HCV antibody and nucleic acid
If you have HIV, you should be tested for HCV.
The standard HCV test is one that looks for antibodies to HCV in your blood. If
your antibody test is positive for HCV, your body has been infected with HCV at
some point in time. However, this antibody test can not tell whether you were
infected in the past and got rid of the virus, or if you are currently
If your antibody test is positive, you should
also get a test for HCV RNA (the actual genetic material of the hepatitis C
virus) called a nucleic acid test (NAT). If your NAT is positive, you are most
likely currently infected with HCV. If your NAT is negative (no HCV RNA in your
blood), then you were infected in the past and are not now currently
The HCV NAT cannot tell if or when someone
with HCV will develop liver damage. However, the HCV NAT can help predict how
well someone will respond to HCV treatment. Generally, the lower the HCV viral
load, the better the chances that treatment will work well.
FibroScan is a relatively new non-invasive
test that is currently approved for use in 70 countries. In April of 2013, the
US Food and Drug Administration (FDA) approved its use in the US. It is similar
to an ultrasound, and is done in the office or clinic by your provider. The
scan uses a dull probe that presses against the skin over the liver. FibroScan
is used to measure liver damage and determine the amount of liver cirrhosis.
Because the sound waves it uses to measure liver damage must pass through body
fat, it is not a good test for those who are obese, since its results are
likely to be unreliable.
Women and Hepatitis C
Women who are infected with HCV are different from HCV-infected men in a few
important ways. First, the good news: women are more likely to clear HCV than
men are. This means that when women become infected with HCV, their bodies are
more successful at fighting it off. Women who develop chronic HCV infections
are also more likely to get rid of HCV with treatment. Lastly, liver disease
tends to progress more slowly in women than in men.
However, women with HCV face a few extra challenges compared with
HCV-infected men. First, women's livers are more sensitive to alcohol and are
therefore more likely to be damaged by it in smaller amounts. The amount of
alcohol women without HCV can drink without damaging their livers is smaller
than men's. For women living with HCV, it is best to avoid alcohol altogether.
For HCV-positive women who do drink, however, it is recommended that they not
have more than one drink per day.
It is also important for women to know that excess body weight can lead to
fat in the liver. Fat in the liver increases inflammation and liver damage, and
increases the risk of cirrhosis (scarring of the liver) in women living with
HCV. Being overweight and having fat in the liver also lowers the chance of
being able to get rid of HCV with treatment.
HIV and HCV Co-Infection
Because both HIV and HCV can be spread by contact with infected blood, many
people are infected with both viruses. This is called co-infection. About one
in four people living with HIV in the US are co-infected with HCV. Co-infection
is even more common among HIV+ injection drug users, of whom about eight out of
ten also have HCV.
HCV can progress more rapidly and lead to serious liver damage more often in
HIV+ people. According to the CDC, having HIV more than triples the risk of
liver disease, liver failure, and liver-related death due to HCV. Co-infection
with HCV may also make HIV treatment more challenging. Therefore, it is
important for HIV+ people to know whether they have HCV. The CDC recommends
that all HIV+ people be screened for both hepatitis B and hepatitis C. Some
experts recommend that HIV+ people at risk for HCV be screened every year.
Treatment of HCV/HIV Co-Infection
Treatment of HIV/HCV co-infection is complicated. It is important to have a
health care provider who is familiar with HIV and HCV to get the best treatment
for both diseases. The good news is that HCV can be treated successfully, even
in HIV+ people.
For more information about HCV treatment, see our Treatment of Hepatitis C info sheet.
Taking Care of Yourself
Because there is no vaccine for HCV, the best way to avoid getting it is to
understand how it is spread and protect yourself through safer sex and using clean needles when injecting. You can also keep your liver healthy
- Eating a healthy diet
- Avoiding alcohol and street drugs
- Getting regular physical activity
- Getting vaccinated against hepatitis A and hepatitis B
See our info sheet on Caring for Your Liver for more information.