Q: What does it mean when your viral load increases over the course of a year or two? Mine went from 4K to 8K. Took treatment twice.

A: Viral load does not indicate disease severity. So the fact that your viral load has gone up does not indicate that your liver disease is worse, or that your disease is progressing. In studies where researchers took blood from people with HCV very frequently, it was found that the amount of virus in the blood fluctuates by huge numbers over time (and even within a single day). In short, what does it mean that your HCV viral load went from 4K to 8K? Based on all the evidence available, it indicates nothing of clinical relevance that you should be concerned about.

Q: My daughter tested positive for hep C. Approximately 4 months ago, she was "using" a needle and I tried to take it away from her, pricking myself. I bled quite a bit, so I know the needle penetrated. What are the chances of my having gotten hep C? How long should I wait before getting tested? Is a one-year period long enough to wait whether I have it or not?

A: Because your daughter is known to have hepatitis C, it is possible that this accidental needle stick could have given the virus entry into your body. If you are being tested with a hepatitis C antibody test, you can be tested now. If the test is negative, you can have it repeated again at 6 and 12 months to be sure (although the chances are if you don't have antibodies at 6 months, you probably were not infected). If you are going to have a test for the hepatitis C virus itself (a hepatitis C viral load test), this can be done at any time. If it comes back with no detectable virus, you can safely assume that you do not have the virus.

Q: How long can you have hepatitis C before you find you? Can you have it for 20 years and not know it?

A: Unfortunately, yes it is entirely possible to have hepatitis C for 20 years (or more, in some cases) before being diagnosed. This is one of the big problems with hepatitis C - it's early "silent" nature. Again, unfortunately, significant damage to the liver can occur during this time. If you have any question about perhaps having been exposed to the hepatitis C virus at some time in your life, talk with your doctor and ask to be tested.

Q: What is hep C RNA and PCR?

A: These are the names of two tests for the hepatitis C virus. While hepatitis C screening tests detect antibodies produced in response to the hepatitis C virus, the hep C RNA and PCR tests detect the virus itself in the blood.

Q: How important is viral count in nonresponder?

A: Hepatitis C viral load is unrelated to disease course or severity. That is to say, the amount of virus measured in the blood is unrelated to the activity of the disease in the liver and is also unrelated to the rate of disease progression. This holds true for anyone with active hepatitis C - regardless of previous response or nonresponse to interferon-based treatment.

Q: Does it take 2 to 6 months for hepatitis c to be come noticeable?

A: People who become infected with the hepatitis C virus are often unaware that they've been infected for up to 10, even 20 years because there are no initial symptoms.

If your question has to do with how long after a potential exposure to the virus would someone test positive, that is a different time frame.

After a potential or known exposure (blood-to-blood contact with another person known to have the hepatitis C virus or who may have hepatitis C), it is recommended that testing for the hepatitis C antibody be performed at 4 to 6 months after the exposure OR that testing for the hepatitis C virus itself (a test often called an HCV PCR or hepatitis C viral load test) be performed 4 to 6 weeks after the potential exposure.

Talk with your doctor to determine what testing is indicated for your specific situation.

Q: A recent blood test showed antibodies of hepatitis C. I was diagnosed with hepatitis B in the 70's after a short stint with drugs. I got tested several times and after 3 years of dieting and living healthy, I was pronounced "healed." I never was sick, donated blood, etc. Now this diagnose of C and no antibodies for B. Is it possible that several doctors in the 70s and 80s misdiagnosed the C for the B. I have no ailments except a gurgling stomach that I have since the diagnose.

A: The tests for hepatitis B and C are quite different. So though I am speculating since I don't have your test results in front of me, I would come down on the side of saying that it is unlikely that there was a mix-up in the B and C diagnosis. My "guess" on this is reinforced by the timing of things since reliable testing for hepatitis C was not available until 1992-3.

Your situation is somewhat complex, and certainly beyond what I can address in this forum. It would be unfair to you for me to speculate about what your situation truly is.

I truly do understand your concerns. I urge you to call your doctor, and sit down and talk over all of this with him or her. You may even want to write down your questions ahead of time so that when you do have the opportunity to talk with your doctor, you can be sure to get all of your questions answered (so that feel in your stomach, at the very least, may start to subside). I wish you well.

Q: I was checked for hep A,B,& C. The tests came back negative for A&B but pending for hep C. I was given an appointment for the hep C clinic. Why? Do I have hep C?

A: I do not know what test you had, so my answer is based on what is a typical situation - but may not be your situation.

Most of the time, people who are being screened for hepatitis C are given a test for antibodies to the hepatitis C virus. If the test comes back positive, that means the person has been exposed to the hepatitis C virus at some time in his/her life. But it does NOT indicate whether the person currently has the virus. Since approximately 20% of people infected with the hepatitis C virus clear the virus without treatment (and often not having known they even had the virus), it is possible to test positive with the hepatitis C screen, but not currently have the virus.

Based on what you've said, it would be my best guess that you may have had a positive hepatitis C screening test and that you were given an appointment so that you could get additional testing to determine if you currently have the hepatitis C virus.

I urge you to talk with your doctor (the one who ordered the original tests). He or she can answer your questions. I wish you well.

