The new test will also help healthcare professionals and public health organizations identify people who are positive for the virus and get them into treatment sooner.
Testing People at Risk
According to the CDC, about 2.4 million people in the United States are living with hepatitis C. The most common cause of the infection is sharing needles or syringes. Cases have been on the rise in the U.S. because of the widespread use of intravenous drugs such as opioids.
According to the Centers for Disease Control and Prevention (CDC), about half of people who become infected with hepatitis C get over the infection. For the other half, it becomes chronic.
A person infected with hepatitis C does not usually feel sick at first. Over time, as their liver gets more damaged, they may start to have mild symptoms which can last for years. Eventually, more serious health problems like cirrhosis and liver cancer can develop and can be life-threatening.
Testing people for hepatitis C antibodies can show whether they were ever exposed to the virus, but that does not mean that they are currently infected. A test that looks for genetic material from the virus, like the new combination test, can show whether the virus is present as well as the level of the virus in the blood (viral load).
Christopher Hall, MD, the medical director for clinical affairs for Molecular Testing Labs (which makes the combined test), tells Verywell that when they were the medical director at a clinic in Oakland, every person who came in got screened for hepatitis C.
“What would happen is you find the subset of people who were positive, and then you’d have to get them to come back to get the viral load to determine whether they needed treatment or not," Hall tells Verywell.
Reaching out to people who are using intravenous drugs to get them back in for a second test meant that some would be lost to follow up. “The missing follow-up for lab work is what has really made it difficult to get folks who have hepatitis C treated," says Hall.
Making Testing Easier
Being able to determine antibody presence and viral load with a single blood test means that a person who is found to have hepatitis C antibodies will not have to return for another test to determine the presence and amount of virus in their blood (which shows if they are actively infected and need treatment).
David Dieterich, MD, a member of the medical advisory board of the American Liver Foundation and a Professor of Medicine at the Icahn School of Medicine at Mount Sinai in New York, tells Verywell that “combining it into one test definitely makes it easier for the labs to perform."
For example, a doctor’s office usually has to draw two tubes of blood—one to send off for antibody testing, and one to hold onto to determine viral load later if antibodies are found in the first test.
However, Andrew Seaman, MD, assistant professor of medicine at Oregon Health and Science University, tells Verywell that antibody testing alone is not enough for high-risk populations like people who use intravenous drugs.
According to Seaman, antibodies might be present in as many as 70% of people being tested at a needle exchange program, which is why determining if the virus is present with the same blood test could be useful.
Testing Anywhere, Anytime
“What’s important about this is that it does not require the patient to be in a clinical setting. They can be anywhere,” says Hall. These settings could include needle exchange programs, addiction treatment facilities, and programs for the homeless.
The combined test only needs a drop of blood that is collected on a card, which is easier to obtain in nonclinical settings than a tube of blood, which needs to be drawn by a healthcare professional.
The blood drop, obtained with a finger stick, is also easier for the people being tested. “It’s really hard to get blood from people who inject or used to inject drugs,” says Seaman. “They often have veins that are quite difficult to access and so having fingerstick tests can be a lot less traumatizing for people.”
Although there are a couple of public health departments that are using a combined test, Hall says that theirs is the first commercially available test. The test will mainly be used in clinics and sites that serve high-risk groups, including the homeless and people who inject drugs.
“An important approach for reaching those folks who are using injection drugs now is to go to the sites where they might exchange needles or where they might be [getting] help for their substance use,” says Hall.
The combined test is currently being used at two sites—one in Portland, OR, and one in Washington state—as part of a program for studying the health and behaviors of people who use intravenous drugs. The patients are tested weekly (or every other week) and given treatment if they are found to be infected with hepatitis C.
Right now, the test is only being used in two states—Oregon and Washington. Hopefully, it will become available in other states soon.
