Concepts in Hepatitis C Exposure Management

Date of Report: va/la/not
Source: National Clinicians' Consultation Center

Source Patient Evaluation

1. Baseline Hepatitis C EIA antibody run with additional blood drawn for possible confirmatory test.


2. If initial Hepatitis C antibody test positive, send either a third generation RIBA or a qualitative or quantitative Hepatitis C RNA PCR. Preference for PCR test if possible.


3. Baseline ALT not sent and no follow-up testing of Hep C in source patients.


4. All results should be disclosed and referral made into appropriate care.



Commentary

1. EIA Hepatitis C antibody is a screening test and confirmatory test of a positive EIA is needed.


2. A third generation RIBA test might be a less expensive way to provide confirmation of true positive antibody, but would not help determine if source patient has circulating virus, which is probably associated with infectivity of the source.


3. Availability of a given test at a given institution and cost issues may influence selection of testing.

Exposed health worker evaluation

1. Baseline Hepatitis C EIA antibody and ALT run. If negative and normal, respectively, no further baseline testing. If baseline EIA abnormal, third generation RIBA should be sent to confirm antibody status. Refer into appropriate care if positive.


2. If source patient is antibody or PCR positive, follow-up protocol initiated for health care worker.


3. In follow-up, if ALT testing at 6 weeks is abnormal, suggest quantitative or qualitative Hepatitis C RNA PCR. At 3 months, perform ALT and Hepatitis C antibody test. If either test is abnormal, confirm with Hepatitis C RNA PCR. Repeat at 6 months.


4. There is little data available to support further antibody testing beyond 6 months, individual program discretion should be advised.



Commentary

1. In cases of new Hepatitis C infection, 6 weeks may be too early for Hepatitis C antibody seroconversion, but Hepatitis C RNA PCR maybe elevated as early as 2 weeks after exposure/infection and ALT is usually elevated by 6 weeks.


2. Follow-up testing beyond 6 weeks has increased likelihood of showing Hepatitis C antibody conversion so ALT and Hepatitis C antibody can be used as screen for early infection.


3. Identify GI specialist at referral site for health care worker with evidence of early infection so options can be discussed for early treatment.