Q: I completed peginterferon/ribavirin therapy 4 1/2 years ago and just tested negative again for the virus. The test that was done was at the level of 50 parts per million. But a newer and more expensive test, not covered by insurance, can detect 5 parts per million. Could I still have the virus at extremely low levels and, if so, what are the chances it's still doing any damage? Should I seek to have the most sensitive test done next year?

A: I do understand your concern, but after testing repeatedly undetectable for 4 1/2 years, the possibility of you still having the virus at levels consistently lower than the lower limit of detection of the test is extremely remote. I cannot say it is absolutely, positively impossible - but pretty close. Should you have the more sensitive test? I cannot answer that for you. I would urge you to talk with your doctor about this, but also do some personal reflection. If nothing short of the most sensitive test can put your mind at ease, then perhaps that is the best course of action for you. Best to you.

Q: My HCV antibody test is reactive while the PCR test is undetectable. Is that cause for alarm?

A: The most common explanation for this finding is that a person has been exposed to the hepatitis C virus at some point (hence the reactive antibody test), but has since cleared the virus (the reason the PCR test result is undetectable). A much less likely reason for these findings would be that the virus level is indeed too low to be picked up by the PCR test (different tests are more or less sensitive to low levels of the virus).

The best way to address this is by talking with your doctor, who knows your past medical history, past test results, and other issues that may influence your test results.

Q: How long after possible exposure to hepatitis C should you wait to be tested?

A: If you've had an accidental or other possible exposure to the hepatitis C virus, you should be screened for the hepatitis C antibody as soon as possible to determine your status at the time of the potential exposure. This is often called a "baseline" test and is used to determine whether a person already had antibodies to the hepatitis C virus at the time of a potential exposure to the virus.

After the exposure (especially if the blood exposure involved another person known to have the hepatitis C virus), it is recommended that testing for the hepatitis C antibody be performed at 4 to 6 months after the exposure OR that testing for the hepatitis C virus itself (a test often called an HCV PCR or hepatitis C viral load test) be performed 4 to 6 weeks after the potential exposure. These tests are done to determine whether or not hepatitis C infection has occurred as a result of the exposure.

Talk with your doctor to determine the appropriate follow-up testing that best suits your situation and needs.

Q: I have hepatitis C antibodies but when I had a blood test to check my strain my doctor told me there is no virus detected in the blood. I want to find out more about what that means.

A: Anyone that has been infected with the hepatitis C virus will test positive for antibodies to the virus. But about 20% to 25% of people infected with the hepatitis C virus are fortunate enough to have their own immune system successfully rid the body of the virus. This is called "spontaneously clearance" by doctors and medical personnel. People that spontaneously clear will continue to have antibodies, but they no longer have the virus in their bodies. It sounds as if you one of the fortunate ones to spontaneously clear the virus without treatment. That's wonderful news for you!

Q: I just tested positive for Hep C and don't know what to do.

A: The initial test for hepatitis C is a screening test. It detects the presence of antibodies to the hepatitis C virus. A positive test means that you have been exposed to the virus at some point in your life, but it cannot detect whether you currently have the virus. Since 20% of people clear the hepatitis C virus on their own, you need to have a test for the hepatitis C virus itself to see if you are currently infected. This test is known by a variety of names including HCV PCR, hepatitis C viral load, and others. Talk with your doctor to get the test done so you will know whether you are currently infected. If you are, your doctor will talk with you about next steps.

Q: Is there a "window" period for a person who may have contracted the HCV virus?

A: The window period refers to the time between when a person is infected with the hepatitis C virus and when antibodies (proteins produced by the immune system in response to the virus) to hepatitis C become detectable in the blood.

The window period for hepatitis C is generally in the range of 30-45 days, but can be longer in some people. The vast majority of people develop detectable antibodies within 60 days (8 weeks) after infection with the hepatitis C virus. In rare instances, some people appear to never develop detectable antibodies despite having the virus. Again, this is rare.

The window period is important because screening tests for hepatitis C detect hepatitis C antibodies, not the virus itself. Therefore, someone in the window period may have the hepatitis C virus, but his/her antibody screening test for hepatitis C will be negative because antibodies to the virus are not yet being produced by the immune system in sufficient quantities to be detected.

Q: Will hepatitis C cause a false reading in a urine sample?

A: There are hundreds of tests that can be performed on urine to detect a wide variety of substances and conditions. The hepatitis C virus itself does not directly interfere with these tests. However, complications of hepatitis C such as advanced cirrhosis may cause there to be high levels of chemicals in the urine (such as bilirubin) that might interfere with testing for other substances.

Q: My doctor sent me to get some blood work before I start treatment, and the form has HCV TMA checked off. What is this test for?

A: HCV TMA is shorthand for Hepatitis C Virus Transcription Mediation Amplification. This is a test to check how much of the hepatitis C virus is present in the blood -- what most people call a viral load test.

There are several ways to do a hepatitis C viral load test; TMA is one of them. Others include PCR (polymerase chain reaction) and bDNA (branched DNA).

Hepatitis C viral load is checked routinely before beginning interferon-based treatment to help the doctor and the client anticipate how long treatment is likely to last, and to have a starting point from which to determine whether the treatment is working.