibroscan), which are then algorithmically analyzed to yield a thorough liver fibrosis assessment.38-41
In a large study of 1,785 patients with chronic hepatitis C, the diagnostic accuracy of this method did not differ significantly from that of standard algorithms, but it provided a more precise diagnosis.42 Also, this new combination method is much more accurate at classifying fibrosis stage than FibroMeters or Fibroscan alone.38
Another noninvasive strategy, FibroTest, uses the results of five blood tests to generate a score that correlates with the degree of liver damage.43
In a study involving 1,457 patients with chronic hepatitis C, noninvasive liver fibrosis tests helped predict 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.44 FibroTest and ActiTest (an assessment of necroinflammatory activity) are marketed in the United States as FibroSure.40,45