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Guideline: South African Hepatitis C Management Guidelines 2010 » Diagnosis
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2. Diagnosis

 

The 2 classes of assays used in the diagnosis and management of HCV infection are

  • Serologic assays that detect specific antibodies to the HCV (anti-HCV)
  • Molecular assays that detect viral nucleic acid (HCV RNA).

All persons suspected of having acute or chronic hepatitis C or are at increased risk of HCV infection should be tested for anti-HCV.

HCV RNA testing should be performed in

  • Individuals who are anti-HCV positive.
  • Patients in whom antiviral treatment is being considered.
  • Patients with unexplained liver disease whose anti-HCV is negative and are suspected of having acute hepatitis C or are immunocompromised.

Historically qualitative molecular assays have been more sensitive than quantitative molecular assays but, with the increasing sensitivity of the latter, this is no longer the case. For monitoring purposes it is important to use the same laboratory test before and during therapy.

HCV genotyping should be performed in all HCV-infected persons prior to Interferon based treatment in order to plan for the dosage and duration of therapy and to estimate the likelihood of a response.

A liver biopsy should be considered if the treating physician requires information on the fibrosis stage for prognostic purposes or to make a therapeutic decision. It is furthermore useful in identifying that subset of patients with significant fibrosis but normal transaminases and to exclude co-existing liver disease.

Iron overload10  and steatosis11,12  reduce the likelihood of achieving a sustained virologic response (SVR) and should be treated prior to embarking on treatment with Pegylated Interferon (Peg-IFN) and Ribavirin. An SVR can now be achieved in almost 90 % of patients with genotypes 2 and 3 and, in this subset, a liver biopsy need only be done if there is clinical evidence of cirrhosis.

Currently available non-invasive tests may be useful in defining the presence or absence of advanced fibrosis in persons with chronic HCV infection but should not replace the liver biopsy in routine clinical practice.13