1. Hepatitis C testing Research Center for Genetic Engineering and Biotechnology “Georgi D. Efremov”, MASA What is Hepatitis C? Hepatitis C is a contagious liver disease that results from infection with the hepatitis C virus (HCV). When first infected, a person can develop an “acute” infection, which can range in severity from a very mild illness with few or no symptoms to a serious condition requiring hospitalization. Acute hepatitis C is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis C virus. For reasons that are not known, 15%–25% of people “clear” the virus without treatment. For approximately 75%–85% of people who become infected with the Hepatitis C virus, the acute infection progresses to a “chronic,” or lifelong, infection. Chronic Hepatitis C is a long-term illness that occurs when the Hepatitis C virus remains in a person’s body. Over time, it can lead to serious liver problems, including liver damage, cirrhosis, liver failure, or liver cancer. How can you get hepatitis C? Hepatitis C is a blood-borne disease. The main source of infection is from blood from an infected person. Most cases are caused by using contaminated needles or injecting equipment to inject drugs or other injuries involving blood spillage from infected people, from sharing toothbrushes, razors, and other items which may be contaminated with infected blood. There is a small risk from re-used equipment used for tattooing, body piercing, acupuncture, etc. Also there is a small risk that an infected mother can pass on the infection to her baby or an infected person can pass on the virus whilst having sex. The virus is not passed on during normal social contact, such as holding hands, hugging, or sharing cups or crockery. What are the symptoms of hepatitis C infection? Many people with hepatitis C feel entirely well and have few or no symptoms. If symptoms do occur, they develop about 7-8 weeks after being exposed to the virus and may include: extreme tiredness, poor concentration and memory problems, muscle and joint aches, vomiting and feeling generally unwell. Some people develop some symptoms due to persistent inflammation of the liver. For example, feeling sick, lack of appetite, intolerance of alcohol, pains over the liver, jaundice and depression. How is hepatitis C diagnosed? A simple blood test can detect antibodies to the hepatitis C virus in your blood. A positive antibody test means that you have at some stage been infected with hepatitis C. However, this test remains positive even in people who have cleared the virus from their body. If the antibody test is positive, then a further blood test is needed to see if the virus is still present. This is called a RT- PCR test. This is a more specialized test which detects particles of the virus. There are several variants of the RT- PCR test by which we can detect and quantify the viral particles as well as to determine their genotype. Who should be tested? The following groups should be tested for HCV: Anyone who shares equipment for injecting drug use, as well as other injecting equipment Patients who have abnormal liver function test results. People who have had a sexual partner who is hepatitis C positive. Patients on hemodialysis. Healthcare workers who perform exposure-prone procedures. HCV tests performed at RCGEB Price (МКД) Real time RT-PCR HCV detection and quantification4300 RT-PCR HCV genotypisation5500 Literature: 1.Davalieva K, Kiprijanovska S and Plaseska-Karanfilska D. (2014) Fast, reliable and low cost user-developed protocol for detection, quantification and genotyping of hepatitis C virus. Journal of Virological Methods, 196: 104-112. 2.Kiprijanovska S, Davalieva K, Noveski P, Sukarova-Stefanovska E and Plaseska-Karanfilska D. (2013) Prevalence of Hepatitis C Virus genotypes in risk groups in the Republic of Macedonia: A five years survey. Journal of Medical Virology, 85: 2072–2078. 3.Kiprijanovska S, Sukarova-Stefanovska E, Novevski P, Chalovska V, Polenakovic M and Plaseska-Karanfilska D. (2012) Study of the hepatitis C virus in the Republic of Macedonia. BJMG. 15: 67-69. Analysis method performed at RCGEB HCV diagnosis at RCGEB is performed by two analysis. HCV RNA detection and quantification is performed by real-time RT-PCR. The analysis has the limit of detection of 112 IU/ml (95% Confidence Interval). The genotype of HCV in HCV RNA positive patients is determined by type specific fluorescent RT-PCR by which HCV genotypes 1-4 can be detected. The limit of detection of the genotyping assay is 600 ± 278 IU/ml (mean ± SD). Material for testing Whole blood specimens in sterile tubes without anticoagulant EDTA Types of hepatitis C virus There are six types of hepatitis C virus, which all have different genes. These different types are called genotypes and they are numbered 1 to 6. In the Republic of Macedonia so far we have detected only genotype 1, 2 and 3. It is important to know which type you have, as different types respond differently to treatment. It is possible to be infected with more than one type of hepatitis C at the same time. RCGEB, 2013