Early detection of hepatitis C

Early detection of hepatitis C means having a simple blood test, the anti-HCV antibody test, to find out whether you have ever been in contact with the virus. Today’s recommendation is clear: every adult should have this test at least once in their lifetime, even if they feel perfectly healthy and have no known risk factor.

Why so much emphasis on looking for it? Because hepatitis C is a silent disease that is now curable. Detecting it early makes it possible to treat and cure it before the virus damages the liver, preventing cirrhosis and liver cancer. Finding it late, once the damage is done, changes the outlook entirely.

Why does detecting it early matter?

Hepatitis C has a feature that makes it dangerous: it causes no symptoms for years, even decades. During all that time the person feels well and suspects nothing, while the virus slowly and silently damages the liver. Many find out they have it only when complications appear, 20 or 30 years after infection.

The good news is that the picture has completely changed. Current treatments, the direct-acting antivirals, cure the infection in more than 95% of cases, with oral tablets taken for 8 to 12 weeks and very few side effects. Curing hepatitis C stops liver damage and reduces the risk of cirrhosis, cancer and the need for a transplant.

The problem is that you cannot cure what you do not know you have. That is why early detection is the missing piece: an infection found in time is almost always cured, and easily, whereas one discovered at the stage of advanced cirrhosis is far harder to manage.

Who should be tested?

For years screening was offered only to people with risk factors. That approach left out many infected people, because a substantial proportion, up to around 40% in our setting, does not recall or have any of the classic risk factors.

For that reason current guidelines recommend broader screening:

• At least once in a lifetime for all adults. The US Preventive Services Task Force (USPSTF) recommends screening all adults aged 18 to 79 years, and the liver and infectious disease society guidelines (AASLD-IDSA) stress universal screening.
• Repeated in higher-risk populations, as long as exposure continues. This includes people who inject or have injected drugs, those who received transfusions before 1996, people on dialysis, people with HIV, and those exposed to blood through medical procedures with non-sterile equipment.
• Pregnant women, in each pregnancy.

If you have never had this test, it is very reasonable to ask for it, regardless of how you feel.

What is the test like?

Detection is done in two steps, and both are blood tests:

1. Anti-HCV antibodies. This is the initial test. It detects whether the immune system has ever been in contact with the virus. If it is negative, there is generally no infection and nothing more is needed (unless there was recent exposure or ongoing risk). If it is positive, you move to the second step.
2. Viral load (HCV RNA). This confirms whether the virus is present and active in the blood right now. This step is essential, because a positive antibody only indicates prior contact: some people cleared the virus spontaneously or were already treated, and in them the virus is gone. A positive viral load confirms current infection and is what indicates the need for treatment.

In short, a positive antibody alone does not mean the disease is active; the viral load is needed to confirm it.

The WHO 2030 elimination goal

The World Health Organization (WHO) has set the goal of eliminating hepatitis C as a public health threat by 2030, with concrete targets to diagnose at least 80% of infected people and treat the great majority of them. Tens of millions of people worldwide are estimated to have hepatitis C, and many still do not know it.

Reaching that goal depends on one basic condition: finding those who are infected. That is why broad screening and early detection are the central strategy of elimination. Without diagnosis there is no treatment, and without treatment there is no elimination.

Hepatitis C in Chile

In Chile, hepatitis C is included in the Explicit Health Guarantees (GES/AUGE), which secures access to diagnosis and to treatment with direct-acting antivirals under both FONASA (public system) and the isapres (private insurers). The country has committed to the WHO elimination goal, and the main challenge remains the same as in the rest of the world: actively finding the infected people who have not yet been diagnosed.

What to do: ask your doctor

The message is simple. If you are an adult and have never had the hepatitis C test, ask your doctor for it at your next visit. It is a simple blood test, and if it comes back positive there is now a treatment that cures the disease. Detecting it early is the best way to protect your liver.

See also

• Hepatitis C
• Cirrhosis
• Liver cancer (hepatocellular carcinoma)
• Undiagnosed hepatitis C in Chile