Ontario Hepatitis Treatment

• Hepatitis C is often diagnosed when patients present to a physician, and risk factors for the disease are identified. These may include:
  • Past history of injection drug use, even in the distant past.
  • Transfusion exposure prior to 1990
  • Household or sexual contact with hepatitis C
  • Origin in a country where hepatitis C is endemic

• Health care worker
• Alternatively, during a regular check-up or testing for unrelated symptoms an elevated ALT is discovered, and further testing demonstrates the presence of hepatitis C.

Hepatitis C Blood Tests

• The screening test for hepatitis C is the hepatitis C antibody test (anti-HCV). This is positive in all patients who were ever exposed to hepatitis C, even if they have spontaneously cleared virus.
  • The test is done by the Public Health Laboratory, by hospital laboratories and by private laboratories. Many private laboratories send the specimen to the Public Health Laboratory for confirmation.
  • The presence of anti-HCV does not automatically indicate current infection. The infection may have cleared. Thus all positive tests have to be followed by a test for the virus itself. This is the HCV RNA test.
  • HCV RNA. There are two HCV RNA tests.
    • The qualitative test gives a yes/no answer, the virus is detectable or it is not.
      • If you suspect that the virus has been cleared, but need to prove it, this is the test to do.
    • The quantitative HCV RNA test is able to measure the amount of virus present. This test is usually done prior to starting a patient on treatment in order to determine the viral load to get some idea of the likelihood of a response to therapy. Hepatitis C Genotypes
• The hepatitis C virus exists in several strains, called genotypes.
• Different genotypes are dominant in different parts of the world.

• Different genotypes respond differently to treatment and treatment duration is different for different genotypes.
• Therefore it is important to know the genotype before starting treatment. The Public Health Laboratory usually does the genotype automatically when the viral load is first requested. Some hospital labs do viral load and genotype, but private labs do not do these tests them selves, but the send the tests to the Public Health Laboratory.