What are the tests?

The only way you can really know that you have Hep C is by having a number of blood tests. The blood tests for Hep C will:

• determine if you have the virus
• determine which Hep C virus (genotype) you have
• determine the amount of virus in your blood
• determine if the virus is damaging your liver

Doctors can only get the whole picture by doing a number of tests.

First test: This test looks for the antibodies to Hep C in your blood. If this test is positive, it means you have been exposed to the hepatitis C virus in the past and will have antibodies for the rest of your life. This test does not tell you if there is active virus in your body. You need the second test to find this out.

Second test: This test checks for the presence of the Hep C virus itself. It is called an RNA test or a polymerase chain reaction (PCR) test. If it is positive, you are infected with Hep C. If it is negative, you don’t have the virus and are not chronically infected.

If the test results show that you don’t have Hep C, you can still get infected with the virus if you are exposed to it at another time—even if you have antibodies. (See Are you at risk? for more information.)

Viral load test: This test is to check how much virus is in your blood, but it doesn’t tell you how long you have been infected. It is often done at the same time as the RNA test.

Genotype test: This test checks to see which type of Hep C virus you have. Knowing the genotype is important when it comes to making decisions about treatment. As with the viral load test, you don’t need to have more blood taken for this test because it’s usually done at the same time as the RNA test. The genotype does not impact how the virus affects your liver, only its response to therapy.

More tests: There are other tests your healthcare provider might do to see how the virus is affecting your liver and the rest of your body. He or she might recommend changes to your lifestyle or that you start or stop Hep C treatment based on the results of a test. Every person is different, so the tests you have and how often you have them will be unique to you. These tests include:

• blood tests (such as liver enzyme tests and liver function tests), which count the amount of different chemicals in the blood
  
  There are two important results when it comes to blood tests: “normal” or “outside of a normal range.” If one or more levels are outside of a normal range, it means that your liver or another organ may not be working as well as it should and you might need more tests to figure out exactly what is causing the problem.

• a biopsy, which uses a small needle to take out a tiny sample of the liver that the doctor can look at to see if there is liver damage. It is more accurate than blood tests and ultrasounds but can be an uncomfortable experience. Biopsies are only done in a hospital and people are usually sent home 3-6 hours after.
  
  Three results to look out for when it comes to biopsies are:

• little to no damage (meaning your liver is pretty healthy but the healthcare provider might want to do more tests in the future to see if it gets sicker)
• moderate damage (some scars or inflammation of your liver)
• cirrhosis (a lot of scarring on your liver)

• an ultrasound, which takes a picture, like a photograph, of the liver to measure how much damage there is and, in serious cases, to look for liver cancer.
  
  Three results to look out for when it comes to ultrasounds are:

• little to no damage (meaning your liver is pretty healthy but the healthcare provider might want to do more tests in the future to see if something changes)
• cirrhosis (a lot of scarring on your liver)
• a lump or lumps on your liver that could be cancer

If you have cirrhosis, it is recommended that you have an ultrasound every 6 months to make sure there are no lumps on your liver. This is true even if you clear the virus from your body.

Most tests are covered by provincial health insurance but some tests are not. Before you agree to a test, ask your healthcare provider if there is a charge for it. If there is, you can ask if there is a different test that is covered by insurance.